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How Korean Medicine Addresses a Diet Plateau

Reviewed by: 자임당
How Korean Medicine Addresses a Diet Plateau

It's been the same number for three weeks. I'm sticking to my diet and haven't missed any workouts. For the first month, I saw noticeable weekly drops, but now it's just fluctuating by 0.2 kg each morning. The word "plateau" appears in the search bar, with advice below it to starve myself more or double my exercise.

What often goes wrong first in a plateau is not the response method, but the judgment. If you don't distinguish whether the current halt is due to body fat, body water, or a discrepancy between recorded and actual intake, you won't be able to interpret the results of any changes you make.

A scale and folded towel by a morning window
A scale and folded towel by a morning window

A Stalled Scale and a Stalled Body Are Different

Body weight fluctuates even within a single day. The water you drink, undigested food and stool, and the amount of salt and carbohydrates consumed the previous day all reflect in the number. Weight gain the day after increasing carbohydrate intake is due to glycogen stored in muscles and the liver retaining water, and this change is not directly related to body fat.

For women, cyclical fluctuations are added to this. A study on weight and body composition changes during the menstrual cycle published in the *American Journal of Human Biology* in 2023 measured 42 women twice a week throughout their cycle. Menstrual weight was, on average, 0.450 kg higher than in the first week of the cycle, and this difference was explained by an increase of 0.474 kg in extracellular fluid. There were no significant changes in other body composition indicators, including body fat. A fluctuation of around 0.5 kg is large enough to completely obscure two weeks' worth of weight loss.

Muscle mass also blurs the numbers. When starting new strength training, lean body mass may be maintained or increase while body fat decreases, creating a period where body weight remains the same but body composition changes. If measurement conditions are not fixed, the judgment of a plateau itself is invalid. The basic approach is to use the same scale, immediately after waking up and urinating in the morning, before meals, in the same attire, and to compare 7-day averages instead of daily numbers.

A True Plateau Is Judged in Weeks

There is no agreed-upon diagnostic criterion for a plateau. Instead, benchmark figures are found in clinical guidelines. The 「비만 진료지침 2022」 (Obesity Treatment Guidelines 2022) from the Korean Society for the Study of Obesity suggests a recommended weight loss rate of 0.5-1.0 kg per week, with a primary goal of 5-10% of body weight within 6 months. 0.5 kg per week overlaps with the body water fluctuation range seen earlier. This is why it's difficult to call a halt of a few days a plateau.

The timing of plateaus has also been studied. A mathematical model study on dietary adherence and weight plateau published in the *American Journal of Clinical Nutrition* in 2014 starts from the discrepancy that weight loss generally stalls around 6 months in clinical practice, whereas validated energy metabolism models predict a plateau at 1-2 years.

Practically, the point for re-evaluation is when the 7-day average body weight, with fixed measurement conditions, does not significantly decrease for 3-4 weeks. Periods before that are more likely to be measurement noise rather than a plateau.

Nuts on a kitchen scale with a notebook for recording next to it
Nuts on a kitchen scale with a notebook for recording next to it

Recorded Meals and Actual Intake Often Differ

The aforementioned mathematical model study tested two explanations side-by-side: one was metabolic adaptation, and the other was intermittent dietary deviation. The metabolic adaptation model did increase final body weight, but it did not advance the timing of the plateau itself. In contrast, a model set to randomly fluctuate intake created a 6-month plateau even with fairly high adherence.

A classic report supporting this direction was published in the *New England Journal of Medicine* in 1992. Columbia University researchers precisely measured 10 out of 224 obese patients who complained of "not losing weight despite eating less than 1,200 kcal per day" for 14 days. Their total energy expenditure and resting metabolic rate were within 5% of the values predicted by their body composition. Instead, they reported actual intake as, on average, 47±16% less and physical activity as 51±75% more. This is closer to the limitations of memory and estimation than outright deception.

The second axis is activity level. In a 6-month randomized study published in *PLoS One* in 2009, the total energy expenditure of the 25% calorie restriction group decreased by 454 kcal per day at 3 months and 316 kcal at 6 months, and physical activity adjusted for sleep metabolic rate also significantly decreased at both time points. The decrease in total energy expenditure was not significant in the group that also exercised. This is not about consciously becoming lazy, but rather an increase in sitting time and a decrease in fidgeting. The mechanisms of metabolic and hormonal adaptation accompanying weight loss are summarized in [Hanbang Diet and Appetite Suppression](/en/journal/hanbang-diet-vs-appetite).

Change What You Can, in Order

Protein and strength training are reviewed first not to maintain weight, but to maintain body composition. In a randomized trial published in the *American Journal of Clinical Nutrition* in 2016, among 40 men who ate about 40% less than their requirements and exercised 6 days a week for 4 weeks, the group that consumed 2.4 g of protein per 1 kg of body weight saw an increase of 1.2±1.0 kg in lean body mass and a decrease of 4.8±1.6 kg in body fat, showing a difference from the 1.2 g group (0.1 kg and 3.5 kg, respectively). The exercise amount recommended by the guidelines is more than 150 minutes of aerobic exercise per week and 2-3 sessions of large muscle group strength training per week.

