To cut calories or take a diet break/refeed when stalled?

Here's a Q&A I ran on my blog a while back that I figured was worth sharing.

Question:

When you have someone who is stalled out, at what point do you look at hormones/leptin as opposed to calorie reduction? Perhaps a better way to phrase it would be: Under which circumstances would you assume that reduction in calories is the wrong answer, and temporary increase in cals (refeed/etc) would be a better solution?

Answer:

This is only speculation, but I'm of the opinion that the VAST majority of plateaus are stemming from people eating too much. I mean there's definitely research out there that supports this, but even without it, my experience dictates this being the case far more often than not. Especially with these smaller women... their calorie allotments are so damn tiny that the smallest of inaccuracies can unknowingly put them at maintenance.

That being said, I'll typically look at a few things when someone messages me about a plateau:

1. How long have they been plateaued? I mean, if they've been stalled for a couple of weeks I tell them to come back in two more weeks. Short term fluctuations mean nothing to me. Fat loss is not a linear process since metabolism and energy expenditure are in constant flux. And weight loss is even more volatile since we're working with so many moving parts when it comes to weight.... fat mass, muscle mass, connective tissue mass, bowel matter, water/hydration, etc. That last one is a huge one!

2. What is their calorie intake in relation to what their maintenance should be? In some regards, the size of the deficit doesn't really matter. People freak out about large deficits, but some people do exceedingly well on them. The "starvation response" is primarily associated with fat mass. Less fat means a dulling of the "fed signal" to the brain, which enacts a host of chemical and hormonal changes that slow things down. But the thing is, generally speaking, large and small deficits lead to the same place. The former simply gets there faster. But any diet is going to invoke the starvation response - it's just that some will do so more gradually while others will do so fast.

But the gradual approach will be accompanied by a slower rate of weight loss while the faster approach will be accompanied by a faster rate of weight loss. All roads lead to Rome... it's just a matter of how quickly you want to get there. Not to mention that mileage will vary from person to person based primarily on genetics and psychology.

Now something to consider is the overall level of stress being placed on the person. A calorie deficit, in itself, is a stress. So the larger the deficit, the larger the stress. And we have a finite capacity to manage a given dose of stress. Some people have better stress management systems than others. But when the system is overridden, wonky things can happen irrespective of the starvation mode. So a big deficit can work for some, but other forms of stress will have to be kept in check.

Today's neurotic fitness enthusiast seems to think that it's okay to do high intensity cardio most days of the week, lift heavy weights a few times per week, eat next to nothing, have a hectic job and social/family life, sleep for lengths of time that resemble a nap, etc and these things typically add up to a poop storm that leaves people wondering why they're feeling like a big pile of steamy turd and not making progress.

So that's a major consideration I'll take into account - the size of the calorie deficit paired with the overall dose of stress. If it turns out they're destroying themselves though, I'm not going to suggest a refeed. Instead I'm going to suggest they chill the hell out, take a break, and regroup. Help them frame a sensible approach and outlook for their next attempt.

3. What's the highest their weight has ever been? It has been repeatedly shown that significant fat loss can depress metabolic rate and energy expenditure for what some are deeming forever. So if they've lost significant weight in the past, I'm not going to tell them to refeed to fix their metabolism or whatever.... instead I'm going to have them assume a maintenance intake that's lower than any calculator is going to predict for them to account for the adaptation stemming from the loss.

How much lower of a maintenance? I don't know. I'll shave 10% off of where the maintenance should be based on their size, age, activity, etc and keep adjusting until I find it. Then I'll base the deficit on this more legit maintenance assumption, which will typically lead to a calorie intake/deficit that's lower than they would have used had they relied the typical calculators. And this usually "fixes" the "plateau."

4. Are they using a food scale? I hate the chronic use of food scales, personally. It's too infringing, restrictive, etc. Some love it, but it's not me. That said, anytime there's a supposed plateau, I'll collect all of the aforementioned information and in addition, I'll make sure they're using a food scale. Because if they're not or if they haven't, I'd put my money on the fact that they're eating more than they believe they are before I bet on them needing a refeed/break or whatever.

5. I can tyipcally get a pretty good read on someone regarding how strict they are with their calorie intake. If I'm sensing that they really have been going about things sensibly and consistently without any progress for an extended period of time, I might have them take their average waking temperature. A low reading can be indicative of something going on with thyroid or something along those lines. It's not the greatest of tests... but it's a start. Obviously their best bet would be to find a quality endo who can run some blood work.

After that stuff is assessed, then and only then MIGHT I suggest some sort of refeed, cylical diet approach, or a diet break. Refeeds haven't really been shown to have any lasting/meaningful physiological impact on metabolic rate. It might, depending on the overall diet and training structure, influence partitioning, but in the grand scheme I doubt it's anything major (though I will admit I tend to favor cyclical approaches). So more often than not, a full diet break is in order where calories are systematically brought back up to supposed maintenance and parked there for a couple of weeks to help with recovery. During this time, I'll often recommend to my clients to take some "me time." If you have vacation days left... use a few. Get a massage. Eat some goodies. Read a book. Take long bathes instead of showers. Just relax. It's not a guaranteed fix, but you have to try something, right? And the alternative is to keep pounding their bodies in attempt to force progress and even if that works, how sustainable is it going to be?