PODCAST: Why Weight Loss Stalls & How to Get Back on Track

ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore, I’m a photographer and editor here and I’m also a longtime podcaster.

KATIE MCCALLUM: I’m Katie McCallum, former researcher turned health writer, mostly writing for our blogs.

ZACH: And Katie, have you ran into any weight loss plateaus?

KATIE: I think in theory I probably have. What I am noticing lately is that I seem to be -- It’s harder for me to maintain my weight. So, my weight’s kinda creeping up even though I don’t feel like much has changed. I’m still eating kind of the same foods, working out the same amount. The only thing that’s changing is I’m getting older.

ZACH: Yeah.

[Laughter]

KATIE: So, I’ve been starting to wonder if my plateau -- my plateau, I think, has been like, I’ve been able to maintain my weight relatively easily, I guess. But now, I’m actually in the stage where I’m, like, creeping up and I’m having trouble getting it back down to where it was. So, a plateau, yes, but in a maybe different way than some people would think.

ZACH: Yeah. I guess you don’t really run into a plateau. You just --

[Laughing]

KATIE: Yeah. Well, I think, right? There’s two different pieces there. Like, in my case, I’m kind of creeping up, but then now I’ve -- I stopped creeping up, but I’m having trouble coming back down.

ZACH: Mm-hmm.

KATIE: You know, so maybe that is the same plateau. But then there’s people, you know, who go on a diet and they’re losing weight, losing weight, losing weight, but then they kind of hit a place where they stop losing weight. So, there’s two different kinda types I would say.

ZACH: Yeah, because my weight has fluctuated over the years, I’ve had my own journeys here. And when you do something, it works for a while…

KATIE: Mm-hmm.

ZACH: And then it doesn’t work

KATIE: Yeah.

ZACH: And there are so many variables to like, “Why am I not losing weight anymore? Why is what I used to do not helping me now?”

KATIE: Another point of that that I get stuck on is like how long before I’m worried about not losing, like, quote and quote, “enough weight?” Like, am I losing weight fast enough? Or, you know, if you know if I’m at a plateau, like, how long of being at a plateau is where you’re, like, at the plateau and you’re not losing weight anymore kind of thing? Like, is it a couple weeks? Is it a couple days? Is it a couple months?

ZACH: Right. Because you wanna see results. Well, everybody wants results. Everybody wants results fast.

KATIE: Mm-hmm.

ZACH: But the sad truth is, it takes a while to have, you know, tangible, long lasting results that stick, right? That are -- That are sustainable, right? And so, you don’t wanna rush it like, “Well, you know, it’s been a couple weeks. I’m still waiting to lose that ten pounds.” It’s gonna take longer than that. But at the same time, if it’s, you know, six months and you’re still waiting to lose those ten pounds, and you’re doing everything you should be doing because, you know, you play a big role in this yourself, your activities, then maybe it’s time to start looking at, “Hey, well, maybe there’s a deeper situation going on here.”

KATIE: Yeah, I agree. And where do you look?

ZACH: Right.

KATIE: Because the internet has a lot of opinions on the topic, and so, that’s why I’m glad we’re, you know, we’re having this conversation today. What do you actually need to think about when you’re thinking about if your weight has stalled at a place that you don’t like? Who do you go to? Like, who do you go to for information? Who do you go to for help? What are the steps to take? What is going on with metabolism? I think I hear that -- I see that the most, like, in my feeds of -- It’s like, “Drink more water. It’ll jump start your metabolism.” And I’m like, “I already drink a ton of water so I’m not sure that’s it.”

ZACH: “More protein.”

KATIE: Yeah, exactly. Yeah, “Protein.” Like, so anyways, I think it’s that too. It’s identifying like, “Am I even at a plateau?” But then also like, “Okay, maybe I am. What do I do about it?”

ZACH: Well, who we went to for answers was Dr. Garth Davis. He is a Surgical and Medical Weight Loss physician here at Houston Methodist. And we had a great conversation about weight loss plateaus.

[Sound effect plays to signal beginning of interview]

Hi, Dr. Davis thanks so much for taking the time to be with us today.

DR. GARTH DAVIS: Thanks, happy to be here.

ZACH: Weigh loss plateaus. Could you define that for us? Could you tell us what it looks like and how quickly should you consider a change if your weight loss plan stalls out?

DR. GARTH: Right. So, a weight loss plateau, you’re losing weight. Things are going down fairly regularly, and then all of a sudden, you’re not losing any more weight. Which actually, adds quite a bit of stress and uncertainty to people. They’re wondering if they need to change anything, do anything different. And we see that obviously, quite commonly.

ZACH: Now, a figure I read was if you’re actively trying to lose weight, but things stall out after -- And whatever that looks like, and then we’ll talk about some of that, but things stall out after about four weeks, that seems to be a good range or is that accurate or inaccurate?

DR. GARTH: Oh, that’s not accurate, no. I mean, the range could be all over the place. People say four weeks, but it just depends what you’re doing, are you on medications, have you had surgery. There’s different things that could control that, and there’s different reasons behind, you know, why you stall depending on why you’re stalling that could make a difference as to when that happens.

ZACH: Okay. Let’s talk about age range. Is there a specific age range where weight loss plateauing can truly be learned about or is okay at any age really?

DR. GARTH: It happens at just about any age. I mean, as you get older, you will see more weight loss difficulties and struggles having to do with hormonal issues, loss of muscle mass, slowing of metabolism. So, you could have someone who, you know, I hear this a lot. Someone comes to see me, and they say, “Look, I’m eating the same as I’ve always eaten, but now I’m not losing weight or I’m gaining weight.” And I have to explain to them, “Well, you’re eating the same, but your metabolism has changed. And because your metabolism has changed, you may have had a metabolism that was burning more calories than you were eating, but now you’re eating the same amount of calories, you’re just burning less. And so, your net calories are positive and that’s gonna lead to weight gain or stall.”

