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.