On Your Health

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What's a Set Point and How Does it Affect Weight Loss?

Today we have a guest post from Dr. Laure DeMattia, who is a bariatrician at the INTEGRIS Weight Loss Center where she focuses on medical weight management and obesity medicine.

How many times have you started a new diet with initial success and then as time goes on your weight loss stalls? You redouble your efforts by increasing your physical activity and decreasing your calorie intake and that works for awhile but then you hit another plateau. You give up in frustration and notice within a short period of weeks or months you regain that weight. Why does this happen?

Imagine a room with a thermostat on the wall set at 85 degrees. There is a cage over the thermostat so that we are not able to adjust it. What would we do? If the outside temperature was lower we could open the windows and let in some cooler air… ahh, that feels better. But that only lowers the room’s temperature a bit. Next, we could open the door, and now we have a cross breeze, much better! But what happens as soon as the windows and door are closed? We will feel the temperature of the room start to creep up again.

Basically, this is what happens to many people when they cut their calories or increase physical activity: the body is protecting itself and counters those moves to regain weight. This is known as the Set Point Theory.  The term "set point" is used to describe the weight at which your body likes to be and you stay there with little effort.

There are many factors that affect the body’s set point, and the set point works both ways. When a weight-stable person intentionally tries to gain weight he can often increase his weight with a higher calorie intake, but as time goes by it becomes harder to eat enough food to maintain that gain, because hunger signaling is lowered and his metabolic rate has increased to burn the extra calories. The person usually falls back to his set point without much effort.

Why would someone's set point get higher over time? It can be influenced by many factors, such as our current food environment (highly palatable, high calorie convenience foods) or medications that are weight influencers (for instance, certain medications used to control diabetes, hypertension and mental health disorders). Things like sleep disruption, chronic stress, genetics, intrauterine environment, early feeding patterns and injury to parts of the brain through stroke or tumor also influence a body's set point.

How do we address an elevated set point and its impact on someone's ability to lose weight? The National Weight Control Registry has been tracking successful weight loss maintainers for over a decade. There are over 10,000 participants that have maintained between 30 and 300 pounds of weight loss for at least a year, which means these people have figured out how to lower their set point.

Here are some of the behaviors that have been reported through the registry:

  • Eating breakfast. 78 percent of participants start their day with some fuel.
  • Getting regular physical activity. A whopping 90 percent exercise for at least one hour each day (walking was the most common).
  • Eating more fiber and less fat in comparison to the typical American diet.
  • Weighing regularly. Over 77 percent track their weight weekly and 44 percent weigh daily.
  • Maintaining consistent eating and exercise patterns, even on holiday or vacation.
  • Taking action when they experience a small regain rather than waiting until more weight is regained.
  • Eating low sugar or no sugar and limit your alcohol intake.

The Harvard researcher Dr. George Blackburn, who is director of the Center for the Study of Nutrition Medicine, has been looking at how to avoid the body's set point regulation. Research supports the idea that slow and steady lifestyle changes are best. Yo-yo dieting with severe limitation of calories and extreme exercising throws your metabolism off and makes it only harder to break a body's set point. Find a way of healthy eating and moderate exercise you can do and stick to it FOREVER.

Research recommends the best way of breaking your set point is to achieve weight loss of 10 percent of your body weight and then maintain that loss for six months before attempting another cycle of 10 percent weight loss. For those who are interested, Dr. Blackburn offers a free online course for weight loss that guides people through an eight week course.

Lastly, I want to leave you with some encouragement. Through lifestyle intervention it IS possible to improve your health. If you are struggling on your own, look for support from others who are on the same journey.

Laure DeMattia, D.O., is board certified in family medicine and obesity medicine. She joined the INTEGRIS Weight Loss Center in Oklahoma City to focus on medical weight management. She earned her medical degree from Midwestern University, Chicago College of Osteopathic Medicine in Illinois and completed her fellowship training in primary care research at the Medical College of Wisconsin. DeMattia is a member of the Obesity Society, ADr. DeMattiamerican Society for Metabolic and Bariatric Surgery and the American Society of Bariatric Physicians. She has dedicated her career to caring for patients that are negatively affected by their weight.

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