ZACH: Let’s talk about some of the other contributing factors and how to combat them. So, boredom. Like, apparently your body can, quote unquote, “Get bored and adapt to its workout routine.”

DR. GARTH: No. So, I wouldn’t say boredom. That’s -- No, your body doesn’t get bored.

[Laughter]

No, you’ve gotta think of the human body. Look, we have the same genes. If you dig up Australopithecus, an old mummy from hundreds of thousands of years ago, and you dig it up and you look at their DNA it’s pretty close to ours. Our DNA evolved in a time of feast famine. What you have to understand about natural selection is it doesn’t care about your weight when you’re older.

[Laughter]

It doesn’t care about you growing old and being healthy. It only cares about you getting to procreation. And to get to procreation during times of feast or famine, it’s all about holding on to your weight. We have a pretty intricate system to control our weight. Our fat cells secrete a hormone called leptin. Leptin feeds back to the very central part of our brain, the part of the brain that controls heart rate and breathing, not the part of the brain that’s the thinking part of the brain. Leptin is kind of a measure of our energy stores. So, let’s say you go on a diet and, you know, in the beginning you go on a diet, if a someone offers you a piece of cake, “No, I don’t want a piece of cake. I’m on a diet.” Three weeks later, four weeks later, someone offers you a piece of cake, you’re like, “Oh, my God, that cake looks good, you know. Is that Betty Crocker? I gotta eat it.”

ZACH: Yeah.

DR. GARTH: And then you eat it, and you feel crappy about yourself, and you say, “I have no willpower.” But it really has nothing to do with willpower. You were losing weight, so you were losing fat. When you’re losing fat, your leptin level drops. Your brain reads this as, “Oh, my God, we’re starving. It’s the Sahara, you know, 10,000 years ago. I need to make this person eat or otherwise we’re gonna starve to death.” And so, you’re driven to eat by this drop in leptin. There’s other hormones too. Your ghrelin level rises. Different things happen to make you hungry. Meanwhile, you also will tend to be losing muscle when you’re losing weight. And as you lose muscle, you lose metabolism. So, your metabolism is slowing, you’re getting hungrier. And your metabolism slows not just by muscle. We always think it’s all muscle. But it has to do with all kinds of things. It could be the number of cells your body is making, how many white blood cells your body is making. Your body has very intricate ways of slowing metabolism. So, metabolism slows, you get hungrier, and your body isn’t bored, it’s simply thinks that you’re starving and therefore, it needs to hold on to weight.

ZACH: You mentioned losing muscle. Muscles, they’re metabolically active tissue which, you know, some listeners might not realize, but that helps you burn more calories when you’re at rest.

DR. GARTH: It does. Yes. So, it’s certainly a problem when you lose muscle. You’re not gonna burn as much at rest, plus you’re just not gonna burn as much during the day even when you’re moving. It is a factor, it’s not the main fac  -- Well, it’s one of the main factors. But there’s multiple different factors controlling metabolism. It’s more than you would think. It’s not just muscle, but muscle certainly plays a big role.

ZACH: Now, stress can be a factor well. Now, stress obviously affects your body in different ways. The most obvious one would perhaps be, you know, coping with stress through, you know, eating comfort food, binging, and that sort of thing. But stress can affect your metabolism in more than one way.

DR. GARTH: It can, I think, probably more of it is that behavioral adaptation to stress like, “Oh, my God. I need to eat for comfort.” I think that’s probably a bigger role.

ZACH: Uh-huh.

DR. GARTH: If you’re seriously stressed, the point that you’re building up cortisol levels -- And cortisol definitely has an effect. You know, it’s a catabolic hormone and that could break down muscle. It changes the way you metabolize sugar and can lead to you holding on to fat. So, if you’re really so stressed that cortisol levels are up, yeah, that’s definitely gonna have a role. But I think the main problem I see with stresses are adaptation to dealing with stress.

ZACH: Now, retaining water, salt and salty foods are the main culprit of this. But also, premenopausal women are especially, quote unquote, at risk for this.

DR. GARTH: Yeah, well, this brings up an important point. It’s that when I’m looking at someone for stalls and for what their weight is, I really am not looking completely at a scale way. When someone comes to see me, they stand on a special scale that puts an electric signal through their body so it can measure how much water is in the body, how much muscle, and how much fat. It’s not 100% accurate but it gives me a pretty good idea. So, there could be someone who is really working out really hard. They’ve built some muscle. They’ve lost fat, but because the muscle offsets the weight of the fat, their scale hasn’t changed and they’re like, “Oh, my God. I’m in a plateau.” And then I’ve gotta teach them, “Well, you’re in a plateau but it’s okay. You’re losing fat. You’re holding on to muscle or gaining muscle. And so, this is actually a good number, not a bad thing.” So, you could have the same situation with water. I mean, you could say, “Okay, you’re retaining water right now. I could see on the scale that your water levels are up.” The flip is true of that too. So, a lot of people go on keto diets, and they say, “Oh, I was successful. I lost all this weight.” A big part of a keto diet, you’re not eating any carbs, so you lose your carb stores. Carbs are stored as glycogen with water. So, when you go on a keto diet, you’re losing your glycogen stores which comes out with a lot of water. And so, therefore, a lot of that weight you lose is actually water and some muscle, because your body doesn't like being without carbs, so it will start to break down muscle and turn it into glucose for -- so your metabolism -- And so, people are like, “I did great on the keto diet.” No. You really didn’t. You just lost water and muscle.

