Pushing through plateaus

Hitting a weight loss plateau can be frustrating, but it’s a common part of the weight loss journey. When you encounter this, it’s important to reassess your habits and make adjustments to be able to see continued success.

There are a lot of things you can do to assess your situation and re-align your approach. This month, we’ll look at some things that you can do to push past your plateau and continue on your weight loss journey.

Why we plateau

• Mental health
• Hormone changes
• Inactivity
• Diet

Keys to overcoming plateaus

Track your intakes

Sometimes we don’t realize how many grams of carbohydrates, fat, or protein are in the meals we’re consuming. Tracking brings awareness to your food choices and allows you to see what modifications can be made to follow the Rule of 15 and the Rules of the Tool. Do you need to reduce the amount of a certain ingredient so you can lower your fat intake? Decrease your total portions? Find healthier alternatives? Use the Baritastic app and join DCBS’ group using the code "050021".

Rules of the Tool

• Daily guidelines:
  • 60-80 plus grams of solid, lean protein
  • 64 plus oz. decaffeinated, 0-calorie fluids
  • 25g of fiber (women) 38g (men)
  • Less than 50g of total fat
    • This can add up quickly and is often over-consumed
  • No more than 120g of total carbohydrates
    • from vegetables, fruits, and complex carbohydrates such as fiber

Nutrition facts label reading: Rule of 15

Step 1:

• Look at serving size — how much are you going to eat?
• Typically listed as "Serving size" on a nutrition facts sheet.

Step 2:

• Aim for less than 15 grams of total carbohydrates per meal.
• Typically listed as "Total carbohydrates" on a nutrition facts sheet.

Step 3:

• Aim for greater than 15 grams of protein per meal.
• Typically listed as "Protein" on a nutrition facts sheet.

Portions

Remember, you are on a volume-restricted diet. Similarly to eyeballing the grams of macronutrients, eyeballing our portion sizes can cause us to consume too large volumes of food (risk of stretching pouch) and consuming too many calories, fat, and/or carbohydrates. This can halt weight loss and lead to weight gain. Using your patient handbook, or the image to the left, determine what size is likely appropriate for you.

For reference, 1 oz. = 2 tbsp. and 8 oz. = 1 cup. The average volume recommendation is 1/2 cup protein plus 1/4-1/2 cup veggies and complex carbohydrates.

Your expected new stomach/pouch size based on surgical procedure

Gastric bypass

• 1-2 oz. from 0 days to 6 weeks
• 2-3 oz. from 6 weeks to 3 months
• 3 oz. from 3 months to 6 months
• 4-8 oz. from 6 months to 1 year
• 6-8 oz. from 1 year and beyond

Gastric sleeve

• 2-3 oz. from 0 days to 6 weeks
• 3-4 oz. from 6 weeks to 3 months
• 3-5 oz. from 3 months to 6 months
• 4-8 oz. from 6 months to 1 year
• 6-8 oz. from 1 year and beyond

Duodenal switch

• 2-4 oz. from 0 days to 6 weeks
• 3-4 oz. from 6 weeks to 3 months
• 3-5 oz. from 3 months to 6 months
• 4-8 oz. from 6 months to 1 year
• 6-8 oz. from 1 year and beyond

MGB/OAGB sizing is in line with the gastric sleeve and the duodenal switch.

Quick measurements:

• 1 oz. (ounce) = 30cc = 30 mL
• 2tbs (tablespoon) = 1 oz.
• 6tsp (teaspoon) = 1 oz.
• 1c (cup) = 8 oz. = 16tbs.

Plan meals and snacks

Keeping your protein, carbohydrate, and fat goals in mind, create a meal plan that works for you! This can be decided upon what you already have in your kitchen, taste preferences, schedule, convenience, interest in trying a new recipe, etc. Create your grocery list, shop sales, and find ways to make the experience fit your lifestyle. Don’t be afraid to use grocery pick-up or delivery options! Organize recipes by total cooking time.

Prep and portion

• With the planned meals and snacks, prep and portion them into appropriately sized containers so they are easy to grab on-the-go or when you are being indecisive.
• Precut vegetables and fruit to make preparing meals quicker!
• Use frozen or canned foods to speed up the cooking process. Rinse canned items to reduce grams of salt/sodium and ensure there’s no sugar added.
• Other tips to help with prepping plus portioning: appetizer utensils, smaller plates, egg cooker, silicone baking/freezing tray, Instant pot, air-fryer, etc.

On-the-go options

• Protein: hard boiled egg, turkey jerky, tuna packets, edamame, roasted chickpeas, 100 calorie almond packets, individual Greek yogurt containers.
• Low-fat dairy plus protein: cheese stick, low sugar Greek yogurt, cottage cheese.
• Fruits: berries, apples, oranges, bananas, peaches, and canned fruit without added sugars.
• Pairs: charcuterie-snack packs (be mindful of carbohydrates and fat), tuna salad with pickle slices, cucumbers plus tzatziki dip, veggies plus hummus, etc.

Utilize your team

Stay connected and supported! There are different types of support. Some include:

• Family, friends, co-workers, and bosses.
• Virtual support groups such as our Facebook support group (Denver Bariatric Nutrition Support Group), Baritastic’s support group, monthly newsletters, support group meetings, etc.
• Health plus fitness professionals: primary care physician, surgeon, dietitian, therapist, physical therapist, specialty physicians, personal trainer, etc.
• Resources to help with meal ideas like the VitalRD/DCBS recipe book.
• Self-advocacy: set boundaries with polite no-thank-you’s plus clear communication.

