May 2, 2021
Earlier this week I was asked a question about the concept of the set point. The person asked if it is possible to reset the set point lower, then mentioned an article she had found online. I asked her to send it to me. The article is infuriating.
Here is how I explained the set point in my book:
“The concept of the set point was introduced in 1982 by William Bennett and Joel Gurin in their excellent (and, sadly, now out of print) book The Dieter’s Dilemma. The theory has been widely debated since then and has a growing body of evidence to support it. The set point refers to a weight range that is different for each person and that is defended by numerous physiological mechanisms. This allows the body to adapt to varying availability of food and activity. Adults who make no conscious effort to change their weight usually maintain a stable weight over time. The set point for weight is primarily determined by genetics, but it can also be influenced by medication, environmental chemicals, stress, illness, microbiota in the gut, and several other factors that are only now being studied… There is strong evidence that dieting for weight loss causes the set point to increase. The body has many ways to defend the set point; when weight drops below the natural range, the metabolism slows down, and hunger increases. Muscle tissue is lost with lost weight but regained as fat tissue, which also contributes to a slower metabolism” (p. 19).
The article in question. “The Science of Set Point,” was part of a series posted by a Famous Hospital Which Shall Remain Nameless (because I don’t want to drive any more traffic to it). It starts from the assumption that your set point should be in some arbitrary “healthy” range and that any increases over time are caused by “excess food and insufficient exercise” which then “fools” your body into a higher set point. This is a profoundly erroneous explanation of the set point theory.
The program goes on to recommend “resetting” the set point through a program of gradual weight loss involving eating less and moving more. What it offers is a rehash of dieting tips, including obsessively monitoring weight, intake and activity, avoiding pleasurable food experiences, substituting foods lower in energy for the foods you really want, high levels of exercise, and other behaviors that are commonly associated with eating disorders. The recommendation is to do this to lose 10% of starting weight, then maintain that (it doesn’t say how) for six months, during which time the body is supposed to “reset” the set point. Then repeat this cycle over and over until, presumably, you disappear from the face of the earth.
There are a couple of comments that refer to “research” that supports the idea that some people can lose 10% of their weight and keep it off for a year, but there are no citations. None. I looked through all of the information available and there was no supporting literature at all. Of course, we all know that keeping weight off for a year is no indication that the loss is sustainable for 2, 5, or 10 years. An abundance of research literature documents that fewer than 5% of dieters maintain weight loss for more than three years.
It is impossible to estimate how many people have been harmed and shamed by this misguided program. Legitimate, factual research indicates that attempts at weight loss, through restricted eating and/or increased exercise, actually raise the set point by making the metabolism more efficient, teaching the body to be fatter on less food. From Ancel Keys classic World War II study on starvation to more recent data on participants on “The Biggest Loser” TV show, we know that metabolism remains lower even after weight is regained. We also know that losing and regaining weight results in poorer physical health outcomes, shame, depression, and low self esteem.
If there was, in fact, an achievable way to reset the set point lower, it would be enjoying amazing success in the weight loss industry. Instead, this program has certainly resulted in increasing the number of people who feel like failures and have worse quality of life than before they began. It has also reinforced the weight stigma that is already so prevalent in our culture, which affects access to health care, economic opportunity, and adequate public accommodation while also contributing to the development of eating disorders in some and to body anxiety in everyone.
Do I have references? Yes, I do:
Bacon, Linda. Health at Every Size: The Surprising Truth about Your Weight. Dallas: BenBella Books, 2008.
Bacon, Linda, and Lucy Aphramor. Body Respect: What Conventional Health BooksGet Wrong, Leave Out, and Just Plain Fail to Understand about Weight. 1sted. Dallas, TX: BenBella Books, 2014.
Bacon, Linda, and Lucy Aphramor. “Weight Science: Evaluating the Evidence for a Paradigm Shift.” Nutrition Journal 10, no. 9 (2011): 1–13.
Bennett, William, and Joel Gurin. The Dieter’s Dilemma Eating Less and Weighing More. New York: Basic Books, 1982.
Bombak, Andrea. “Obesity, Health at Every Size, and Public Health Policy. American Journal of Public Health 104, no. 2 (February 2014): e60–e67.
Brown, Harriet. Body of Truth: How Science, History, and Culture Drive Our Obsession with Weight—And What We Can Do about It. Boston: Da Capo Lifelong Books, 2015.
Dulloo, A. G., J. Jacquet, J.-P. Montani, and Y. Schutz. “How Dieting Makes theLean Fatter: From a Perspective of Body Composition Autoregulationthrough Adipostats and Proteinstats Awaiting Discovery.” Obesity Reviews: An Official Journal of the International Association for the Study of Obesity 16, Suppl. 1 (February 2015): 25–35.
Ellis-Ordway, Nancy, Thrive At Any Weight: Eating to Nourish Body, Soul and Self Esteem. Santa Barbara, CA.: Praeger, 2019.
Fildes, Alison, Judith Charlton, Caroline Rudisill, Peter Littlejohns, A. Toby Prevost, and Martin C. Gulliford. “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records.” American Journal of Public Health 105, no. 9 (September 2015): e54–e59.
Fothergill, Erin, Juen Guo, Lilian Howard, Jennifer C. Kerns, Nicolas D. Knuth,Robert Brychta, Kong Y. Chen, et al. “Persistent Metabolic Adaptation 6 Years after ‘The Biggest Loser’ Competition.” Obesity 24, no. 8 (2016): 1612–1619.
Keys, A., J. Brožek, A. Henschel, O. Mickelsen, and H. L. Taylor. The Biology of Human Starvation. 2 vols. Oxford, England: University of Minnesota Press, 1950.
Macpherson-Sánchez, Ann E. “Integrating Fundamental Concepts of Obesity and Eating Disorders: Implications for the Obesity Epidemic.” AmericanJournal of Public Health 105, no. 4 (April 2015): e71–e85.
Mann, Traci, A. Janet Tomiyama, and Andrew Ward. “Promoting Public Healt in the Context of the ‘Obesity Epidemic’: False Starts and Promising New Directions.” Perspectives on Psychological Science: A Journal of the Association for Psychological Science 10, no. 6 (November 2015): 706–710.
Mann, Traci, A. Janet Tomiyama, Erika Westling, Ann-Marie Lew, Barbra Samuels, and Jason Chatman. “Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer.” American Psychologist 62, no. 3 (April 2007): 220–233.
Ochner, Christopher N., Adam G. Tsai, Robert F. Kushner, and Thomas A. Wadden. “Treating Obesity Seriously: When Recommendations for Lifestyle Change Confront Biological Adaptations.” Lancet Diabetes & Endocrinology 3, no. 4 (April 1, 2015): 232–234.
Rothblum, Esther. “Slim Chance for Permanent Weight Loss.” Archives of Scientific Psychology 6 (2018): 63–69.
Tomiyama, A. Janet, Traci Mann, Danielle Vinas, Jeffrey M. Hunger, Jill DeJager and Shelley E. Taylor. “Low Calorie Dieting Increases Cortisol.” Psychosomatic Medicine 72, no. 4 (May 2010): 357–364.
Tylka, Tracy L., Rachel A. Annunziato, Deb Burgard, Sigrún Daníelsdóttir, Ellen Shuman, Chad Davis, and Rachel M. Calogero. “The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss.” Journal of Obesity 2014 (2014): 1–18.
For more on this topic, see chapter two of my book.