ZACH: Undereating, people might think, “Oh, that’s the key to losing weight.” But actually, your body can realize what you’re doing and kinda go into its own survival mode and slow down your metabolism then, right?

DR. GARTH: It can. I mean, I don’t like it when people are like, “Oh, I’m eating more in order to lose weight.”

[Laughter]

That’s -- That doesn’t really work.

ZACH: It’s like spending money to make money you’ll say.

DR. GARTH: That doesn't work. There is time you feel like, “I’m in starvation mode.” Well, I mean, yes, you could eat a low amount and lose weight like we’re talking about. Your metabolism could slow. Then eating more is just gonna make you gain weight.

ZACH: Okay.

DR. GARTH: You need to expend more energy, not eat more in that situation. Your body, if you don’t eat, will break down its tissue and you will get sticklike. So, yes, there is a little bit of a slowing in metabolism, but, you know, there’s not just like a starving mode where all of a sudden your body is holding on. That’s not exactly true.

ZACH: Yeah. There’s some obvious things like snacking. Obviously, if you eat too many snacks, even healthy snacks and like guacamole. Everybody loves avocadoes, but if you eat too much of that that’s gonna slow down your metabolism. That’s gonna mess up your weight loss journey, correct?

DR. GARTH: Not slow your metabolism but it’s going -- you’re just eating more calories.

ZACH: Yeah.

DR. GARTH: If you eat more calories, you’re gonna gain weight. Yeah, there was a professor in Kansas who wanted to prove this point. And he was a nutrition professor, and he was showing his nutrition students he went on an all Twinkie and Dorito diet. But he measured his metabolism, made sure he ate less than his metabolism, but it was all Twinkies and Doritos, and he lost weight. He lost a considerable amount of weight. Because if you --

ZACH: I might try that diet now.

DR. GARTH: Yeah. It’s all while you gotta know your metabolism. Make sure you’re eating under your metabolism. Is not necessarily healthy but he did lo -- In fact, his cholesterol level went down and his numbers all looked -- All his numbers looked better. So, I mean, weight loss is pretty powerful. I don’t recommend that diet, but the point of it being that in the end it is calories in verses calories out.

ZACH: Right. I mean, you’ve mentioned just tracking food right there. I mean, simple, but a lack of tracking food, right? People start to eyeball like, “Ah, it’s probably good enough.” But if you’re really serious about losing weight, you know, track your food. And there’s lots of food tracking apps. And --

DR. GARTH: Yeah, there’s lot of food tracking apps. I -- People do a very bad job of tracking.

[Laughter]

So, there’s been many studies on this. So, they’ve had people track their food but also take pictures and then kind of like had a dietician look over and say exactly what they ate. And people are about 50%-75% off on their calorie intake. They also, not surprisingly, overestimate how many calories they burn a day.

ZACH: No, I’m sure. Yeah.

DR. GARTH: So, this is kind of the problem. People are like, “Well, I’m tracking and I’m still gaining weight.” That’s because you’re not tracking properly. And there’s many reasons for that. People don’t count the oils they cook in. You know, cooking spray?

ZACH: Mh-hmm.

DR. GARTH: It says on it that it’s no calories and no fat. It says, “no fat,” on the cooking spray.

It’s 100% fat.

[Laughter]

So, how does it say, “No fat, no calories?” Because the serving size is a quarter of a second of a spray, which I don’t even know what that is, a quarter of a second of a spray.

ZACH: No.

DR. GARTH: But no one’s using a quarter of a second of a spray. They’re like, “Oh, this is low calorie,” and they’re spraying, and they don’t count that in their calories, or they don’t measure properly. They forget. You know, people go into a closet and grab some chips, and they’ll eat, you know --

ZACH: Serving size. Yeah.

DR. GARTH: Yeah, they’ll eat ten or 15 -- Yeah, they don’t -- It’s like they’ll eat ten of 15 chips and not even count it as a serving size. They’d be like, “I’m just gonna eat a few of these to see if I even want chips or I don’t want chips,” then that doesn’t get counted. And so, yeah, we’re way off on our counting. We’ve kinda stopped doing the counting with patients just because it hasn’t been that successful. I kinda like people to be knowledgeable. Like, get an idea of what a frappuccino, how many calories is in it. ‘Cause people just don’t even know.

ZACH: Right. It’s scary when you look at the numbers.

DR. GARTH: It’s scary when you look at the numbers. But I think it’s a good idea to kinda know. But what we try to do is emphasize low calorie density in food. So, what foods tend to have a low-calorie density. And if they have a low-calorie density, don’t count how many -- how much of it you eat. For instance, a watermelon. You could probably eat a whole watermelon without gaining weight. And first of all, there’s so much fiber and water that you’re gonna get full before you could eat the whole watermelon. So, you’re gonna get full real easily without a lot of calories and that’s kind of what our goal is to get you full without getting a lot of calories, and to have that fullness last and that’s based on fiber.

ZACH: That’s interesting that you’re kind of moving away from the calorie tracking and that sort of thing with patients. And, no, I agree. I’ve drifted in and out of doing that myself and I find that like, look, if you have no concept of anything like you said, it’s good to kind of put some numbers to some foods and drinks there. But then, you know, once you kinda get in the routine of it, you kinda have a feel and a pattern for it. And once you get started, you don’t need to be logging every last thing you do. And it’s, you know, it’s a barrier to what you’re doing too. It’s an exhausting thing.

DR. GARTH: It’s exhausting, yeah.

ZACH: First thing to drop when you get busy. It’s like, “Oh, I’m not gonna log this meal.” So, that’s interesting how we’re just evolving through this.

