Weight Loss Plateau: Reasons, Challenges, and Solutions: A Narrative Review

Weight loss plateau (WLP) is one of the most significant obstacles for individuals with overweight and obesity during weight loss (WL). Preventing WLP is essential for maintaining long-term WL and minimizing the risk of weight regain. Despite the widespread challenge of combating obesity and barriers to WL, this area has received limited attention in research. Therefore, the present narrative review discusses the reasons, challenges, and management of WLP, which often occurs alongside diet-induced WL.

A comprehensive literature search was conducted using search strategies and keywords to identify studies published until January 2025 in several databases. Data were synthesized using a narrative review approach. Given the descriptive and exploratory nature of this review, no formal methodological quality or risk of bias assessment was performed for the included studies.

WLP typically emerges approximately 6-8 months into WL programs, although this timeline may vary among individuals. In addition to individual differences related to WLP, even with adherence to dietary and lifestyle modifications, WLP can occur primarily due to metabolic adaptations. These adaptations occur because a reduction in dietary intake decreases all components of total energy expenditure (TEE). Furthermore, calorie restriction can increase appetite and hunger. Reductions in TEE, combined with increased appetite, contribute to the development of an energy gap. Factors such as initial WL, previous WL experiences, a tendency toward passive overconsumption of calories, behavioral changes and genetic factors can contribute to an earlier WLP. Although all components of TEE decrease during WL, the most significant reduction is often observed in non-exercise activity thermogenesis (NEAT).

Several strategies may help address metabolic adaptation and prevent and manage WLP. These include caloric reduction, high-protein diets, gradual WL, planned overfeeding, increased physical activity, maintenance of reduced body weight, body recomposition, nonlinear dieting approaches, and appetite-regulating dietary plans.