Adjusting a client's macros: change one thing, then wait

A stall under four weeks is not a plateau

Coaches ask about adjusting macros for clients about a month before the readings can answer them. A client stops losing for two weigh-ins, they message you on a Sunday night, and by Monday you have cut 200 kcal. You cannot yet tell a plateau from a flat fortnight, so change nothing and check four things first.

The ISSN's 2017 position stand on diets and body composition would not accept a trial shorter than four weeks into its review, because four weeks is the minimum period in which fat mass changes enough to be read. Those trials had laboratory body composition equipment. You have a bathroom scale and a client who weighed in after dinner.

Rule out the cheap explanations before you touch a number

Four checks, one message each, and all of them are free.

1. Count the complete logging days. Not "is she tracking", but how many of the last seven days are complete. Five out of seven at a 1,800 kcal target is not a 1,800 kcal diet. It is a diet at a number nobody has measured, and cutting it to 1,600 makes the unmeasured number smaller too.
2. Check the weigh-in is comparable. Same morning, after the toilet, before food, same scale, same floor. One Sunday evening reading against a Monday morning one can differ by a kilogram with nothing at all having happened to fat mass.
3. Ask what else changed. A new shift pattern, a chest infection, a fortnight of travel, a training block that stopped. These produce a stall that a calorie cut will not fix and may make worse.
4. Look at the trend, not the point. Take the average of the last seven readings against the average of the seven before. A weekly average that has fallen 0.2 kg is not a plateau, it is slow progress that a single Monday number hid.

If all four come back clean and the seven day averages have been flat for four weeks, you have something worth changing.

When you do adjust a client's macros, change one variable

When a coach changes two things at once, the check-in afterwards cannot be read. Calories down 250 and steps up 2,000 is a single intervention with two knobs, and if the client loses 0.5 kg you have learned nothing about which knob did it, or which one to turn next time.

Pick one:

• Energy: the calorie target.
• Protein: the protein target, held while calories move.
• Activity: a step target, or a session added.
• Structure: meal timing, a fixed breakfast, a pre-planned Saturday.

Two targets are enough to move a population. The Diabetes Prevention Program gave its lifestyle group a weight loss goal of at least 7 percent of initial body weight and at least 150 minutes of moderate activity a week, taught through a 16 lesson curriculum over the first 24 weeks. Fifty percent of them hit the 7 percent goal by the end of that curriculum, and diabetes incidence in the group came out 58 percent lower than placebo, against 31 percent for metformin.

Wait two check-ins before you judge the change

This is the part coaches skip. We change one variable at a time and wait at least two check-ins before we change another, because a target moved twice in three weeks cannot be attributed to anything.

Two check-ins is a different amount of calendar time depending on how you run your practice, which is the real reason cadence matters. On weekly check-ins that is a fortnight of data, two more seven day averages to compare. On fortnightly check-ins it is a month. If you have not settled your cadence, check-in cadence is the article to read before this one, because the waiting period here is counted in check-ins and not in weeks.

The trial that cut diabetes incidence by more than half did not check in weekly either. After those first 24 weeks the Diabetes Prevention Program moved its lifestyle group to individual sessions roughly once a month, with group sessions alongside them, to hold the behaviour changes in place. Waiting is not neglect.

A real plateau is appetite rising, not metabolism collapsing

Coaches reach for metabolic adaptation to explain a plateau, and then cut calories to outrun it. Hall and Kahan's 2018 review in Medical Clinics of North America puts the two sizes side by side, and they are not close. For every kilogram of weight lost, calorie expenditure falls by roughly 20 to 30 kcal a day, while appetite rises by about 100 kcal a day above the pre-diet baseline. At the point a typical plateau arrives, expenditure has dropped by less than 200 kcal a day and intake has climbed 600 to 700 kcal a day since the start.

Obesity interventions typically result in early rapid weight loss followed by a weight plateau and progressive regain.

Their modelling puts that plateau at around six months for a patient who then regains, and the cause is intake creeping up, not expenditure falling away. The same review calls the old rule of a pound lost per 3,500 kcal of accumulated deficit outdated guidance. The arithmetic that says "cut 250 kcal and she will lose half a pound a week forever" was never true.

So a client on the same plan who has stopped losing is usually eating more than they were, and more than they think. That is an adherence conversation, not a calorie cut. Cutting the target of someone who is already eating above it widens the gap between the plan and the week.

Make the deficit smaller when lean mass is what you are protecting

The direction of a change is not always down. The ISSN's position stand is explicit that a leaner client should lose more slowly, and that the size of the deficit you can impose scales with how much body fat the client started with.

The long-term success of a diet depends upon compliance and suppression or circumvention of mitigating factors such as adaptive thermogenesis.

Compliance is first in that sentence for a reason. Take two clients, one at 32 percent body fat and one at 14 percent. The stand's direction is that the first has room for a deficit that would cost the second lean mass. For the leaner one, training four times a week and sleeping badly, the change that keeps the plan working is a smaller deficit with the protein target held.

What to do on the Monday morning

The client weighed in flat for the fourth week. Her logs show six complete days out of seven, the weigh-ins are all Monday mornings, nothing has changed at work, and the seven day averages are 68.4 kg and 68.5 kg.

One variable. Our call: leave calories alone and raise the protein target from 110 g to 135 g, because a higher protein target at the same calories is the change that costs adherence the least and protects lean mass while the deficit runs. Then we would write the next two check-in dates in the plan and change nothing until the second one.

Changing the target is the easy half. Rebuilding the week so the client can actually hit the new number is the work, and it is why a protein change turns into an evening of swapping meals around. That is the job Peas & Pans does, and it is why we would rather change one target properly than three in a hurry.