DR. GARTH: Right. I mean, I never count anymore. I don’t count my calories. I know that my oatmeal is fine. I could eat as much of it as I want. I know that my salad with beans and a baked potato, I could eat as much of it as I want. I know these foods are low, I can eat as many apples as I want.

ZACH: Mh-hmm.

DR. GARTH: I know that these foods are low calorie density, high in fiber and water, and therefore, there is no way I’m gonna eat too many calories with those foods.

ZACH: Now, you mentioned a couple diets already, so can having a history of restrictive diets contribute to weight loss plateaus? I’ve heard the term, you know, “Yo-yoing diet,” right? Where your body kinda counteracts and that --

DR. GARTH: I mean, yo-yo diet is basically what we’re talking about earlier. You’re dieting, your metabolism slows, your hunger increases, and then you can’t stick on the diet because now, you’re ghrelin level goes up, your leptin level has dropped, and your brain is like, “I gotta eat.” That creates this inability to stick with these crash diets.

ZACH: But then it makes it hard to lose weight in the future ‘cause your metabolism --

DR. GARTH: ‘Cause your metabolism is slower.

ZACH: Start to get it back to that point.

DR. GARTH: You know that show, “The Biggest Loser?” Do you remember that’s show?

ZACH: Yeah, yeah, yeah.

DR. GARTH: They actually studied those people. So, those people came in, they lost a humongous amount of weight. They measured their resting metabolism before going on the game show and then afterwards. They had a huge drop about -- I think it was about 800 calories if I remember correctly, 800 calorie drop in their resting metabolic rate. That’s huge. What was crazy about it, as they lost that metabolism, they followed these people back six years and ten years after, and they never regained that metabolic rate. The metabolic rate stayed permanently low, which is this kind of idea that you could diet yourself fat by going on these crash diets, slowing your metabolism, making it harder to lose weight in the future.

ZACH: Wow. Are there any specific genetics that can play a part in it being harder to lose weight?

DR. GARTH: There were some very interesting twin studies that were done where they -- In Holland they had identical twins and fraternal twins that were separated at birth and grew up in different environments. So, you can imagine one is in a healthier household, and one is in an unhealthy household. And then they looked at genetic factors and what genetic factors were most inherent to genes. And actually, weight was the most inherited gene that they found, weight and height were on par. So, like, if an identical twin is growing up in one environment separated from their other identical twin, they tend to have the same weight. Genetics definitely play a factor. We’re just starting with the genome projects to get an idea of which genes contribute. But there’s no doubt that -- They did a study with prisoners, and they took a group of prisoners that were really skinny and tried to get them to be morbidly obese, gave them tons of food. You know, “You could have whatever you want. We’ll give you pizzas, whatever you want.” They wanted them to eat 10,000 calories a day, they couldn’t do it.

ZACH: Wow.

DR. GARTH: I mean, they gained some weight, but they felt sick with it and they just couldn’t eat anymore. They just couldn't do it, which is very different than someone who suffers with morbid obesity. Their body says, “Okay, feed me. Keep feeding me. Keep feeding me. I’m fine.” So, they don’t have that feedback mechanism that stops them from eating.

ZACH: That’s some real interesting science there ‘cause I think people, you know, they look at, you know, themselves and they try to compare themselves to other people. And everybody is, you know, different. Everybody’s metabolism is different. Everybody’s weight loss journey is different.

DR. GARTH: Yeah. It’s very different. You can’t compare. And that’s the thing about saying, “Oh,” -- I see all these, like, online influencers and they’re like, “Just do what I do.” You can’t. Unless you walked a mile in someone else’s shoes, you just do not understand. They don’t understand what hunger is. And we have now like functional MRI studies where they’ve taken people and put them in these MRI machines and they’ll take a normal weight person and show them like a cheeseburger and their brain kinda lights up but doesn’t go crazy. Then they’ll take someone who suffers with obesity, and they showed them and their brain is lighting up, like, “Oh, my God, I need that cheeseburger right now.” It’s a very big difference. They’ve also looked at dopamine receptors in the brain and the part of the brain that gives us satisfaction. And what they have found is that in a person that’s not suffering with obesity, they have plenty of dopamine receptors, but in someone who suffers with obesity, they have a lack of dopamine receptors, which is similar to an alcoholic. And because of this lack of dopamine receptor, it’s harder for them to feel satisfied. And so, this really is a physiologic genetic disease that would be fine if we were in an environment where there wasn’t a lot of food around. But in an environment with copious amounts of food anywhere you could go, and highly processed unhealthy food, and a lot of food misinformation, works together to create an obesity society.

ZACH: Medical conditions that can contribute to weight loss plateaus. Hypothyroidism, any other ones?

DR. GARTH: Yeah. I mean, hypothyroidism. It’s probably -- We diagnose it a lot less than you would think when it comes to this. Menopause, or perimenopausal will have an effect. That’s a rapid time of change for many women, and they tend to lose muscle mass. They tend to be under stress, not sleeping well which leads to more eating and less metabolism leads to plateaus and weight gain. And then there’s, you know, rare things like Cushing’s disease. Diseases that have to do with cortisol secretion.
And then there’s different medications people are taking, like insulin could make you hold on to weight, gain weight. A lot of the antidepression medications can do that. Amitriptyline, Paxil, just meds that are given commonly, and no one’s even told that, you know, this could actually make you gain weight.

[Music to signal a brief interjection in the interview]

ZACH: Up after the break, more with Doctor Davis on weight loss plateaus and how to overcome them.

