Beyond the Maximum Dose: Navigating the Path When Weight Loss Medications Plateau

Struggling with a weight loss plateau despite being on maximum-dose GLP-1 medication? You're not alone. In this candid conversation, board-certified nurse practitioners Kelli White and Nicole Baldwin tackle one of the most common frustrations patients face on their weight management journey.

Many patients mistakenly believe that climbing to higher medication doses is the key to continued success. Nicole emphatically debunks this myth, explaining why "more is not better" and the importance of staying at the lowest effective dose. But what happens when you've reached the maximum dosage and the scale stops moving?

Nicole shares several powerful strategies to break through plateaus without increasing medication. The synergistic effect of cardiovascular exercise combined with GLP-1 therapy ("one plus one equals three") tops the list, alongside the crucial importance of weight training for maintaining bone health. Dietary adjustments, including increasing protein while decreasing carbohydrates, can reignite progress when weight loss stalls.

For those truly stuck, Nicole offers several medication strategies: temporarily reducing dosage, taking a complete break from medication, or switching between different GLP-1s. Each approach can help reset your body's response and restart your progress. Kelli adds an essential psychological perspective, reminding listeners that "sometimes my goal weight is not my body's goal weight." This powerful insight helps reframe plateaus as potentially healthy responses rather than failures.

The conversation concludes with a refreshing discussion about body acceptance through different life stages. What looked healthy on you twenty years ago may not be appropriate now, and clothing sizes don't define health or worth. This nuanced approach to weight management acknowledges both medical realities and psychological well-being.

Have questions about breaking through your own plateau? Reach out to us through our website at hamiltontelehealth.com or connect with us on social media. Your weight loss journey doesn't have to end at a plateau!

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Chapters

• 0:31 Welcome to Tattoos and Telehealth
• 1:09 GLP-1 Medication Plateaus Explained
• 2:24 Breaking Through Weight Loss Plateaus
• 4:51 Setting Realistic Body Goals
• 7:06 Episode Closing with Theo

Transcript

Kelli: 0:17

Hey guys, welcome back to another episode of tattoos and telehealth. I'm Kelli White, my board certified family nurse practitioner, and this is my good friend and colleague, nicole Baldwin, who is also a board certified nurse practitioner, and she is going to chat with you guys about her specialty, which is weight loss and overall wellness in that area and nutrition and kind of what that looks like. We have had a lot of patients actually that have had some pretty good questions when it comes to medications and how to treat their weight loss journey, and so, nicole, can you like touch base on what that's looking like right now for patients and what they do when they reach a peak, essentially, in their treatment?

Nicole: 0:56

So patients have reached out now that GLPs have been out for a while and they are at some of them not all of them, but some of them are at the max dose and they're kind of like a plateau. Where do we go from here? And that's you know. That's a really good question and I want to just back up when you're prescribed these medications for those of you who are just starting the medication or who are restarting the medication or have never taken these medications, when or if you get on GLP-1s the goal is weight loss and appetite suppression.

Nicole: 1:26

The goal is not to climb the dose. More is not better with this. Number one for side effects Number one, that's a big one. And number two when you get to the top, there's nowhere to go, and so it is important that you stay at the lowest effective dose. And so, even though we preach this to our patients, stay at the lowest effective dose. Stay at the lowest effective dose. Save your money, save. They still think more is better and more is not better if you need to go up Absolutely. But now we have patients that are at the top and they're like I'm at a plateau, I don't know what to do, and so you know there certainly is different things. Number one you can increase your cardiovascular activity. That is super, super important. When you're on GLP-1 therapy and you and you increase your cardiovascular activity, your movement, that's like one plus one is three. I mean it is super, super helpful. And weight training too, right?

Kelli: 2:15

Yes.

Nicole: 2:15

Yes, weight training especially for, especially for women and men. As we age, women's bones just get fragile and so even low, low weight training is super helpful to keep our skeleton strong, because keeping our muscles strong to support our skeleton as our bones naturally become fragile is super, super important. So increasing your protein intake, decreasing your the amount of carbohydrates you're taking in, is super helpful.