Sleep changes the outcome of the same calorie restriction. A crossover study published in the *Annals of Internal Medicine* in 2010 compared 10 overweight adults under calorie restriction for 14 days, dividing sleep opportunities into 8.5 hours and 5.5 hours. Under the reduced sleep condition, the proportion of fat in the lost weight decreased by 55% (1.4 kg → 0.6 kg), lean body mass loss increased by 60% (1.5 kg → 2.4 kg), and hunger also increased.

A diet break is a method of temporarily pausing restriction. The MATADOR study, published in the *International Journal of Obesity* in 2018, divided 51 obese men into a continuous restriction group for 16 weeks and an intermittent restriction group that alternated 2 weeks of restriction with 2 weeks of maintenance for a total of 30 weeks. During the restriction periods, intake for both groups was 67% of maintenance calories. Among participants who completed the protocol, weight loss was 14.1±5.6 kg for the intermittent group and 9.1±2.9 kg for the continuous group, and the reduction in resting energy expenditure, adjusted for body composition changes, was smaller in the intermittent group. However, this "maintenance" was a period of eating at maintenance calories, not eating freely, and the subjects were only men.

Dried herbs in glass jars on a wooden shelf
Dried herbs in glass jars on a wooden shelf

Korean Medicine Views the Same Person Differently at Different Times

The unit by which Korean Medicine addresses obesity is Byeonjeung (辨證, pattern identification). The explanation of pathogenesis by the Korean Society for the Study of Obesity presents a cycle where the transportation and transformation function becomes weak due to Giheo (氣虛, Qi deficiency), leading to Damsup (痰濕, phlegm-dampness), which in turn obstructs the circulation of Qi, exacerbating Giheo. A pathway where the transportation and transformation of the Biwi (脾胃, Spleen and Stomach) become imbalanced due to Bigamhoomi (肥甘厚味, rich, sweet, and heavy foods) is also presented.

The point where a plateau is discussed in Korean Medicine treatment lies in the fact that these patterns are not fixed. In the early stages of weight loss, patterns of Siljeung (實證, excess pattern) characterized by food stagnation or heat sensation are common, whereas after several months of reduced intake and increased activity, cases may lean towards easily getting tired, slow digestion, and swelling. Korean Medicine views such states as Biheo (脾虛, Spleen deficiency) or Giheo (氣虛, Qi deficiency) patterns, and believes that continuing a prescription tailored for an excess pattern in a deficient state would be misguided.

This is also the meaning of re-examination. It is a procedure to re-evaluate whether to maintain the initial prescription, change its composition, or address diet and sleep before medication. Jaimdang's Gongbihwan is also a Korean medicine prescribed by a Korean medical doctor, with its intake and continuation determined through diagnosis and prescription, and it is a proprietary prescription formulated according to the Gunsinjwasa (君臣佐使, Sovereign, Minister, Assistant, Envoy) principle.

It is also accurate to mention the limitations of the evidence. The 「비만 한의표준임상진료지침」 (Korean Medicine Standard Clinical Practice Guidelines for Obesity) published by the Korean Society for the Study of Obesity in 2024 applies the GRADE methodology to indicate the level of evidence for each recommendation. Assigning grades means that recommendations with lower grades are also included. It is not yet at a stage where individual prescriptions can be definitively asserted to resolve a plateau.

Tofu, vegetables, and a glass of water on a windowside table
Tofu, vegetables, and a glass of water on a windowside table

Four Things to Check Before Concluding It's a Plateau

  • Have you fixed your measurement conditions? — Use the same scale, immediately after waking up and urinating, before meals, and in the same attire. Compare 7-day averages, not daily numbers.
  • Has the stall lasted 3-4 weeks or more? — The guidelines suggest a weight loss rate of 0.5-1.0 kg per week. A halt of a few days or 1-2 weeks falls within the range of body water fluctuations.
  • Does it coincide with your menstrual cycle? — Extracellular fluid can increase, leading to menstrual weight being measured about 0.5 kg higher. You should compare measurements from the same point in your cycle.
  • Have you weighed and recorded 3 days' worth of meals? — Record immediately with a scale, not from memory. Include beverages, cooking oils, leftover side dishes, and weekends to get closer to your actual intake.

References

*This article was written to convey research and guideline information related to the interpretation of weight changes and does not guarantee the diagnosis or treatment efficacy of specific diseases, nor weight loss results. Korean herbal medicines, including Gongbihwan, are prescription medications whose intake is determined by a Korean medical doctor through diagnosis and prescription, and responses and progress may vary by individual. If you are taking any medications or have been diagnosed with a disease, please be sure to inform your practitioner during consultation.*

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