>> ANNOUNCER: From annual checkups to managing chronic conditions, your healthcare should be personalized to you. At Houston Methodist, our primary care doctors provide customized care for you and your family with more than 40 convenient locations across Greater Houston. We offer a variety of ways to get care, from in-person and virtual appointments to same-day visits when you're sick. Choose your doctor and schedule online at houstonmethodist.org/stayhealthy. Houston Methodist leading medicine.

[Sound effect signals return to the interview]

ZACH: Alright, I’m gonna read out a list here of strategies and tricks to potentially help with weight loss plateauing. Stop me if any of these are inaccurate. Cutting down on carbs.

DR. DAVIS: Absolutely, completely and utterly wrong.

ZACH: Oh okay.

DR. DAVIS: I mean, stupefyingly wrong. Like, if I could do one thing to just jump up and -- Look, if you look around the world at the healthiest cultures, you ever heard of blue zones.

ZACH: Oh yes, yeah.

DR. DAVIS: Okay, so these blue zones are these cultures with long, healthy lives.

ZACH: Uh-huh.

DR. DAVIS: Are they cutting back on carbs? They’re eating mainly carbs. Like Okinawa, it’s sweet potato and rice and soybean. The Mediterranean diet that everybody raves about…

ZACH: Mhm.

DR. DAVIS: Pasta, breads, potatoes, lots of beans. Nicoya Peninsula Costa Rica, beans and rice and fruit. So, they’ve actually done over-feeding studies where you put someone in a room and you feed them huge amounts of carbs. It is very, very difficult for the human body to turn a carb to fat. It’s called De novo lipogenesis. And your body has a very hard time doing it. And if it does it, it expends energy to do so. Now, if you are insulin resistant on the way towards diabetes, you don’t process carbs correctly, and then you could start building up more fat from carbs. But still, carbs are not and never were the problem.

ZACH: Noted.

DR. DAVIS: Noted, yeah. The problem is that people are like, “Oh, carbs are good. I’m gonna go and eat a donut.” That’s not what I’m saying, right? And the other thing is like labeling a donut a carb or labeling pizza a carb is just wrong, right? I mean, a pizza’s probably got more calories from fat than it does from carbs, as does a donut. I mean, a donut is mainly -- it’s fat and carbs mixed.

ZACH: Yeah. ‘Cause carbs have their role. You know, like, a lot of athletes eat a lot of pasta before a game and get that energy. But everything, like, has their role and their space, so.

DR. DAVIS: Pasta’s actually great. Just -- but, you know, a pasta with butter sauce and --

ZACH: All the things you don’t think about.

DR. DAVIS: Yeah, and meat. Like a, oh, the meatballs and some meat sauce. No, that’s terrible.

ZACH: So, increasing exercise frequency and intensity.

DR. DAVIS: Definitely. There’s several parts of having an efficient metabolism. One is how many steps do you get? And we call those non exercise activity thermogenesis, or NEAT. What’s your NEAT? Do you take the stairs, do you park further away? How many steps are you getting in a day? Do you go for walks? Then I look at two parts when it comes to actual exercise, which for me, exercise is a concerted effort to raise your heart rate and to move your body. Now, in that, there’s -- what I’d like people to do is low intensity cardio. I don’t like when people are losing weight actively to do a lot of high intensity cardio. We could get to the science of that. But I like them to focus on low intensity cardio. So, that is -- there’s all these zones now people talk about, and there’s a fat burning zone, or zone two, or whatever you wanna call it. Lower zones. Your body actually does burn fat for fuel rather than carbs. It’s a little bit less stressful on the body, it’s a little easier to do. So, I tell people to get on a treadmill, or a bike, or a rowing machine. Whatever you wanna do. And go in a effort that is a little bit difficult, it’s harder than just going for a walk. You’re a little bit sweaty, but you could carry on a conversation. If someone comes, you could talk with them, you could sing, you could whistle a tune.

ZACH: You’re not like…

[Breathing Heavily]

DR. DAVIS: You’re not…

[Breathing Heavily]

Right. You’re not totally out of breath.

ZACH: Uh-huh. You know, I’ve heard that like as long as you sweat, that’s a good work out.

DR. DAVIS: Yeah, if you’re breaking a sweat, that’s pretty good. Yeah, if you’re breaking a sweat, it’s pretty good. You don’t need to do these crazy, high intensity intervals and things like that, sprints, stuff like that. And then the other thing we really ought to be working on is resistance training. Trying, like, actually to build muscle. And again, you don’t need to go super crazy with this. Let’s say I want you to do three sets of ten squats. You should be able to do a weight where you could do 12, but you do 10. So, you don’t have to go to failure with these sets. Now, it shouldn’t be where you could do 15 but you do 10. It should be about 11 or 12 that you could do, but you do 10.

ZACH: Yeah. Finding that goldilocks zone.

DR. DAVIS: And keep in mind that that will change over time. So --

ZACH: Yeah. And you can’t keep incrementally getting higher and higher.

DR. DAVIS: Exactly. So, you do have to progress with either sets, reps, or weight.

ZACH: Yeah, absolutely. Eating more protein.

DR. DAVIS: Absol -- you know I wrote a book about this called, “Proteinaholic.” It’s amazing to me how in America, we think protein somehow magically makes you lose weight.

ZACH: That’s why they always ask you if you want that in your smoothie when you --

DR. DAVIS: Yeah, it’s ridiculous. It’s a big sales scam that they’ve got on us. Look we know -- like, if you wanted to absolutely maximize every muscle that you possibly could, there was a meta-analysis looking at a bunch of studies, and it came up with the fact that the maximum amount of protein that your body’s gonna help you to build muscle is about 1.6 grams per kilogram of your ideal body weight, not your current body wight, but ideal body weight.

ZACH: Okay.

