Wednesday, December 29, 2010

Set point theory is stupid!


[Originally posted June 2007]

Yesterday someone in the comments asked me what I thought about "Set Point Theory".

What set point theory suggests is that a person's body, metabolism and caloric drive strive to maintain a specific preset weight and therefore if your "preset" weight is high and you lose weight, your body will just try its darndest to gain it back.

I think it's an asinine theory.

Some obvious problems (one pointed out quite rightly by the comment yesterday):

  1. Why have the world's setpoints gone up dramatically over the course of the past 50-100 years?
  2. Why is the world getting bigger so much faster (are all of our setpoints 1,000lbs?)
  3. Why do the setpoints of many non-American folks seem to change the moment they step into North America?
Set point theory is something that allows folks and governments to take even less responsibility in treatment design and implementation.

Now it is indeed true that as the body loses weight it does compensate in multiple ways to try to preserve the weight it's losing. The body of course perceives weight loss as an environmental threat - an ice age or a flood or something, and so it jumps into action and changes the way the body handles certain processes, decreases something called the thermic effect of food and basically tries to hold on but it doesn't throw any magical switches to get folks to open their freezers and cupboard doors.

I don't completely discount the whole theory however. I do believe that there is a range of weight within which a person can comfortably live, but I also believe that range is very wide and it depends not only on the genetic makeup of the individual, but also his or her learned and fixed environment.

You might even stretch and say that I do believe in set point theory, but in my own version of it - I'll call it Life-Set Theory with weight being primarily lifestyle related.

People regain their weight as they regain their old lifestyles.

I say this to new patients daily,
"The more weight you'd like to permanently lose, the more of your lifestyle you'll need to permanently change"
The problem is, most weight loss efforts don't really do much to address lifestyle. Weight loss usually involves a food regime - either overt overall restriction and hunger or the magic food approach of this food's good and that food's bad. Those approaches are of course non-sustainable becase they invoke the suffering of hunger or of blind, thoughtless restriction. Any weight lost through suffering will be gained back when the suffering stops and the person reverts back to their prior life that might have led them to have weight to lose, but was easy to live.

The environment also of course matters. Look at the Pima Indians - heaviest people in the World in Arizona and while still heavy, much lighter weights back home in Mexico. I'd imagine this would work in reverse too. For example, take someone who's lost weight with a restrictive approach while working a sedentary job in an urban environment and plop him or her down on a farm where they've got to work all day long and there's no access to food other than what they cook and grow themselves. Do you think their "set point" will have them magically gain? Of course not, because their environment no longer allows for their prior calorie rich lifestyle.

So to sum up this rant. For me lifestyle dictates set point. Change your lifestyle and eating patterns (combining hunger prevention strategies like frequent eating and increased protein with calorie awareness and an explicit lack of forbidden foods) and you've definitely got a shot, but do remember with lifestyle change it's not necessarily the changes that are difficult, it's change itself.

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20 comments:

  1. Yet again another great post! Thank you.
    D

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  2. I was always curious about this theory, because in the past, every time I lost weight, I'd get incredibly hungry and gain it all back. But when I gained weight, my hunger didn't just vanish until I lost weight. I just kept getting bigger. It wasn't until I started food journalling, I had recorded a string of days where my daily calorie intake was really low, then I would consistently get hungry after those days. When it was pointed out to me that the calories were too low and that was causing me to be hungry the following days, I fixed that, then that particular hunger issue went away. So I had THOUGHT that my hunger was coming from my body wanting to gain back what I had lost, but the problem was the way I was going about losing weight in the first place (undereating). I just assumed I knew what the problem was because people told me about the set point theory all the time ( they did not refer to it as this name, but it was the same concept). Perhaps the set point theory explains bodily functions like what you provided as an example in this blog article, but I think it's useless if we're trying to use it in the context of weight loss/maintenance.

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    Replies
    1. Good for you. you are absolutely correct. Just as the body can resist some weight loss by reacting to it as an "event" so too, the body will react to starvation as an "event" and try to limit calorie consumption. Eating small(ish) meals throughtout the day of good, clean, healthy foods will result in much more weightloss than starvation. It is especially important to eat enough for breakfast and through the day, to avoid the craving or hunger later in the day (late night cravings) or in subsequent days, as you pointed out.
      Basically what most people know but are not willing to strive toward is true: Healthy amounts of exercise, and good, wholesome food is the key to a healthy lifestyle. Weight loss is the added benefit to that lifestyle...
      As for set-point itself, while it's true that genetics often determine your body shape and the smaller details, there is no evidence that with some effort there are certain people who will "just be" overweight for no reason...

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  3. Nothing demonstrates more clearly that medicine is a field of DOGMA , more than scientific knowledge , than your article.


    Stop moralizing obesity , "doctor". Get familiar with what sceince has turned up about obesity. Lose your ASSUMPTIONS.



    People REGAIN the fat DESPITE adherence to their exercise and diet regimes. Look up Dr. Linda Bacon, Dr. Stephan Guyanet and Dr. Jeffrey Friedman - people who know MUCH MORE about this topic than yourself.

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    Replies
    1. Anonymous11:54 am

      This man knows. Whoever posted this article is incredibly ignorant.

      Delete
  4. You are grossly misinformed of the science on this subject. Doctors should know better.


    I am a layman and I know much more than you do about this. My blog shows this.

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  5. Razwell,

    I cede to your clearly superior intellect.

