He eats a balanced diet, he moves regularly, he is motivated... and still nothing happens: no weight loss. In some patients, that plateau in fact reveals a metabolic lock, in which insulin resistance plays a central role1.
But how do you recognise it in practice? And above all, what do you do with an insulin-resistant patient who is “doing everything right” yet has stopped losing weight?
In this Simplycure webinar led by Dr Pierre Dez, we reviewed the real barriers to slimming down, the assessments not to be overlooked, the key behaviours to adjust, and the useful micronutrition levers.
This guide brings together what the session covered, to help you refine your care without discouraging your patients.
When the body resists despite the effort: how to make the right diagnosis
Dr Dez makes the point straight away: in some patients, the plateau is neither a post-weight-loss stall nor a lapse in effort. It usually reflects a multifactorial metabolic block: high insulin, hormonal imbalance, poorly timed meals, chronic stress, deficiencies, and more.
First instinct: do not focus on weight alone. A patient may not be “losing weight” in kilos while still genuinely slimming down (loss of fat mass, falling waist circumference, restored body water).
Hence the central value of bioimpedance analysis combined with waist measurement, to avoid misreadings and keep the patient engaged.
Insulin at the heart of the block
In patients who are overweight, and especially where there is visceral obesity, insulin resistance blocks access to fat stores, despite dietary effort and physical activity.
What to look for first:
Night-time snacking, typically around 10pm to 11pm (fruit, fruit puree, a biscuit).
At that point insulin is starting to fall; any carbohydrate intake sends it back up.
Carbohydrates placed badly across the day, particularly in an insulin-resistant patient who eats them at breakfast.
This keeps the insulin curve high from the morning onwards, which works against slimming.
High waist circumference: > 88 cm in women, > 102 cm in men.
An excellent clinical marker of established insulin resistance.
The clinical reflex: measure HOMA at the initial work-up. If it is high, that confirms the hypothesis of an insulin lock and lets you adapt your recommendations:
a finer spread of carbohydrates
moving complex sugars to a better time of day
leaning on protein and good fats to steady blood glucose
Three major barriers to weight loss that often go unnoticed
Once insulin is suspected or confirmed as a blocking factor, it is still essential not to stop there. Other drivers can sustain the resistance, or even make it worse, if they are left unmanaged.
Dr Dez highlights three underestimated barriers in particular: stress2, sleep, and certain micronutrient deficiencies.
FactorWhy it is a barrierWhat to look for in practiceTools / possible supportStress↗︎ Cortisol
⇒ Blocks slimming, reinforces insulin resistance, unbalances neurotransmitters- Anxiety, nervous fatigue
- Sugar cravings
- Difficulty sticking to a protocol- Stress questionnaire (Cohen)
- Neurotransmitter questionnaire
- Magnesium, rhodiola, L-tyrosine, saffronSleep↗︎ Ghrelin
↘︎ Leptin
⇒ Disrupts appetite and metabolic regulation- Difficulty falling asleep
- Waking during the night
- Restless legs
- Shifted chronotype- Sleep diary
- Sleep questionnaire
- Horne & Östberg chronotype
- L-tyrosine in the evening (restless legs syndrome)Micronutrient deficiencies↘︎ Basal metabolic rate
↘︎ Cellular oxygenation
↘︎ Hormone or neurotransmitter synthesis
- Low vitamin D
- Low ferritin
- TSH > 2.5
- Diet low in omega-3
- Chronic stress
- Blood work: vitamin D, iron, iodine, selenium
- Fatty acid profile (if needed)
- Targeted support: omega-3, magnesium, iodine, selenium
Insulin resistance: the key assessments for understanding the block
In an insulin-resistant patient who cannot slim down despite steady effort, simple dietary advice is no longer enough.
Dr Dez recommends relying on a few targeted markers to pick up the silent barriers: insulin, inflammation, hormones, deficiencies3 and so on.
ParameterWhy measure it?Alert thresholdsClinical interpretationHOMAAssesses insulin resistance↗︎ depending on the reference range usedInsulin resistance = a major barrier to slimmingTSHScreens for functional hypothyroidism> 2.5 mIU/LTo be completed with T3/T4 and urinary iodine; think of seleniumHigh-sensitivity CRPAssesses low-grade inflammation↗︎ above the usual valuesInflammatory terrain = resistance to fat mass lossFerritinShows iron status, essential for the thyroid and cellular energy< 50 µg/L (depending on context)Deficiency = fatigue, slowed metabolism, difficulty slimmingLipid profileChecks fat metabolism↗︎ triglycerides or ↘︎ HDLOften altered in insulin resistanceUrinary iodine(if TSH is high)Looks for iodine deficiency< 100 µg/LMay explain hypothyroidism with normal T3/T4Fatty acid profile(optional)Assesses the omega-6/omega-3 ratioRatio > 4:1Imbalance = inflammation, impaired beta-oxidationHormone work-up(if needed)Menopause, PCOS, thyroid disordersDepending on context (oestradiol, testosterone, LH, prolactin, etc.)To be adapted to sex, age and clinical terrain
Not all of these tests are routine. But faced with a lasting or unexplained block, it is better to check one or two metabolic axes than to pile up dietary advice that achieves little.
It is also a valuable way to motivate the patient: putting numbers on the problem lets you personalise care and restore a measure of hope.
Clinical case: multifactorial resistance in a postmenopausal woman
Patient profile
Woman of 60, postmenopausal, with abdominal overweight and under heavy stress.
Complaints: chronic fatigue, unsettled sleep, evening cravings, discouragement at being unable to lose weight despite her efforts.
Terrain analysis
High HOMA → insulin resistance confirmed
Unbalanced lipid profile: omega-3 very low
Chronic stress, heavy mental load
Sleep disturbed by restless legs syndrome
Moderate but irregular physical activity
Recommended strategy
Overall rebalancing along three priority axes:
- Stress
- Adaptogen support (rhodiola + magnesium)Gradual work on mental load and routines
- Sleep
- Correcting the tyrosine shortfallManaging restless legs syndrome with magnesium + moving the evening meal
- Lipid metabolism
- Omega-3 supplementation at a clinical doseRestarting targeted physical activity (gentle intervals, brisk walking)
Clinical follow-up
At 3 months:
Clear improvement in sleep
Reduced waist circumference
Fat mass loss resumed with no major change in calories
Patient engaged and better equipped to handle stress
Conclusion: target better to help patients slim down
As we have seen, in some patients weight loss does not hinge on a calorie deficit but on a genuine metabolic lock.
In that setting, insulin resistance often plays a central role, working alongside other silent barriers: chronic stress, low-grade inflammation, hormonal imbalances, micronutrient deficiencies and more.
Dr Pierre Dez’s message is clear: do not stop at the dietary protocol. Look for what is blocking, measure it, put numbers on it, prioritise the right levers. Targeting a few major axes is often what delivers concrete, lasting results that keep the patient motivated.
Do you support patients with metabolic resistance? Contact us to refine your protocols and recommend suitable supplements through the Simplycure platform.