DR. DAVIS: But, you gotta understand, in that study, these were trained athletes, probably a lot of them on steroids and stuff. So, 1.6 is probably pretty high. And when you look at the difference between 1.6 and 1.2, there wasn’t a huge difference. Really, I think you need about 1 gram per kilogram, lean body mass, or your ideal body mass, maybe even less than that.

ZACH: How does that translate to pounds.

DR. DAVIS: Well, you’d have to get -- get the calculator. I can’t tell you that off hand. But a 70 kilogram, like 165 pound guy would need basically somewhere between 80 -- and this is an athletic 70 kilogram person. Would need about 80 grams in a day.

ZACH: Okay. Intermittent fasting.

DR. DAVIS: So, intermittent fasting doesn’t work at all.

ZACH: Okay, alright.

DR. DAVIS: But here’s the caveat on that. In -- when I say it doesn’t work at all, when we’ve done randomized controlled trials where let’s say we’re gonna say we’re gonna put two groups of people on 1,500 calories. One group is gonna eat 500 calories in each meal three times a day, regular breakfast, lunch, and dinner. The other group is gonna skip one meal and then get the 1,500 in the other two meals. So, they’re eating the same amount of calories. There’s no difference. So, people thought, “Oh, by skipping a meal, your metabolism changes, da-da-da-da-da.” Didn’t work out to be the case. There’s some people that will say like, “I just am not hungry at breakfast and therefore I do lunch and dinner, and I’m able to keep my calories lower by skipping breakfast.” Then it might work for you as an individual. But in general, the studies have been pretty poor on it. I will say this. Breakfast has become a hot topic of debate. It’s funny in the nutritional circles what we debate about. In what was called the National Weight Control Registry, they studied people that actually have lost weight and kept it off ‘cause that’s very rare that someone loses weight and keeps it off without medicine or surgery. And so, they wanted to know from these few people what did you do? And one of the main things they did was to start eating breakfast. And we have found that people that skip breakfast tend to eat more at lunch and dinner. So, if that’s what’s happening, if you’re skipping breakfast but you’re eating more at lunch and dinner, intermittent fasting isn’t gonna work for you. But if you can skip breakfast and still eat the same at lunch and dinner so that you’re getting a net loss, then it will work.

ZACH: Yeah. The way it’s been described to me in the past is if you eat even just a little bit of breakfast, it kinda jumpstarts your metabolism for the day. That’s wrong?

DR. DAVIS: Yeah.

ZACH: Okay.

[Laughing]

DR. DAVIS: No, these “jumpstarts your metabolism”, stuff like that, no.

ZACH: Okay, okay. Avoiding alcohol.

DR. DAVIS: That’s a good thing. So, I mean -- first of all, alcohol, when you look at calorie density again, so a fat is 9 calories per gram. A carb or a protein is 4 calories per gram. Alcohol is 7 calories per gram. So, it’s pretty dense calorie. Plus, we usually mix it in drinks and things like that. So, it’s gonna be even higher calories. It also tends to disinhibit so that you will then eat with it. And overall, just isn’t that healthy for you. So yeah, I would definitely cut back on alcohol.

ZACH: Okay. And then sleep. Sleep affecting your metabolism, get your recommended seven to eight hours of sleep every night.

DR. DAVIS: Absolutely. Yeah, so sleep plays quite a big role with weight management. Maybe somewhat in metabolism, but also in - they found that in people that eat less that tend to be more driven toward sweets consumption, and tend to be -- also have more disordered eating behaviors. And so, it’s just the stress of lack of sleep also causing, almost like alcohol, disinhibition to then drive you to eat poorly.

ZACH: Gotcha. And then last rapid fire here, eating vegetables with every meal.

DR. DAVIS: Absolutely. Yes. More vegetables. Fruits, vegetables, beans. That’s what we’re missing.

ZACH: Uh-huh.

DR. DAVIS: I mean, back to the protein argument. When you look around the world, we eat more protein than any other country in the world by far, alright? And so, how’s it working for us? Okay, not very well. We have one of the lowest life expectancies, highest obesity rates etcetera, etcetera. The recommended daily allowance for a male is 56 grams, for females, 46 grams of protein. I told you, with an athlete, it’s a little bit more, so we’re saying 70-80. Probably for the average person, I would say a little bit more than the RDA. So, for a male, 60 grams to 70 grams, for a female, maybe 60 grams. Most Americans are getting about 100 grams to about 112 grams of protein a day, so we’re almost doubling the RDA on protein. We don’t have a protein deficiency in this country, alright? People are getting way by enough protein. And again, how’s it working for us? Meanwhile, the RDA for fiber is 30 grams for a male and 25 grams for a female, which I think is really low. It should be a lot higher than that. But let’s just take the 30 grams of fiber a day. Only about 3% of the country is hitting that 30 grams of fiber. So, we are fiber deficient and way over protein, so we need to shift that. If there was one thing people could do to lose weight, it would be increase the fiber in their diet. And not just lose weight, control their cholesterol, control their blood sugar, prevent cancer. I mean, fiber is, to me, the key and the number one thing missing from the American diet.

ZACH: What would you recommend people -- if they’re looking for more fiber, what would you recommend for them?

DR. DAVIS: Fruits, vegetables, beans, beans, beans. With beans, you get your protein and your fiber. Potatoes, I mean everything. All these different foods are loaded with fiber and a lot of other nutrients. And so, they get you full, they don’t have a lot of calories, and it’s a great way to lose weight.

ZACH: Great. Now, weight loss drugs. They seem to be more popular now than ever.

DR. DAVIS: Yeah.

ZACH: How would that play into metabolism plateaus and, “Oh, I’ve been trying this and trying this. Like, I feel like this weight loss drug might be the thing that gets me over the top.” What are your thoughts on that?