Optimize rest and recovery

• Sleep
  • Adequate sleep is essential for physical, mental, and emotional health. Disturbed sleeping patterns (quantity and quality) can lead to increased calorie intake. Lack of sleep affects circulating levels of ghrelin and leptin, hormones that regulate hunger. It also triggers a cortisol spike, the stress hormone that signals your body to conserve energy to fuel your waking hours.
  • Optimal sleep duration is seven to nine hours, with an optimal average of seven and a half hours.
• Stress
  • Stress also increases the secretion of cortisol. Stress plus the secretion of cortisol can lead to
    • Increased appetite
    • Poor sleep
    • Cravings for unhealthy/hyper-palatable foods
    • Reduced motivation to engage in physical activity

Switch up physical activity

Research shows that changing exercise routines can help prevent plateaus and support further weight loss. Every four to six weeks, switch up your physical activity using the F.I.T.T method. Check out the following page to learn more about finding your optimal heart rate zone. Find ways to get extra movement in your daily activities.

F.I.T.T.: Effective principles to reach fitness goals

• Frequency: Frequency is the first step in creating an effective workout plan. How often will you exercise? Adjust and increase to challenge yourself overtime.
• Intensity: Intensity refers to how difficult an exercise is. Start at a level that feels comfortable, and then gradually increase the difficulty as your strength and endurance builds.
• Time: The next element of your workout is how long you exercise during each session. Start off with 15-20 minutes and increase as able. Recommended 150 minutes per week.
• Type: The type of exercise you do can be manipulated to avoid overuse, injuries, or prevent weight stagnation. Examples: walking, swimming, strength training, etc.

The standard recommendation for adults is at least 150 minutes a week, broken up into smaller segments, maintaining a moderate heart rate. Moderate Intensity Exercise is in between 50% and 85% of your max heart rate. 

To optimize your workouts, aim to train in your moderate intensity zones. Here’s how to find yours.

The standard calculation begins with subtracting your age from 220. This value represents your maximum heart rate, or MaxHR.

• example 40 year old: 220-40 = 180
• 180bpm is the MaxHR for a 40 year old.

Try this for yourself and record your MaxHR:

From here, we need to find a target heart rate range. Moderate intensity is considered anywhere from 50-85% of MaxHR*.

Multiply your MaxHR by these percentages to find this range

• example 40 year old: MaxHR = 180bpm
  • 180 x .50 = 90bpm (low end)
  • 180 x .85 = 153bpm (high end)
• The Moderate Intensity heart rate zone for this individual will fall somewhere in between 90 and 153 beats per minute.

Try this for yourself and record your Moderate Intensity Zone.

Monitoring your progress

• Fitness trackers and smart watches can track your heart rate zones.
• Cardio machines have sensors built in that can help keep track.
• The more fit you get, the more intense your activities will need to be to maintain these zones. This is a good way to assess progress!

Multivitamins

Bariatric-specific multivitamin supplementation is a lifelong necessity. The vitamins and minerals found in a multivitamin are essential in numerous metabolic processes, which affects the body’s ability to use fat for energy. Each vitamin has specific functions which can include supporting metabolism, the breakdown of fat, and insulin function.

Additionally, when your body is low on vitamins and minerals, your body can increase your appetite in an effort to replenish the nutrients you’re missing through food. The increased appetite likely prompts you to eat, even if your body doesn’t need the extra calories.

Bariatric-specific multivitamins are recommended because they have higher amounts of vitamins and minerals to compensate for the lack of nutrients from a portion-controlled bariatric-appropriate diet. They are also easier for your body to absorb.

By filling in the nutritional gaps with multivitamin supplementation, you can directly and indirectly positively influence your weight loss goals.

Weight loss/anti-obesity medications

Feel like you’re doing all the recommended things and the weight still won’t come off? Having to use weight loss medication doesn’t mean you’re a failure; it just means that you may need to use another tool in your weight loss toolbox! There are a variety of different types of weight loss medications on the market. If you feel that you could use additional support in your weight loss journey, reach out to your surgeon to discuss the next steps. They will help determine if this is the appropriate option for you, what medication would work best for you, and ensure you’re consuming adequate nutrition.

Studies show that patients who receive continued counseling with their Dietitian lose more weight and keep it off compared to those who try to manage on their own.

Use this checklist to identify areas in your lifestyle where you can make some improvements.

Recipe of the month: Tuna garbanzo bean salad

Ingredients:

• 2 tablespoons lemon juice
• 1 tablespoon capers, rinsed and chopped
• 1 tablespoon finely chopped shallot or red onion
• ¼ teaspoon salt
• ¼ teaspoon ground pepper
• 1, (15 oz) can no-salt-added chickpeas (chickpeas), rinsed
• 2, (5 oz) canned light tuna Iight water , drained
• 1 cup halved cherry tomatoes
• 1 cup thinly sliced English cucumber
• ½ cup reduced-fat crumbled feta cheese
• 2 tablespoons chopped fresh dill
• 3 tablespoons extra-virgin olive oil
• 3 cups leafy greens (baby spinach, arugula, spring mix, etc.)

Instructions:

1. Stir lemon juice, capers, shallot/red onion, salt and pepper together in a bowl. Let stand for five minutes.
2. Toss garbanzo beans, tuna, tomatoes, cucumber, feta and dill together in a large bowl.
3. Whisk oil into the lemon juice mixture until fully immersed. Toss and coat five tablespoons of the dressing into the garbanzo bean mixture.
4. Add leafy green(s) to the remaining dressing in the large bowl; toss to coat. Divide the spinach evenly among six plates; top each plate with 3/4 to 1 cup garbanzo bean mixture. Serve immediately.
5. If you want to meal prep, leave the garbanzo bean mixture and leafy green(s) separate until eating.

Nutrition per serving (six servings per container): 230 calories, 10g fat, 17g carbs, 20g protein.