Hands up if this is you right now, or if it's happened to you. You're three weeks out from surgery, you're eating less than you ever have in your whole life, and the scales just stop moving.
You weigh yourself again after a wee, then again after your morning "coffee", and nada. Next day, same thing. What the actual?
This is so common it has a name, the three week stall. Here's what's going on and what helps.
The kilo-a-day bliss can't last forever
For most of us, the weight loss starts before surgery. Here in New Zealand the pre-op diet tends to run for somewhere between two and six weeks, and it's common to drop a bunch of weight in the first couple of weeks alone. Then comes surgery and the liquids stage, and the number keeps dropping.
I remember waking up giddy in those early weeks after my own gastric sleeve in 2019. I'd step on the scales, update my weight loss app and delight in that steady line heading down towards my dream weight. The dopamine rush of watching the number drop is real, but the sheer bliss of losing a kilo every day can't last forever.
Then one morning when I hadn't lost a whole kilo overnight, the disappointment was crushing. CRUSHING. It was confusing too. Was it that Vita-Weat cracker from yesterday? Surely nightmare-eating an entire packet of Tim Tams couldn't affect the scales?
If your brain goes where mine always does ("of course it isn't working for me, there's something wrong with me, I'm not good enough"), stop. Changing those self-sabotaging thoughts is part of the weight loss process too, and that's a whole other blog.
What is the three week stall?
Three week stall is the name for the pause that often turns up a few weeks after surgery, when the fast early weight loss slows right down or stops for a bit. It can happen whether you had a sleeve, bypass, mini bypass or duodenal switch, and even when you're doing everything your bariatric team recommended.
Why the scales stop moving after weight loss surgery
Nobody can see exactly what's going on inside your body, but there are a few likely explanations, and they often overlap.
Early weight loss includes water as well as fat. Your body stores carbohydrates as glycogen in your muscles and liver, and each gram of glycogen holds around three grams of water. The pre-op diet and the liquids stage use up a lot of those stores, and the water attached to them goes too. That's a big part of why the number drops so fast at the start, and why it can't keep dropping at that speed.
When you move on to puree and soft food, your body gets a bit more fuel and may start topping those stores back up, which brings some water back with them. Fat loss can carry on underneath, but the scales don't show it yet.
And you're still healing. You're sore and inflamed, you were pumped full of IV fluids in hospital, and your body is running a repair job on very little food. Holding on to fluid can be part of that repair, and it's temporary.
Did you know? Most of the fat you lose actually leaves your body when you breathe out, as carbon dioxide. The rest turns into water, which leaves in your wee, sweat and tears, so a little bit of your fat really does go down the loo.
The graph worth saving
There's a graph that has done the rounds in the bariatric world for years, and we've drawn our own version. Save it, screenshot it, or send it to the friend who is three weeks out and panicking.
While the scales sit still, a lot is going on. More energy, feeling stronger and clothes starting to loosen all count, and one number on one morning isn't the whole picture.
How long does the three week stall last?
It can last anything from a few days to a few weeks. I know that's a frustrating answer, but everyone's body has its own timetable and it doesn't consult you.
If it's been more than a month with no change at all, or you're struggling to keep liquids or protein down, that's not a "wait it out" situation, that's a "ring your bariatric team" situation.
What helps during an early stall
Stick to your team's eating plan. You're already eating a tiny amount. Cutting back further to chase a number on the scales won't speed anything up, it just makes healing harder and leaves you feeling awful. Don't punish yourself.
Keep the protein going. Your body uses protein to repair itself and hold on to muscle, so keep focusing on the target your team gave you. All your protein Qs covers why it matters, and if shakes have already lost their appeal, 10 easy-peasy ways to top up your protein has options that aren't a shake.
Sip, sip, sip. Water helps your body let go of the fluid it's holding, which sounds backwards but is true. Little and often, all day.
Take your supplements. When you're eating this little, there isn't much room for your nutrition to come from food, so keep taking your multi.
Walk. Nothing heroic, just what your team has cleared you for. Around the block, then around it again if you feel up to it. It's good for your mood and helps you feel like a person again.
Hide the scales. Actually. Give them to someone, put them in the boot of the car, whatever it takes. Weigh yourself once a week at most, at the same time and in the same conditions, and let the rest of the week go. Beyond the scales has a good list of non-scale victories (NSVs) worth tracking instead.
Stalls further down the track
The three week stall usually isn't the last one. Most people hit a few more pauses, known as plateaus, somewhere between six months and two years after surgery, and they're a little different to the three week stall. By then you're eating more, your routine has settled, and your body has had time to get used to it.
Your body has a set point, a weight it works hard to defend, a bit like a thermostat. When you lose weight, it pushes back by turning your hunger up and burning a little less. Surgery is thought to turn that thermostat down, partly by changing your gut hormones, which is a big reason it works when diet after diet hasn't. As you get closer to your body's new set point, though, the loss slows and eventually levels off. So a later plateau might not mean you're doing anything wrong at all. It might just mean your body is getting near where it wants to settle.
My personal go-to way to shift a plateau (or a little regain for that matter) is to switch up what I'm eating and move my body in a new way.
Eating
Often you're not eating enough, so double check you're still reaching your protein goals (they don't go away). Think about what you've been eating lately and pick one unhelpful thing to ditch (like taking peanut M&M's to bed) and one helpful thing to add in, like getting back into the habit of a daily protein shake. Our WLS-friendly recipes are a good place to find shake inspo.
Moving
If you usually walk, swim or do yoga, try lifting some weights, and if you're already a gym regular, try some laps at the local pool or find a yoga class and work on those stress levels.
If a plateau hangs around, book in with your dietitian. They'll have the best info.
On Wegovy or Mounjaro? Your stall looks a bit different
If you're using a weight loss injection rather than surgery, the pattern isn't the same. Doses start low and go up slowly over several months to keep side effects down, so the first few weeks are often the slowest part rather than the fastest.
Short flat weeks along the way are normal and don't mean the medication has stopped working. The bigger plateau tends to come much later, often somewhere between six and twelve months in, as your body settles at a new weight.
One thing to watch is that these medications can turn your appetite down so far that it's easy to eat too little, especially protein. Go too long and you can end up so empty you feel too queasy to eat and the only thing you can face is a soggy Weet-Bix. There's a difference between eating less because food isn't on your mind all the time and being too nauseous to eat. One is a much friendlier path. Get ahead of it and eat by the clock if you have to, because going all day without food isn't the win it feels like. If the scales haven't moved for more than four to six weeks and you're sticking to your plan, have a chat with your prescriber or dietitian.
Is this normal? Yes. Is it fun? No.
Whether you're three weeks out, two years in or sitting on a flat patch with your injections, a stall is a bummer. Nobody enjoys doing the hardest thing they've ever done and getting nothing back from the bathroom scales. But a stall doesn't mean the honeymoon is over, it's not a sign your surgery or medication isn't working, and it isn't a preview of how the rest of your weight loss will go.
If you're in the middle of a stall right now and want a chat, I'd love to hear from you. Send us a message through our contact page and tell me how many weeks out you are. Already been through it and happy to share your experience? I'd love that too.
From my new tum to yours,
Emma