The last few kilos: why they are so stubborn

Why won't those last kilos come off?

With every kilo you lose, your body becomes a little more economical. A lighter body needs less energy to maintain itself and to move. The eating pattern with which you lost ten kilos simply produces a smaller deficit at your current weight.

There is also something that goes beyond arithmetic. Research into adaptive thermogenesis shows that after weight loss, energy expenditure falls on average about 120 kcal per day further than you would expect based on the change in body composition. Your body shifts down a gear to limit the damage. That difference is not dramatic, but it is just enough to halve a deficit of 200 kcal.

At the same time, habits creep back in. Portions unconsciously get a little bigger, the weekend counts a little less strictly, the splash of oil in the pan is no longer measured. With a deficit of 500 calories a day, that goes unnoticed. With a deficit of 200 calories, it is the difference between progress and a standstill.

Your movement changes too. After a long period of losing weight, many people unconsciously move less outside their exercise sessions: less fidgeting, less walking, more sitting after a workout. The gym counts, but the rest of the day counts more. You can read more about the broader causes in our article on why you are not losing weight.

What happens in your body: calorie burning, hunger and hormones

Losing weight changes your hunger hormones, and that change lasts much longer than the diet itself. That is the main reason why the last phase feels so much harder than the first.

In a frequently cited study in the New England Journal of Medicine, researchers followed fifty people with overweight who lost a considerable amount of weight in ten weeks. More than a year later, their hormone levels had still not returned to where they were: ghrelin, the hormone that drives hunger, was still higher, and leptin, which signals satiety, was still lower. The subjective feeling of hunger was still increased after 62 weeks.

That means something important. The hunger you feel at this stage is not a weakness, but a measurable hormonal signal. Your body is trying to regain the lost weight and is using biology to do it, not logic. Once you know that, you no longer need to blame yourself for something that "should just be a matter of keeping going".

Stress and lack of sleep make the picture a bit harder still. Both increase cravings for fast carbohydrates and reduce the quality of your choices at the end of the day. We set out what does and does not help against that feeling of hunger in our article on appetite suppressants.

The last kilos and menopause: why it works differently now

For women going through menopause, it is not only how much you weigh that changes, but also where the fat settles. The same eating pattern suddenly gives a different result, and you are not imagining it.

In research into the menopause transition, women were followed for years. Only in the women who actually became postmenopausal did the belly fat around the organs increase significantly. Their resting energy expenditure fell one and a half times more than in women of the same age who had not yet reached menopause, and their fat burning decreased by 32%.

In practical terms, that means three things. You burn less at rest, you store fat around your belly more readily and your muscle mass is under more pressure. So at this stage of life, the last kilos are not only tougher, they also sit where you least want them. Strength training and enough protein therefore carry more weight than extra cardio. We go into this in more depth in our guide to weight loss during menopause.

How to lose the last few kilos after all

The most common mistake at this stage is making the deficit bigger. Eating even less and exercising even harder feels logical, but it reinforces exactly the mechanisms working against you: more hunger, more muscle loss and a calorie burn that drops even further.

Five things that do make a difference in practice:

1. Make your deficit smaller, not bigger. A modest deficit you can keep up for months beats a large deficit that collapses after three weeks.
2. Do strength training twice a week. Muscle mass is the only part of your calorie burning you can influence yourself. Preserving it keeps your daily energy expenditure up.
3. Measure again what you actually consume. Weigh your portions for a week and include the calories from drinks, sauces and oils. Liquid calories are the most underestimated source of a standstill.
4. Protect your sleep and limit your stress. Poor sleep increases your cravings and lowers your discipline at the end of the day, without you realising it.
5. Look beyond the scales. Measurements, clothing size, blood pressure and fitness often tell a more positive story than the number.

Underneath all this lies a question of pace. Losing weight slowly feels unsatisfying, but it is the only speed that does not put your hormones into extra resistance. And you often already feel noticeably better once a few kilos have come off, even if your target weight is not yet in sight.

Are the scales not moving while you have already tried everything? At Qlinic, your own BIG-registered doctor (the BIG register is the Dutch register of healthcare professionals) looks with you, one to one, at whether a medical programme makes sense in your situation. Take the eligibility check →

In a calorie deficit and still not losing weight? This may be what is going on

If you are in a genuine deficit and still not losing weight, in most cases it comes down to fluid, measurement or timing. Only once those three have been ruled out is it worth looking further.

