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

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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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Episode Transcript

Kelli (00:17):
Hey guys, welcome back to another episode of tattoos and
telehealth.
I'm Kelli White, my boardcertified family nurse
practitioner, and this is mygood friend and colleague,
nicole Baldwin, who is also aboard certified nurse
practitioner, and she is goingto chat with you guys about her
specialty, which is weight lossand overall wellness in that
area and nutrition and kind ofwhat that looks like.
We have had a lot of patientsactually that have had some

(00:41):
pretty good questions when itcomes to medications and how to
treat their weight loss journey,and so, nicole, can you like
touch base on what that'slooking like right now for
patients and what they do whenthey reach a peak, essentially,
in their treatment?

Nicole (00:56):
So patients have reached out now that GLPs have been out
for a while and they are atsome of them not all of them,
but some of them are at the maxdose and they're kind of like a
plateau.
Where do we go from here?
And that's you know.
That's a really good questionand I want to just back up when
you're prescribed thesemedications for those of you who
are just starting themedication or who are restarting

(01:17):
the medication or have nevertaken these medications, when or
if you get on GLP-1s the goalis weight loss and appetite
suppression.
The goal is not to climb thedose.
More is not better with this.
Number one for side effectsNumber one, that's a big one.
And number two when you get tothe top, there's nowhere to go,
and so it is important that youstay at the lowest effective

(01:39):
dose.
And so, even though we preachthis to our patients, stay at
the lowest effective dose.
Stay at the lowest effectivedose.
Save your money, save.
They still think more is betterand more is not better if you
need to go up Absolutely.
But now we have patients thatare at the top and they're like
I'm at a plateau, I don't knowwhat to do, and so you know
there certainly is differentthings.

(01:59):
Number one you can increaseyour cardiovascular activity.
That is super, super important.
When you're on GLP-1 therapyand you and you increase your
cardiovascular activity, yourmovement, that's like one plus
one is three.
I mean it is super, superhelpful.
And weight training too, right?

Kelli (02:15):
Yes.

Nicole (02:15):
Yes, weight training especially for, especially for
women and men.
As we age, women's bones justget fragile and so even low, low
weight training is superhelpful to keep our skeleton
strong, because keeping ourmuscles strong to support our
skeleton as our bones naturallybecome fragile is super, super
important.
So increasing your proteinintake, decreasing your the

(02:37):
amount of carbohydrates you'retaking in, is super helpful.
The other thing is you canalways go off of it for a little
while and then start back up atwhatever dose your provider
deems appropriate, which willprobably not be the 15
milligrams or 2.5 or whatever itis.
So it's a good idea to give, ifyou're not diabetic, to give
the body a break.
You can go down a dose rightFor a little while and just see

(02:58):
how you do.
But you know patients can gooff this, off this cold Turkey
and just try to maintain thehealthy lifestyle that you've
learned the decrease in amountportions.
You know you, your stomach hasshrunk, your energy has likely
increased, so stay active justlike you are.
Then if you need it, you canalways go back to it.
But once you climb that dose,there's not, there's not
anywhere else to go, so it'simportant.

(03:20):
You can switch in between GLPones as well.
That might be a helpful optionto you as well, Switching from
one GLP to the other, becausethey do have a little bit of
difference and then, althoughthey're still in the same class.
And so the first thing isincreasing your activity.
It's increasing your activity.
The other thing is possiblygoing down a dose.
The other thing is possiblygoing, going off of it for a

(03:41):
little while before restartingit.
So you know, just be diligentwith with what you're eating, be
diligent with trying to stay ontrack, and, um, You'll be.
I mean, you'll be back tolosing weight in no time,
especially as we get to our goalweight.
Our body really wants to keep ahold on those pounds, Really.
So most everybody who gets neartheir goal weight is going to

(04:02):
reach a plateau.
So, even though you didn't loseany weight, or maybe a minimum
weight for a month or two, andyou're still doing okay with
your appetite, stay the course,increase your hydration,
increase your protein, increaseyour cardiovascular activity and
chances are it'll pick rightback up.

Kelli (04:19):
I think it's important.
When you mentioned goal weight,I think it's important also to
remind folks because this was ahard one for me to digest
sometimes that sometimes my goalweight is not my body's goal
weight.
Your body knows what's healthyfor you.
Your body knows what's rightfor you and you may want to see
yourself a little thinner thanyour body realizes is healthy
for you and it may not want toget there.
Like Nicole said, it wants tohold onto that because it knows.

(04:40):
No, this is where I feel thebest and I want to stay here.
So sometimes setting arealistic goal is really
important in these settings.

Nicole (04:49):
It is certainly because if I was even though the BMI was
normal, if I was ever to get toand I don't want to, but if I
was ever to get to the weightthat I was 20 years ago, which
was the low end of normal, Iwould look sick, just because as
we age and have children, ourbody shape changes and so what

(05:12):
you were 10, 25 years ago maynot be what is going to be
healthy for you now.
So it really is a case by casebasis and it also is just how do
you look and how do you feel?
You know, the number on thescale doesn't necessarily define
you.
You know, it was hard for me to.
I mean, I've kind of gained andlost just over the course of I

(05:33):
mean, I'm mid 40s, right, we've,nobody ever stays there
perfectly, but sometimes it'slike I don't want to squeeze
into.
I want to try to squeeze into asmaller number on the shorts,
but when I think about it,nobody sees that number but me,
right?
Do I want to look like a poundof potatoes and a five pound and
a five pound sack?
So no.
So so you know, get the nextsize up or get whatever,

(05:55):
whatever fits you, and that maybe what's healthy for you.
You know, a size 10 lookshealthy on me, based on my
height.
You know I'm five 11.
I think you're five 11 too,aren't you?

Kelli (06:08):
count yeah.

Nicole (06:09):
Oh, five, eight, I thought you were.
I thought you were talleranyway.
Um, eight, I thought you were,I thought you were taller anyway
.
Um, so it, you know, based onmy height and my age, a size 10
looks.
I just.
I can't go down any lower, Iwould just look sick, even
though that was a healthy weightfor me back in the day.
So, um, yeah, so just, so, justyou know healthy goals.

(06:29):
Yeah, yeah, but your body willtry to hold onto the weight.
Your body knows.
But stay the course.
Increase your activity and ityou will.
You will definitely burn.
It'll definitely burn some moreso definitely that is a wrap
for today.
This is Theo.
This is Theo, and he's mysupervisor for today.

Kelli (06:46):
He's a rescue kitty Also.
We always love our comfortcritters.

Nicole (06:49):
Yeah, for sure, for sure , he's definitely comfortable.
So all right, guys, thanks forjoining 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 (07:06):
You can like and subscribe comment.
Follow us all the good things.
Okay, all right, guys, takecare, we'll see you next time.