You’re doing it! You’re lowering your calorie intake. You’re exercising. And yet, your scale doesn’t seem to want to recognize your hard work. Or maybe it did for a while. But now your weight has stayed steady despite your best efforts. Or even more frustrating — it’s creeping back up.
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It’s an all-too-common scenario. But you’re not alone. And it’s not your fault.
“People used to think that if you increase your exercise, or cut your food intake, you’re going to lose weight,” says endocrinologist and obesity specialist Marcio Griebeler, MD. “But obesity is a disease. It is a physiologic dysfunction. In a variety of ways, your body will work to defend itself and keep you from losing weight.”
But … why? And what can you do about it? We talked with Dr. Griebeler about set point theory — the idea that explains why your weight may not change much even when you’re dieting and exercising. Read on for tips to get to a healthier weight range, even when your body wants to fight you every step of the way.
The truth about obesity
Obesity isn’t just a number on a scale or a measurement of your body mass index (BMI). Instead, those numbers are symptoms — indications of something more complicated than weight alone.
Think of it like this: Your cough may be a symptom of a cold. But a cold is more than a cough, it’s an upper respiratory infection that may also be causing your runny nose, fatigue and so on.
The same is true of obesity. Your BMI is a sign of obesity, but obesity itself is a chronic condition that affects the way your body functions in a range of ways.
Dr. Griebeler says that when you’re living with obesity, it changes the way your body functions. It changes the way you metabolize food. It changes your hormonal function. It puts you at risk for conditions like:
Obesity is defined as a BMI of 30 or greater. BMI is a calculation that takes into account your height and weight as an indication of whether your weight is putting you at risk for health complications. And while health researchers and practitioners agree that BMI is a rather crude method of understanding your health and risk, it’s the best indication we have at this time.
“BMI is an easy calculation, and it gives us a good idea of whether a person is at risk of obesity and related conditions, but it’s far from a perfect indication of your overall health,” Dr. Griebeler states.
What is set point theory?
If you’re living with obesity, you know that losing weight — and sustaining weight loss — can be a monumental challenge.
Set point theory is a scientific explanation for that phenomenon. It says that your body mounts a defense to keep you from losing weight. The idea is basically that your body fights tooth and nail to keep weight on. And it thinks it’s doing you a favor.
“What we see all the time is that people will change their diet and exercise to lose weight, and maybe they will lose some weight at first. But then their weight will hit a plateau and get stuck there,” Dr. Griebeler says. “That’s because there’s a difference between losing weight and changing your set point. If you’re going to have lasting weight loss, you need to change the set point.” (And that’s possible. More on that later.)
How your body reacts to weight loss
Diet and exercise are supposed to be the path to getting to a healthy weight, right? At least that’s what everyone seems to say. So, why aren’t you getting results?
The issue is that your body doesn’t want to give up the weight. And it has some built-in defense mechanisms to keep you at your set point.
As you work to lose weight, your body reacts by releasing more ghrelin hormones. Those are the ones that make you feel hungry. And it sends out less of the leptin hormone (the one that makes you feel full).
So, it’s not just in your head. As you diet, the very inner workings of your body are conspiring to make you feel like you need to eat more.
“Fighting back against those hormones is very difficult,” Dr. Griebeler notes. “The hunger you feel isn’t an indication that you’re lacking in willpower. It’s a hormonal change that makes it very difficult for you to stick to your diet in the long term.”
In addition to hormonal changes, dieting changes the way your body metabolizes your food.
“When you lose weight, you start by losing fat,” Dr. Griebeler explains. “But when you have less fat, you burn fewer calories. It’s a vicious cycle.”
What’s more is that when you restrict calories, you can begin to lose muscle mass, which also is counterproductive. Muscle burns calories faster than fat.
So now, for all your hard work, what do you have to show? You have less fat and less muscle, all of which means less opportunity to burn off calories.
Set point and evolution
There’s a method to this madness. Your set point is an evolutionary adaptation that’s trying to keep you healthy … it’s just not very useful to us these days.
“Every time there’s an opportunity, your body will try to defend you from losing weight because it’s trying to protect you from starvation,” Dr. Griebeler says.
In terms of human evolution, starvation was one of the greatest threats to humanity since the beginning. For most of the time that people have been on Earth, food hasn’t been as accessible as it is today. (Of course, it’s still true that in many places, access to food — especially to nutritious food — remains a huge barrier. But these days, most of our dinner plans don’t revolve around hunting buffalo and gathering berries in the way our early ancestors did.)
So, our bodies adapted to protect us from the threat of starvation. Our evolution created pathways to ensure that when our caloric intake drops from the level our bodies are accustomed to, we would continue to function by holding on to the calories we’re taking in.
That evolution was essential to our survival back in the days when we relied on a bountiful crop to last through a long winter. It’s much less helpful in a modern world of supermarkets and convenience foods.