    What with your capitals, your lack of substantive argument, your citing of other people's names, how can I compete?

    I'm certain your blog is a fount of helpful information.

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  6. That graphic makes my head spin :-)

    I do believe that once we get obese and stay that way for a while, whatever you want to call it, our bodies will fight us all the way in our efforts to reduce. Because our bodies will have to sense "famine" for a sufficiently long time to lose a lot of weight.

    Apparently our bodies can't tell the difference between a self-induced famine and an imposed one. Apparently our bodies can't tell we've been living off of enormous excesses of body fat all along and there's no danger of starving. Therefore the predictable survival instinct would be to eat to replenish those stores.

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  7. Anonymous6:30 pm

    Huh, I don't think it's "stupid". The basic assumption goes back to the experiments by Sims et al on prisoners published 1968 and 1974 (doi:10.1016/S0300-595X(76)80027-8 and http://www.ncbi.nlm.nih.gov/pubmed/5721398 ) Despite the small numbers and that it would be considered unethical these days, this looks rather convincing for me in principle.
    There's people who don't easily gain weight over a certain percentage and there are others who do.

    The problem is not in a set point theory or that it's stupid, it's in saying "everyone has a fixed weight that his body tries to maintain" which is not what was deduced from the experiment, but is a stupid oversimplification.

    Also, nobody said that a given set-point cannot change, the opposite is true - see page 749/750 in this article doi:10.1016/0272-7358(91)90128-H. Quote:

    "Other studies indicate that
    the ingestion of palatable foods, particularly over a prolonged period, may lead to elevated body weight that resists subsequent downregulation even when the
    animal is returned to a normal diet or exposed to dietary restriction"

    So if you eat a lot too much for a very long time, your body will now defend the new set-point of your heigher weight. (Which answers most of the questions in your blog entry, doesn't it?)

    Do some research into scientific literature before blogging, why don't you?

    Cheers,
    I.

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    Replies
    1. See now this is the kind of argument that these comments need, not "Nooo, you're a stupid doctor". I respect that you took the time to explain how he was wrong, what the correction was, and even cited peer reviewed sources... if every online argument was as eloquent as this I dont think I would be able to tear myself away from the computer!!

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  8. Anonymous5:56 am

    Probably should have quoted two more sentences directly following the one I already quoted from the paper:

    "These animals make the initial metabolic adjustments designed to defend the lower weight, but the process attenuates with prolonged exposure to the palatable diet. The animals appear to have attained an elevated set-point, in that they regulate or defend their new higher weight level against further gain or loss (Keesey, 1986)." (from the Garner and Wooley review).

    Same article questions if weight loss is really desirable for obese. While there was an relation found between obesity and higher mortality, things a) ain't that easy and b) it is not so clear that losing weight reduces the risk.

    Cheers,
    I.

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  9. I am curious: is it possible for antidepressants like Cipralex to "reset your set-point", or assuming that set-points are relatively controversial, that they can slower your metabolism for the long-term, even after one stops using them?

    Thanks

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  10. Regardless of your views on setpoint, I can't think of any physiologic mechanism by which cipralex could have any lasting effect on metabolism.

    Further, my experience and readings on cipralex would suggest it doesn't generally have a tremendous impact on weight while taking it either.

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  11. Interesting. Thanks for your insights

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  12. Anonymous2:53 pm

    Nice informative article. Thanks

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  13. Anonymous1:42 pm

    Is it just me or is YF only choosing to address some of these comments. I guess it could be worse he could have deleted the commentor who brought to light the peer reviewed publication.

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  14. Anonymous6:35 pm

    It sounds like you're saying set point theory may have some validity when it comes to weight loss, that is to say the body will utilize resources much more efficiently when confronted with a famine situation, but can only do so much with excess calories before it converts them to fat. The body resists weight loss, but not so much weight gain.

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  15. Anonymous6:33 pm

    I wish you were right and I share you concern for people not taking personal responsibility for their behavior. That said, it says your a doctor. Did you read any research before coming to your conclusions. It is certainly not a universally held theory, but there Is research in humans outlining increased energy efficiency after significant weight loss. This certainly does not mean weight loss cannot be maintained. You probably know a great deal specific to you field, that gives you a responsibility IMO in tangential areas like this to go beyond some semi-logical ranting.

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  16. Anonymous4:03 pm

    The Harvard school of medicine talks about set points as your bodies "fight" to maintain your weight within 10-20%. Other Bariatric doctors in Minneapolis I have talked to also believe in this theory. The Harvard SOM does say you can reset your set point by losing 10%, maintaining that for 6 months (which again, your body is fighting) then lose another and so on. I agree that we are not born with a set point of being Obese, we fight for that set point with the fast food and crappy diets you spoke of. However, when we try to undo the damage, we have to fight what becomes our (the individual's, societies') new set point

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  17. Why I believe in Set Point Theory:

    I am 5'6" tall and I am a 38 year old female. At 32 years old I weighed 320lbs. I lost a great deal of weight through diet and exercise and at one point was 186lbs (my lightest weight as an adult). In spite of working out 6-9 hours a week (regular and repeated triathlon and/or half-marathon training, weightlifting, and yoga) and regularly logging my food intake in consultation with a registered dietitian, I have regained weight back to 250lbs. This time, though, my 250lb self is 27% bodyfat instead of 45% bodyfat.

    It is completely possible for set point theory to be correct. It is also possible for people to be "morbidly obese" and also fit and healthy.

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