DR. DAVIS: Yeah, so the weight loss drugs are gonna -- so we -- we’re talking about why people plateau, and part of that plateau I told you is this leptin level dropping and your brain signaling, “Oh, my God, we need to eat.” And the ghrelin hormone from the stomach saying, “Eat, eat, eat.” These medications block that. So, they’re working at that same part of the brain, and they’re blocking that signal that says, “Go and eat.” And so, these people are able to lose weight without having that rebound hunger. Without saying, “Okay, I gotta eat.” Now, I do see plateaus, it’s just, you know, you ask me when does it plateau. Well, it might be four weeks for someone just on a diet, but someone on a medication, it may be much longer than that. What is their plateau? It’s not necessarily that they’re hungry or eating more, now their plateau is actually a drop in metabolism. So, their body is slowing their metabolism, and now they’re eating a certain amount, which is much less than they used to eat, and their metabolism catches up with them. Unfortunately, we’ve seen these meds just given out like crazy, and people are giving to them. And without any, you know, dermatologists giving this out, plastic surgeons. And they’re not giving any kind of lifestyle training, information, no guidance at all. And what we’re seeing is a lot of people losing a lot of muscle mass. And with that muscle mass, comes a drop in metabolism. They’re not exercising. They’re eating less and their body is basically eating its own muscle, and that’s gonna slow metabolism. And so, we are seeing plateaus with the medicines. But the medicines are, you know -- no doubt that they’re extremely effective, as are the surgeries.

ZACH: If you maintain your exercise regimen, is that a way to counteract that muscle mass loss?

DR. DAVIS: It’s a great way and a lot of my patients do a fantastic job with maximizing their weight loss on these medicines. Not just maximizing their weight loss on these medicines, but being able to actually come off the medicines because the problem with the medicines are once you’re on ‘em, you basically gotta be on ‘em for life. At least that’s what the data shows. So, as people stop the medications, they start to regain the weight. But we’ve had quite a few people that have gone through our program where we’ve actually taught them to eat differently, we’ve taught them to exercise differently, and they’ve been able to wean off the medicine. But for other people, they’re taking the medicine, they’re just eating, you know, maybe they were eating a cheeseburger before, now they’re eating half a cheeseburger. So, as soon as the meds go away and they’re hungry again and they go back to a cheeseburger, they’re just gonna -- you know, you do what you always done, you get what you always got. So, our big focus with our patients is to use the medicines as a tool, but to really work on lifestyle and behavior, and if that’s the case, often times you can wean from the medication.

ZACH: Great. So, any final thoughts to leave the listeners with today about the weight loss plateauing?

DR. DAVIS: I mean, look. Don’t go to social media for information, you know? Don’t -- you know, some 20-year-old gym rat on Instagram is not where you should get your scientific information. Also, don’t take medications without a program, without guidance. These medications are supposed to be done with a program, not by themselves. And be cognizant of the fact that if you do what you always done, you get what you always got. There has to be a real change. And if you do what Americans have always done, you get what Americans always got, so you have to look outside the box. You’re not gonna lose weight eating eggs and bacon for breakfast and, you know, a deli meat sandwich, and your steak for dinner. You’re not gonna lose weight if you sit at your desk all day and you don’t exercise. There are changes that have to be made. But also understand that struggling with weight is not a willpower issue. It doesn’t mean you’re weak, it doesn’t mean that you’re a failure. It just means that you need to get some help with some genetic issues that we could help you address.

ZACH: Great. Well, that was some great knowledge and wisdom. Thanks for sharing those with us today, Dr. Davis.

DR. DAVIS: No problem. Great talking with you.

[Sound effect plays to signal end of the interview]

ZACH: Alright, well that was a great conversation with Dr. Davis. I gotta say, I was a little surprised by a lot of his feedback to some of my questions. I mean, he was like, “No, no, no. That’s wrong.” This is probably -- fascinating stuff though. Insightful.

KATIE: Yeah, absolutely and it’s kind of as we expected, a lot of what we kind of hear on the internet is probably just too simplified. I will say, it was really cool to hear him talk about, even aside from, sort of, the plateau part of it all, just the very, like, intricate concepts around weight generally and the way he talks about it. And one thing that really stuck out to me that he said that I think a lot of our listeners, myself included, probably can like, sit with, and take away, and think about is that having a challenge with weight loss is not a willpower issue. I think we need to get over that. A lot of it can be your genetics. We’re surrounded by delicious food all the time. There’s tons of stuff out there to light our brains up, kind of, as he said, whereas back in the day, there wasn’t anything interesting to eat, you ate to survive. Now --

ZACH: Going on the farm, you’re growing carrots. I mean, what else do you need, right?

KATIE: Now, we’re thinking about our next meal all the time. So, you know, when you -- that alone was, I think, something I, like, took -- I stepped away and just, kind of, like, giving myself a pat on the back and being like -- Hey, when you make those, like, bad food choices, like, don’t beat yourself up about it. It’s gonna happen. But I don’t know, Zach. What about you? There are so many good parts to this episode, I don’t even know where to start. What was your favorite part?

ZACH: Yeah, no. I talked to Dr. Davis before about weight loss medication. So, we, kinda, followed up on a little bit of that and he pretty much has the same attitude now as he did then. And look, it’s a newer thing, it’s an evolving thing. We don’t have the data, we don’t have the studies to know, you know, the long-term results of that. Intermittent fasting is another -- I mean, I hesitate to call it a fad, but it’s popular right now.

KATIE: It’s definitely a fad, I would say.

ZACH: It’s a go-to thing, and then we mentioned that, and he was like, “Oh yeah, well.” He was very skeptical of that as well. You know, I’d done, you know, a little research before talking to him, and I presented him with some of these facts, and he was like, “No, that’s wrong.”