We evolved a set point to fend off starvation, meaning your body will work to keep you at or close to your weight at its higher point. It won’t keep you from gaining weight in the first place.
How to get to a healthy weight
So, the question becomes: If you’re trying to lose weight, how do you overcome an evolutionary adaptation that wants you to hold on to every pound?
“We have to remember that your body reacts and will behave differently on the journey to weight loss. That’s not a surprise,” Dr. Griebeler says. “But it is really frustrating for people when they hit those weight-loss plateaus and their methods for weight loss aren’t showing them results anymore.”
He adds that while diet and exercise alone may not be enough, they’re still an important part of the equation.
Changing your set point
You probably already know that losing weight is a matter of lowering your calorie intake and getting more exercise. Check.
But changing your set point to manage your weight for the long term is more complicated.
In order to achieve long-term weight loss, you need to convince your body that you’re safe and healthy at a lower weight.
The good news is that it is possible to change your set point, especially if your healthcare provider, preferably an obesity specialist, is on your side.
“Working with a provider can help you to gain perspective on why your weight is plateauing,” Dr. Griebeler says. “They can also help you find solutions to change your set point so you find lasting effects.”
What does it take to change your set point? Dr. Griebeler helps break it down.
We know, we know — dieting isn’t working. We get it. But in order to change your set point, what you eat is still one slice of the metaphorical pie.
The key is that you should be eating nutritious foods — like lean proteins and lots of fruits and veggies. The Mediterranean diet is a good choice. But don’t limit your caloric intake too much too fast.
Remember, your set point kicks in to keep you from starving. So, if you hyper-restrict your diet, your body is going to think you’re in danger and will send in the hunger hormones to try to fight against it.
Again, you already know that exercise is important. You’ve heard that before. Too many times probably.
But exercise is still important to change your set point. And the kind of exercise matters.
“When you exercise, you burn calories, of course, but also, there is a potential for muscle mass preservation and to gain muscle mass,” Dr. Griebeler explains. “Preserving and adding muscle mass will change your metabolic rate and help change your set point.”
That’s because muscle burns calories faster than fat does. So, more muscle mass will help you overcome the weight-loss plateau and lower your set point. Strength-training exercises like lifting weights, Pilates and kettlebell training can be especially beneficial.
You may find that your BMI can stay flat or even notch up a bit as you gain muscle. That’s OK.
Muscle weighs more than fat, so gaining muscle may naturally raise your BMI, but it’s healthier for your body to replace fat cells with muscle, even if the scale says otherwise.
“People may feel frustrated when they’re not seeing weight loss, but when you’re changing your body composition to be more muscular, that’s success,” reassures Dr. Griebeler. “Even if you’re maintaining your weight, if that weight is a reflection of gaining muscle, that’s fantastic.”
In our busy lives, it’s easy to overlook the importance of getting good sleep. More than a chance to let your mind clock out for a few hours, sleep is an integral part of a healthy lifestyle.
In terms of its impact on your set point, sleep is important for hormone regulation. Research shows that not getting enough sleep is associated with more hunger hormones and less of those “full” hormones. Keeping a regular sleep schedule, about eight hours per night for most adults, can help keep those hormones in check and reset your set point.
Similar to the effects of sleep deprivation, living with a high level of stress does a number on the hormones that regulate your appetite.
Keeping your stress at a manageable level, through techniques like meditation, deep breathing and yoga (also a great exercise for your body) can help lower your set point and improve your quality of life. Win-win!
Dr. Griebeler says anti-obesity medication is proven to help you lose weight and lower your set point.
Anti-obesity medications work by making you feel fuller sooner or decreasing your appetite. These medications must be prescribed by a healthcare provider who should oversee their use.
While using anti-obesity medication, you’ll need to still stick to a healthy lifestyle that includes healthy eating, exercise, sleep and stress management. Consider the medication a complement to those strategies. It’s important to keep up other healthy habits to sustain your weight loss in the long haul and keep your set point at a lower level.
Bariatric and metabolic surgery (sometimes called “weight loss surgery”) has been around since the 1970s and is available to a lot of people living with obesity.
The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) are the leading authorities on bariatric surgery. Their research shows that people who undergo bariatric and metabolic surgery see “significant improvement in metabolic disease.” In other words, the surgery can work to lower your set point.
Just as with anti-obesity medication, people who have bariatric surgery need to continue to practice healthy habits in order to keep their set point at a lower level.
If you’re living with obesity and aren’t seeing lasting results from your efforts at weight loss, try not to be too hard on yourself. It’s undoubtedly frustrating to not see your efforts pay off. But know that you’re doing the best you can and that help is available. Talk with a healthcare provider or obesity specialist to better understand how you can reset your set point.