plateau from the git-go

Question
Hello- I am a 35 year old female who had a baby after 30 and now am unable to lose the 20 pounds I need to lose.  I am eating 1200 calories per day, exercising 3 times per week (cardio), and strength training 3 times a week on opposite days from the cardio.  I am 5 feet 6 inches tall with a medium frame and weigh 148 pounds.  I am wanting to lose down to 130.  I only eat complex carbohydrates, lots of fish (we only eat red meat probably once or twice a month, and chicken the same), lots of green vegetables, and fruit. We rarely eat out (less than monthly) and do not buy any processed, canned, frozen dinners, or boxed food. I cannot seem to get in the dairy I need, so I am not getting enough calcium, but I am hitting my RDA of fiber every day.  I have been dieting now for a month, and am tracking every food I eat and every calorie.  I measure all of my food and drink 10 8 ounce glasses of water per day.  In the past, when I wanted to lose a few pounds, they would fall off in a matter of a couple of weeks. This time, I initially lost 4 pounds and then immediately gained back two (I started at 150).  I am (barely) within my weight range for my height and have a BMI of 23.2.  I know I am not overweight, but I am also not at my best health and weight wise.  Any suggestions for when you experience a plateau at the start!?  Thank you.

Answer
Challenging question, Christy.  It sounds like you are very motivated and are working hard at this.

It is difficult to say why someone would not lose more pounds with the regimen you describe.  We think there are times when a person's metabolism drops to a "burn rate" or caloric usage that is quite low, well under 1200 kcal, in rare circumstances.  An office calorimetry test can help ascertain if this is going on, though it is unlikely in your case.  Other explanations are that there are some hidden calories sneaking in, though your meticulousness seems to argue against that being the case.  But it is worth looking through everything to be certain you have not missed something.  (I once had a patient who eventually reported that he was eating cashews every day - pretty high in calories - from a jar at work.)

What I would recommend is that you consider lowering your caloric intake to 1000 kcal per day.  When we work on induction diet plans, we generally begin a meal replacement program with diets that bring the calorie count well below this level, but at 1000 kcal daily, you should be able to create an even greater calorie deficit than you are currently, and that should lead to greater weight loss.  I would recommend you be certain to have a breakfast, preferably a protein shake or bar, keep taking a multivitamin daily, and continue your exercise and water consumption.

And then hang in there; it may take time, but you will succeed with determination and perseverance.

Good luck and let me know how it goes in four weeks.

Kent C. Sasse, M.D., MPH, FACS, FACRS
Medical Director,
International Metabolic Institute
www.iMetabolic.com

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