The scale hasn't moved in weeks. You're doing everything right. What's going on? Before you panic or assume the medication stopped working, let's understand what might actually be happening—and what to do about it.
First: Is It Actually a Plateau?
Weight fluctuates daily—by several pounds—due to factors having nothing to do with fat:
- Water retention (sodium, hormones, stress)
- Digestive contents (fiber, food timing)
- Muscle glycogen (exercise, carbs)
- Menstrual cycle (can cause 3-7 lb swings)
A real plateau: No downward trend for 4-6+ weeks, not just a few days or even a couple weeks. Short stalls are completely normal.
Look at the trend over time, not day-to-day numbers. Weekly averages are more meaningful than any single weigh-in.
Why Real Plateaus Happen
1. Your Body Adapted
As you lose weight, your body requires fewer calories. What created a deficit at 250 lbs might be maintenance at 200 lbs. Your metabolism also adapts to prolonged calorie restriction.
2. Calories Have Crept Up
Appetite suppression can fade slightly over time, or portion sizes gradually increase without noticing. If you're not tracking, you may be eating more than you realize.
3. You're Building Muscle
If you've added exercise (especially strength training), you may be building muscle while losing fat. The scale stays flat, but body composition improves. This is actually good—check how clothes fit or take measurements.
4. Dose Optimization Needed
You may benefit from a dose increase if you haven't reached the maximum and appetite suppression has waned.
5. Normal Weight Loss Patterns
Weight loss isn't linear. People often lose in "stair-step" patterns—periods of loss followed by periods of stability. This is normal physiology, not failure.
Plateau-Breaking Strategies
1. Audit Your Intake
Track everything you eat for one week—accurately, with measurements. You may be surprised. Liquid calories, cooking oils, and "just a bite" moments add up. This isn't about restriction—it's about awareness.
2. Check Your Protein
Are you hitting 60-100g daily? Adequate protein preserves muscle (which keeps metabolism higher) and increases satiety. If protein has slipped, prioritize it.
3. Add or Adjust Exercise
If you're not exercising, start (even walking counts). If you are, change something: increase intensity, add strength training, try a new activity. Bodies adapt to routine—surprise yours.
4. Evaluate Sleep and Stress
Poor sleep increases hunger hormones and cortisol. Chronic stress does the same. These can stall weight loss despite good eating habits. Address lifestyle factors.
5. Discuss Dose with Provider
If you're not at maximum dose and appetite suppression has decreased, a dose increase may help. This is a conversation for your prescribing provider.
6. Consider Medication Timing
Some people find changing injection day or time affects their weekly pattern. There's limited science here, but anecdotally some people find certain timings work better.
What NOT to Do
- Don't crash diet: Severe restriction backfires—it increases hunger, slows metabolism, and triggers binge patterns
- Don't panic at two weeks: Short stalls are normal. Give it time before declaring a crisis
- Don't stop medication: The plateau isn't evidence medication stopped working—stopping will likely reverse progress
- Don't over-exercise suddenly: Dramatic exercise increases can increase water retention and stress hormones, temporarily masking fat loss
Reframing the Plateau
Consider: a plateau might be your body stabilizing at a new set point. It's not failure—it's consolidation. The ability to maintain a lower weight for a period IS progress, even if the scale isn't moving.
Some questions to ask yourself:
- Am I healthier than when I started?
- Do I feel better?
- Am I maintaining significant weight loss?
- Are my health markers improving?
If yes, you're succeeding—even during a plateau.
When to Talk to Your Provider
Reach out if:
- Weight has been completely stable for 6+ weeks despite your efforts
- You're experiencing new side effects
- Appetite suppression has significantly decreased
- You're struggling with the psychological impact
Plateaus are part of the journey. They're frustrating but not permanent. Stay the course, make adjustments where appropriate, and trust the process.