[Laughing]

I love that, though. I love that.

KATIE: Yeah. I loved -- I really enjoyed the part of y’all’s conversation where you talked about food tracking…

ZACH: Mm-hhm.

KATIE: ‘Cause I think that’s the one that I’ve, kind of, always got tripped up on. For instance, I’m getting older, I’m kinda starting to gain weight easier than I used to. Nothing really substantial has changed, but I’m putting on weight. So, I was like, “Hey, maybe I should track my food again.” And all that did was confirm to me that I’m not really eating more than I used to. So, it’s like that’s not the piece of my quote unquote “weight loss plateau” that’s gonna help me get over this. And to his point, I think he said something like 75% of what we track is off, just off.

ZACH: As someone who has and hasn’t, over the years tracked calories, he said 50-75% to be fair.

KATIE: Well, okay half, at least, of what we’re putting in there is, like, not even the correct numbers.

ZACH: Right.

KATIE: He also said that we overestimate how many calories we burn while exercising.

ZACH: Well that’s -- I’m sure that should truth, yeah.

KATIE: Put the two together and probably one of the biggest problems is we go to these simple, easy ways, you know, quote unquote, “simple, easy ways” to lose weight. And it’s like, “I’m gonna track my calories and I’m gonna see how many calories I burn. So, calories in, calories out, I should be losing weight.” But okay, you’re not really tracking properly, you’re probably overestimating how many calories you burn. The actual simple thing is like what he said, fiber.

ZACH: Yeah. It comes to just becoming more knowledgeable about it. Like, he says, like, I don’t track my calories anymore. I know salads, potatoes, I can eat as much of X or Y as I want. I do think there is value in the calorie tracking to, kinda, get started and, kinda, start wrapping your mind around it.

KATIE: Yes.

ZACH: ‘Cause to me, like, when you start looking at how much some of these meals are, you’re like, “Oh, my goodness. Like, if I ate one of these, you know, fast-food meals, then I can’t eat the rest of the day. And that’s supposed to be -- quote, unquote, “supposed to be” one third of what you eat that day. It just -- that, kind of, really puts things in perspective for you, as well as, you know, when you’re first starting to get into exercising, how much are you burning? Okay, that gives you, kind of, a ballpark. Because I feel like, you know, when you’re jumping into these apps that help you out, you need the help. That’s why you’re doing it, right? So, I think at that stage, I think it is very helpful. But you’re right, over time, like, you cannot live and swear by the calorie tracker.

KATIE: Yeah. And I think -- I have an example today. I was like just -- I went to the grocery store this morning, and got, like, a tub of queso ‘cause we’re having some friends come over. And I looked at the serving size -- I can’t eat cheese, but I was just like, man, you know, I miss it and I’m just looking at it. And I’m like -- two tablespoons is the serving size.

ZACH: That’s crazy.

KATIE: Find me a person who only eats two tablespoons of queso. And that’s, kinda, gets back to where the calories in that serving size mean nothing anymore, right? Like, you probably use a tablespoon per chip you dip it into. So, like --

ZACH: Even the bags of chips or cookies, it’s like -- to me, logic would dictate this is one serving size. No, it’s like, what? A third of this? Like, I’m supposed to eat one third of this bag of chips and then put it away? This is a mini bag of chips we’re talking, not the giant bag of chips.

KATIE: I was gonna say the mini bags is where it really gets me ‘cause like, feasibly, I could get myself just to take a small amount of something. But then when it comes like a queso or a dip and you can only have two table -- or he - a great example, he talked about the cooking sprays…

ZACH: Yes.

KATIE: And how it’s zero calories, but for a quarter second. Like, what’s that? How long is that?

ZACH: Are you timing that?

KATIE: Yeah, like. There it was or that was too long. I don’t know. Like, this gets back to this thing of that is to me where the tracking apps kind of just go haywire. It’s like I don’t know how much three ounces of chicken is.

ZACH: How much sauce is on this fish, or whatever, right? But some of my favorite conversations we have on this podcast is when our experts, kinda, challenge a lot of our…

KATIE: Yes.

ZACH: You know, understandings of things. And this is one of my favorite conversations we’ve had.

KATIE: Yeah. I also really like that you guys talked about water weight.

ZACH: Yes.

KATIE: And he brought up the keto diet, and I didn’t really know this but it was interesting -- I’m not surprised to hear it that with the keto diet, like, a lot of what you’re losing is water ‘cause you’re not eating as many carbs and, you know, processing carbs takes water. So, you’re just losing this water weight. And then you’re also losing muscle which is arguably worse potentially. So like, the two -- you’re losing weight, yes. You’re not losing fat. You’re losing two things that you need, water and muscle.

ZACH: And you know, he went back to something we’ve talked to many other experts about on this podcast. Our bodies, we are still programed to be the hunter gatherers we were thousands of years ago.

KATIE: Yeah, he --

ZACH: As opposed to this sedentary lifestyle we have now, sitting at screens and…

KATIE: Yeah. He described it as our brains still live in a time of feast and famine.

ZACH: Yeah.

KATIE: And we just live in a time of 24/7 feast. So, like, yeah, it’s -- again, this is where -- I think one thing that I really took away is the willpower aspect. What I loved about this was he challenged some of the -- you know, the questions you came with that are based on nothing. He gave us very factual information of what to actually do and just reminded us that some of this is out of our control, so we have to take control where we can and then realize that some parts of it are just really hard given where we are today.

ZACH: Absolutely. Well, that’s gonna do it for this episode of On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop new episodes Tuesday mornings, so until next time, stay tuned and stay healthy.