Fluid is the most common explanation for a plateau of two to three weeks. New strength training, more salt, a menstrual cycle or simply a busy week can make you retain a few kilos of fluid that completely mask the underlying fat loss. So weigh yourself at fixed times and assess the average over a week, not the individual day.

Measurement is the second. Under-reporting of what we eat is one of the best-documented phenomena in nutrition research and it affects almost everyone, including people who track it seriously. The deficit you think you have is usually smaller than the deficit you actually have.

If the scales really remain unchanged after eight to twelve weeks of consistent eating and exercise, a medical explanation is worth investigating. An underactive thyroid, PCOS, insulin resistance and certain medicines can slow weight loss. Which ones they are and how to have them ruled out is set out in our overview of medical conditions that prevent weight loss. Always discuss a suspicion with your GP (huisarts).

When does medical support make sense?

For the last two or three kilos above a healthy weight, medical treatment is neither necessary nor intended. We want to state that plainly. If you are at a healthy weight and want to lose the last kilos purely for aesthetic reasons, you are better served by patience, strength training and a realistic target weight.

It is different when your BMI is 30 or higher and you have been stuck for years, despite diets, exercise and professional support. Then those "last kilos" are not a cosmetic remainder, but the kilos that affect your health. At that point, medication is a serious option to discuss.

Medicines that resemble the gut hormone GLP-1 make you feel full sooner and less hungry. The College ter Beoordeling van Geneesmiddelen (CBG, the Dutch Medicines Evaluation Board) names semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro) and liraglutide (Saxenda) as the best-known active substances in this group. The most common side effects are nausea, vomiting, constipation and diarrhoea, and more serious side effects have also been reported. They are not miracle cures and they do not replace a healthy diet and exercise.

These medicines are prescription-only and should only be used under a doctor's supervision. Online suppliers that deliver without a prescription are breaking the law, and you do not know what you are taking. The safe route is always through a doctor who assesses your situation, your other medicines and the effect.

At Qlinic it works like this: you have a consultation and intake with a BIG-registered doctor who stays your doctor throughout; if the doctor finds the treatment suitable, you receive a prescription and discreet home delivery; and after that you speak to that same doctor every four weeks. Most people notice the first effect after about four weeks, mainly because the feeling of hunger decreases. We have now helped around fifty people and have a 5.0 rating on Google from more than twenty reviews.

Do you recognise yourself in this story? With us, you get your own BIG-registered doctor who speaks with you every four weeks, and your medication is delivered discreetly to your home. Take the eligibility check →

Frequently asked questions about losing the last few kilos

Why won't my last kilos come off?

Because your body has adapted. A lighter body burns fewer calories, so your old eating pattern only produces a small deficit. On top of that, your energy expenditure falls further and your hunger hormones become more active. Larger portions and less daily movement also often creep back into your routine without you noticing.

Why is it so hard to lose those last few kilos?

Because the margin gets smaller while the hunger gets bigger. In the early phase, you lose weight quickly on a generous deficit. In the last phase, you are working with a small deficit, while your hormones are pushing you to eat more at the same time. Research shows that this hormonal shift is still present more than a year after losing the weight.

How can I lose the last few kilos?

Make your deficit smaller rather than bigger and keep it up for longer. Do strength training twice a week to protect your muscle mass and therefore your calorie burning. Measure exactly what you eat and drink for a week, including oils and drinks. Protect your sleep and judge your progress on weekly averages.

What should you do if you are not losing weight?

First check whether your measurements are right and whether you have allowed enough time: eight to twelve weeks of consistent behaviour. If it still does not work after that, have your GP rule out medical causes such as an underactive thyroid or PCOS. With a BMI of 30 or higher, a medical programme with a doctor is a realistic next step.

I have stopped losing weight after 5 kilos, how is that possible?

That is a classic plateau and usually a combination of three things: your calorie burning has fallen, your deficit has become smaller and you are retaining fluid. Judge your weight on the weekly average rather than day by day. If it is still stuck after eight weeks, look at your actual intake before you start eating even less.

Can you lose those last kilos without medication?

Yes, for many people that is the appropriate route. A small and sustainable calorie deficit, strength training, enough protein and good sleep are the foundation, and remain so during a medical programme too. Medication is intended for people for whom the lifestyle approach does not produce enough results and whose weight is putting a strain on their health.