#12 Ending Stalls and Regain

Welcome

Imagine this scenario: you decide to tackle your type 2 diabetes by losing weight. You cut calories and start exercising. In the first few weeks/months, the pounds steadily come off and your blood sugar starts to improve. But then the progress stalls - your weight loss plateaus, even though you're still dieting. You feel cold, tired and hungry. Then the scale stops moving completely, and you see a few higher days creep back in. Frustrated, you might wonder: "What am I doing wrong?"

The answer often lies in a powerful but invisible adaptation: a falling metabolic rate. When we lose weight, our bodies burn fewer calories - sometimes far fewer than expected - as a survival response. This metabolic slowdown can become a stubborn obstacle on the road to diabetes reversal.

Worse, you might create a long-lasting reduction in your metabolism that makes it extremely hard to avoid regain. That’s a real thing and it’s worth dodging!

This issue covers how to avoid that trap and see better and more consistent results.

Well, no more stalling!

Why Metabolism Matters for Diabetes Reversal

Metabolic rate is the rate at which your body burns calories to keep you alive and active. For most people, this includes the basal metabolic rate (BMR) (the energy your organs use at rest) plus the calories burned through daily activities and exercise. When metabolic rate drops, it means you need fewer calories per day. That might sound efficient, but if you're trying to lose weight or maintain weight loss, a “slower” metabolism makes fat-loss harder and weight regain more likely. This is especially relevant for type-2 diabetes because diabetes can return as the weight comes back - or just not go fully into remission if your fat-loss efforts are frustrated.

Research from the landmark DiRECT trial in the UK illustrated this challenge. In that study, people with type 2 diabetes went on a very-low-calorie diet and lost an average of around 15 kg. And, of those who reached or exceeded the 15 kg milestone, over 85% put their diabetes into remission. But by the two-year mark, many had regained some weight, and the remission rate for the whole study fell from 46% at one year to 36% at two years (Lean et al., Lancet, 2018). One reason for this relapse is that the body’s energy needs drop after weight loss. Essentially, your “calories out” shrink, so the same food intake that once caused weight loss can now just maintain or even cause regain. In short, falling metabolism is a hidden force that can undermine diabetes reversal if not addressed.

Aging and metabolism: It’s worth noting that metabolism naturally changes over the lifespan. Interestingly, a 2021 study in Science found that our metabolism stays remarkably stable from our 20s until about age 60 - contrary to the popular belief that it slows in midlife. Only after age 60 does it decline by roughly 0.7% per year (Pontzer et al., Science, 2021). By our 90s, people burn about 26% fewer calories per day than someone in midlife. Lost muscle mass as we get older is partly to blame, but it’s not the whole picture: even when controlling for muscle, cells were expending less energy in older age. This age-related metabolic drop can make weight loss a bit more challenging for older adults. But the more immediate drop in metabolic rate happens whenever we lose a significant amount of weight, at any age. That diet-induced drop is the key issue in a weight-loss-based diabetes reversal strategy, and it can happen faster than you might expect.

Why Does Metabolic Rate Fall When You Lose Weight?

When you intentionally lose weight, your body undergoes a series of adaptations - some logical, some not so much - that lower your energy expenditure:

• Smaller Body, Fewer Calories: The most straightforward reason is simply that a lighter body needs less energy. If you go from 200 to 180 pounds, you carry less mass around. Your heart, muscles, and even your lungs have slightly less work to do each day. In fact, every pound of weight loss means your body burns about 7 fewer calories per day at rest (Doucet & Schwartz, Obes Rev, 2010). That may sound small, but losing 20–30 lbs could reduce your resting metabolism by roughly 100–200 calories per day just due to size.

• Metabolic Adaptation (Adaptive Thermogenesis): Beyond the change in body size, the body also makes active adjustments to conserve energy. After weight loss, many people’s metabolism becomes more efficient than predicted. This phenomenon is called adaptive thermogenesis - essentially, your body burns fewer calories than it “should” for your new weight. From an evolutionary perspective, this makes sense: if you’ve lost weight (especially rapidly), your body assumes food is scarce and tries to save energy. Studies have measured this effect and we’ll see how bad it is in the next section.

• Hormonal Changes - “Starvation Signals”: Weight loss, especially if achieved through calorie restriction, alters key hormones that regulate hunger and metabolism. One major player is leptin, a hormone produced by fat cells that signals fullness to the brain. When you lose a lot of fat, leptin levels plummet. The brain perceives this as a starvation signal. Research shows that a 10% body weight reduction causes a dramatic drop in leptin, which in turn increases appetite and may reduce energy expenditure. In one experiment, giving leptin injections to individuals who had lost weight reversed some of the intense hunger and metabolic slowdown - highlighting leptin’s role in the body’s fight to regain weight. Other hormones shift as well: the thyroid hormones T3 and T4 (which help set your metabolic rate) decline with calorie restriction, and the hunger hormone ghrelin often rises when weight drops. The net effect is a body biochemically primed to eat more and burn less after weight loss.

• Less Everyday Movement (Often Unconscious): When you’re in a calorie deficit, people often experience fatigue or a subtle drop in spontaneous activity. You might not fidget as much, or you choose the elevator over the stairs. This is known as a reduction in non-exercise activity thermogenesis (NEAT). In fact, studies suggest that a significant part of the calorie-burning decline during weight loss comes from reduced activity. One study found that after a period of calorie cutting, of the drop in people’s total daily energy about 58% of that drop was due to people moving less, not just a slower resting metabolism (Redman et al., PLoS ONE, 2009). It appears the body instinctively seeks to conserve energy by dialling down both the metabolic furnace and our activity level. This is often an unconscious effect – you might feel a bit more lethargic without realising it. The result, however, is a double whammy: fewer calories burned at rest and fewer calories burned through activity.

• “Thrifty” Muscle Fibres: There’s also evidence that when you lose weight, your muscle cells actually become more efficient, burning less energy for the same work. Your muscles might use slightly less fuel to perform the same exercise after you’ve been dieting, compared to before. This improved efficiency is great if you’re a shipwrecked sailor on a raft trying to survive, but not so great when you’re intentionally trying to expend calories.

All of these mechanisms explain why people often hit a weight loss plateau. It’s not that your diet “stopped working” per se; it’s that your body found a new equilibrium. Your calorie needs dropped, and now your intake is no longer low enough to continue weight loss. For someone trying to reverse diabetes, this plateau can be discouraging. But understanding that it’s a normal physiological response – not a personal failure – is important. It’s your body’s built-in survival programming.