In the 25-plus years that I’ve worked in medicine, I’ve seen many changes and advances in the science of weight loss. I’ve also worked with countless people and helped them reach their health and weight-loss goals. And in my experience, pretty much everyone can lose some weight by simply reducing or eliminating their intake of sugar, white flour, and processed foods; changing their portion sizes; adjusting the carbohydrate-to-protein-to-fat ratio of their meals, and increasing both their cardiovascular and resistance-training activities.
Invariably, however, there is always someone who loses weight initially and then plateaus. And though they do find that they feel healthier and more energized with their lifestyle changes, they are frustrated when they don’t see the scale drop. So aside from my usual recommendations for specific nutrition and exercise plans, I also recommend the following for the individuals who find they are not meeting their goals:
1. Assess your sleep.
Sleep deprivation leads to inflammation and elevated cortisol levels, a stress hormone that can lead to poor metabolism and insulin resistance. Lack of sleep can also wreak havoc on the hormones that regulate appetite and satiety (leptin and ghrelin). And when you have higher levels of ghrelin and lower levels of leptin, you will want to eat more and feel full less often.
Growth hormone levels may also be negatively affected by lack of sleep, disturbing your ability to maintain lean muscle mass. For extra help you can get a monitor to see how well you are sleeping or see your doctor for a sleep study to make sure you do not have an underlying condition like sleep apnea. Aim for at least eight hours to feel rested upon awakening, without the help of caffeine.
2. Try early time restricted feeding (eTRF).
Recent studies show that having your last meal in the mid-afternoon and not eating again until breakfast can help with fat and carbohydrate metabolism and reduce hunger swings—which may help with weight loss. In my clinical experience I have found that even if you eat just a very light meal or snack around 5 p.m. as the last meal, weight loss is more likely. Keep in mind that this is not about calorie restriction, just the time period over which the calories are consumed.
3. Check your thyroid.
The thyroid hormone helps your body regulate its energy use and storage. Oftentimes the clients who are unable to lose weight also experience symptoms like constipation, hair loss, dry skin, fatigue, joint or muscle aches, or rashes—all characteristic of a low-functioning thyroid gland.
To check your thyroid function, your doctor will need to do some blood work and check your thyroid-stimulating hormone levels (TSH) and levels of T3 and T4 (the main thyroid hormones). If your thyroid levels are low, your doctor can then start you on thyroid replacement therapy as necessary.
4. Consider food sensitivities.
Most people don’t have actual allergies that would show up as a rash or allergic attack, but many people do have food sensitivities that could be causing inflammation and a poor metabolism. These sensitivities can present with other symptoms like irritability, mood swings, asthma, headaches, fatigue, and joint or muscle pains.
You can certainly be tested by your doctor for allergies or simply go on an elimination diet for three to four weeks by removing all gluten, dairy, sugar, processed foods, white flour, nuts, soy, and eggs. If you notice a difference, you can then try reintroducing a food group and see if the symptoms return. You may also find that adding a probiotic with at least 10 million bacteria alleviates some symptoms.
5. Check for deficiencies.
I have also found that patients with low vitamin D levels and/or low iron levels have a hard time losing weight. These same patients often experience concurrent symptoms like fatigue, hair loss, joint aches, or skin problems. If your levels are low, you will find taking the appropriate supplement (see your doctor for levels and recommendations) will alleviate your symptoms and help you lose weight. Women who are nearing menopause or are postmenopausal may also want to have their hormones checked as hormonal imbalances can also affect your ability to lose weight.
6. Find a way to de-stress.
Similar to lack of sleep, high stress levels lead to high cortisol levels, which can result in weight gain and a poor metabolism. Stress will also negatively affect your sleep and your other hormones. Ways to de-stress include meditation, mindful walks, support groups, enjoying social time with friends, or spending time in nature.
This article originally appeared in MindBodyGreen.