Doctor’s Call: Your Weight ‘Set Point’ And Why It Matters

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Our brain, it turns out, likes to work like a thermostat. It needs a reference set point to regulate many human functions, including heart rate, blood pressure and temperature.

Having a set point makes it consistent for the brain: It always tries to bring each function it regulates within a narrow range of the set point. Researchers who introduced the concept believe the same is true with our weight. People with obesity have a higher weight set point than people with normal weight.

An Unfair Battle

When people with obesity try to lose weight with diet and exercise, they are usually successful in the short-term. Their body, however, senses their weight has decreased below the set point and tries to bring it back up — similar to how a thermostat would react. This happens by increasing the hunger hormones and slowing down the metabolic rate. Most people on a diet or a fat-burning exercise program feel hungry and their body slows down the burning of calories. This leads to regaining weight and a vicious cycle of losing and gaining weight: The yo-yo effect.

What Causes Weight Set Point To Go Up?

Abnormal diet, sedentary lifestyle, stress, sleep deprivation, disruption of the circadian rhythms (a 24-hour internal clock running in the background of our brain) and weight-producing medications are all factors that can increase the weight set point to an abnormally high level. To make things more complicated, this process is influenced by our age, gender and genetic makeup, and varies significantly from person to person. Aging alone brings our weight set point up.

How To Bring Your Weight Set Point Back Down?

1. Change the composition of your diet

Changing what you eat is as important as lowering the calories you consume. Sweets, refined carbohydrates and foods with a high glycemic index tend to increase the insulin production in your body, which in turns increases appetite and storage of fat. Adopting a balanced, healthy diet that substitutes high glycemic index carbohydrates with low index ones, will change the metabolic reaction of your body to the food and lower your weight set point.

2. Exercise  

A combination of resistance training and high-intensity aerobic exercise will help lower the weight set point. Muscle is a “metabolically active” tissue, and adding muscle to your body will increase your basal metabolic rate (your body will burn more calories while at rest). The more muscle you have the more efficient your body becomes in dealing with excess calories and storing less fat. In other words, you have more “wiggle room” which helps for long-term compliance with healthy diet.

3. Medications

There is a number of new medications that act on the metabolic response to food, helping the body to use insulin more efficiently, store less fat and curve the feeling of hunger. In the long-term these medications may lower your weight set point. Not everyone has the same response to medications, and some people may need to try different types of medication until they find one that works for their body.

4. Metabolic surgery

Sleeve gastrectomy and Roux-en-Y gastric bypass lower the weight set point and help most people lose a significant amount of weight and maintain their weight for many years. These procedures have become very safe and have helped thousands of people with a Body Mass Index (BMI) over 35 reach and maintain a healthy weight. These procedures may have side effects and not all people respond the same way to them. A thorough evaluation is necessary prior to proceeding with surgery.

There is hope:

  • Self-directed lifestyle change (with the help of online tools and programs).
  • Professionally directed lifestyle change (with the help of a health coach, dietician, therapist).
  • Medications (prescribed by your PCP or Obesity Medicine Specialist).
  • Metabolic/Bariatric surgery (performed in an accredited program).
  • Post-surgery combination treatment to address suboptimal response to surgery and expected rise of the weight set point due to aging.

Dr. Pavlos K. Papasavas is the Director of Surgical Research and Co-Director of Metabolic and Bariatric Surgery at Hartford Hospital.

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