Nicole: 2:40

The other thing is you can always go off of it for a little while and then start back up at whatever dose your provider deems appropriate, which will probably not be the 15 milligrams or 2.5 or whatever it is. So it's a good idea to give, if you're not diabetic, to give the body a break. You can go down a dose right For a little while and just see how you do. But you know patients can go off this, off this cold Turkey and just try to maintain the healthy lifestyle that you've learned the decrease in amount portions. You know you, your stomach has shrunk, your energy has likely increased, so stay active just like you are. Then if you need it, you can always go back to it. But once you climb that dose, there's not, there's not anywhere else to go, so it's important.

Nicole: 3:20

You can switch in between GLP ones as well. That might be a helpful option to you as well, Switching from one GLP to the other, because they do have a little bit of difference and then, although they're still in the same class. And so the first thing is increasing your activity. It's increasing your activity. The other thing is possibly going down a dose. The other thing is possibly going, going off of it for a little while before restarting it. So you know, just be diligent with with what you're eating, be diligent with trying to stay on track, and, um, You'll be. I mean, you'll be back to losing weight in no time, especially as we get to our goal weight. Our body really wants to keep a hold on those pounds, Really. So most everybody who gets near their goal weight is going to reach a plateau. So, even though you didn't lose any weight, or maybe a minimum weight for a month or two, and you're still doing okay with your appetite, stay the course, increase your hydration, increase your protein, increase your cardiovascular activity and chances are it'll pick right back up.

Kelli: 4:19

I think it's important. When you mentioned goal weight, I think it's important also to remind folks because this was a hard one for me to digest sometimes that sometimes my goal weight is not my body's goal weight. Your body knows what's healthy for you. Your body knows what's right for you and you may want to see yourself a little thinner than your body realizes is healthy for you and it may not want to get there. Like Nicole said, it wants to hold onto that because it knows. No, this is where I feel the best and I want to stay here. So sometimes setting a realistic goal is really important in these settings.

Nicole: 4:49

It is certainly because if I was even though the BMI was normal, if I was ever to get to and I don't want to, but if I was ever to get to the weight that I was 20 years ago, which was the low end of normal, I would look sick, just because as we age and have children, our body shape changes and so what you were 10, 25 years ago may not be what is going to be healthy for you now. So it really is a case by case basis and it also is just how do you look and how do you feel? You know, the number on the scale doesn't necessarily define you. You know, it was hard for me to. I mean, I've kind of gained and lost just over the course of I mean, I'm mid 40s, right, we've, nobody ever stays there perfectly, but sometimes it's like I don't want to squeeze into.

Nicole: 5:41

I want to try to squeeze into a smaller number on the shorts, but when I think about it, nobody sees that number but me, right? Do I want to look like a pound of potatoes and a five pound and a five pound sack? So no. So so you know, get the next size up or get whatever, whatever fits you, and that may be what's healthy for you. You know, a size 10 looks healthy on me, based on my height. You know I'm five 11. I think you're five 11 too, aren't you?

Kelli: 6:08

count yeah.

Nicole: 6:09

Oh, five, eight, I thought you were. I thought you were taller anyway. Um, eight, I thought you were, I thought you were taller anyway. Um, so it, you know, based on my height and my age, a size 10 looks. I just. I can't go down any lower, I would just look sick, even though that was a healthy weight for me back in the day. So, um, yeah, so just, so, just you know healthy goals.

Nicole: 6:29

Yeah, yeah, but your body will try to hold onto the weight. Your body knows. But stay the course. Increase your activity and it you will. You will definitely burn. It'll definitely burn some more so definitely that is a wrap for today. This is Theo. This is Theo, and he's my supervisor for today.

Kelli: 6:46

He's a rescue kitty Also. We always love our comfort critters.

Nicole: 6:49

Yeah, for sure, for sure, he's definitely comfortable. So all right, guys, thanks for joining us today and we hope you have a wonderful week. If you have any questions, please send us a message. You can email us. You can go to our website, hamiltontelehealthcom.

Kelli: 7:06

You can like and subscribe comment. Follow us all the good things. Okay, all right, guys, take care, we'll see you next time.