Our Weight is Regulated by Our Biological System

- POSTED ON: Oct 01, 2017

I continually read a great many books, articles, blogs, and forum posts on the subject of obesity.

No one,…. not even the most qualified medical doctor or scientist, … knows everything or holds only beliefs that are absolutely correct.

However, I am often amazed by the vast amount of existing misconceptions, myths, and wishful-thinking that gets spread and promoted by people who present themselves as obesity “experts” or “gurus”.

One thing that Scientists know for sure about obesity management, is the sad fact, that no diet, exercise, medication, not even bariatric surgery, will permanently reset the body’s tendency to defend and regain its body weight to its set point .... this generally being the highest weight that has been achieved and maintained for a notable length of time.

Thus, any effective long-term treatment MUST OFFSET the complex neurobiology which is designed to eventually doom every weight-loss attempt to ultimately "fail".

A comprehensive review recently published in Endocrine Reviews describes the complexity of  the biological system that regulates our body weight.

The 30+ page research paper, backed by about 350 scientific citations, was written by the undisputed leaders in the medical field of Endocrinology (Michael Schwartz, Randy Seeley, Eric Ravussin, Rudolph Leibel and colleagues)  and is actually a “Scientific Statement” from the Endocrine Society. 

In other words, these Scientists know that they are talking about when they speak about the Science of Energy Balance, and in this paper they outline in excruciating scientific detail just how complex the biological system that regulates, defends, and restores body weight actually is.

From the Abstract of this research paper:

We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained.

A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time.

Growing evidence suggests that
obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight.

Their position is that, despite all we have learned about this system, we are still far from fully understanding it.

Science knows about one of the pathways, but there are many pathways in a complex network of multiple interacting pathways that involve virtually every part of the brain.

They say that the medical field currently needs a great deal more information about the specifics of this issue:

The identification of neuromolecular mechanisms that integrate short-term and long-term control of feeding behavior, such that calorie intake precisely matches energy expenditure over long time intervals, will almost certainly enable better preventive and therapeutic approaches to obesity.”

To be viable, theories of obesity pathogenesis must account not only for how excess body fat is acquired, but also for how excess body fat comes to be biologically defended.

Answering this question requires an improved understanding of the neuro-molecular elements that underlie a “defended” level of body fat. What are the molecular/neuroanatomic predicates that help establish and defend a “set point” for adiposity? How do these elements regulate feeding behavior and/or energy expenditure, so as to achieve long-term energy balance?
By what mechanisms is an apparently higher set point established and defended in individuals who are obese?”

They conclude that:

Given that recovery of lost weight ... (the normal, physiological response to weight loss irrespective of one’s starting weight) ... is the largest single obstacle to effective long-term weight loss, we cannot overstate the importance of a coherent understanding of obesity-associated alterations of the energy homeostasis system.”

So, in essence, this scientific paper shows why no simple solution to obesity is in sight; details the existence of an enormous Problem; and raises Questions for which Science still needs to find answers.

To get a simple explanation of the basic concept, see: Set Point. 

Any “health & wellness” professional, medical doctor, or guru who claims that any particular Diet, Behavior, or LifeStyle can fundamentally change the part of the body’s biology which acts to protect and restore body fat in the long term is Simply Wrong. 

They are either spreading a Lie, sharing a Myth, or offering a hypothesis for which no proof or reasonable evidence exists… which means that they are simply sharing their own Wishful-Thinking.

At this point, all credible Scientific Research indicates the following:

No matter how much weight gets lost, or is maintained for the short-term, …
No matter whether that weight loss was slow or fast, ...
No matter when food intake occurs ...

No matter whether “unprocessed” or “healthy” food is eaten, ...

Ultimately NO diet or behavior
manages to “reset” the body-weight set point to a lower level,
in order to biologically “stabilize” weight loss for the long-term.

NOTE: Originally posted on 7/23/2017.  Bumped up for new viewers.

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Existing Comments:

On Jul 13, 2017 AJ wrote:
I don't mean to get off topic, but are you still on a very restricted calorie count? I don't count calories, but I eat two smallish meals a day, most days, and I think I'm losing more of my hair than usual (I'm 61 y/o). Have you had that problem? Also, with your restricted calorie count, how do you deal with parties, picnics, vacations, etc...?

On Jul 14, 2017 Dr. Collins wrote:
             Hi AJ. Yes. The reason that I have maintained my large weight-loss for the past 11+ years is that I am STILL doing the things I did to lose weight, AND now... even though I am eating far less than I did WHILE I was losing weight originally ... my weight keeps slowly creeping up. Today, I am just above the BMI of "normal" and doing my best to drop a few pounds are at least keep my weight from going further up. You can easily find reports on my current details, as well as my entire history here in the BLOG CATEGORY: Status Reports. 25 years ago, right after my RNY my hair thinned out, but came back, and at present (age 72) my hair might be a bit thinner than in the past, but I've always had a great deal of thick, curly hair, and so there's still plenty left. I deal with social events and special occasions just like everyone else, except I work very hard to eat less than other people. Even when I overeat - it is always my conscious choice and I keep track of everything I've had, write everything down, and enter it into my computer food log ASAP that same day. I do this EVERY SINGLE DAY - including EVERY DAY when I choose to eat "too much". I am not Perfect, and I am unable to eat as little food as my body requires in a perfect way. BUT, I hold myself accountable for every bite, every day, and Face my food log, calorie count, and scale weight every day. For ME, I find that one individual day of overeating, ...not binging or gluttoney - just overeating - requires about 7 to 10 days of undereating to drop my calorie average and my weight back down to where it was Before I over indulged. At this point, my daily average calorie count is in the 700 range, undereating is defined as around 300 to 400 calories, and overeating is defined as between 1000 and 1400 calories. For the past 11+ years, in order to keep from regaining all of my lost weight, back up to my Set Point in severe morbid obesity, it has been necessary for me to be vigilent with my food ALL of the Time. I have been fighting my biological system for a very long time, and it is my intention to continue doing so. I know that FOR ME, if I stop the battle and eat ONLY WHAT MY BODY TELLS ME TO EAT, I will again become morbidly obese very quickly. Yes, I get hungry. Yes I want to eat more. Yes it is Hard. But one-day-at-a-time, I am choosing to continually do what it takes to fight my own Body in order to keep it at or near a "normal" BMI.

On Jul 14, 2017 oolala53 wrote:
Phyllis, I've meant to ask you, despite the fact that you very often want to eat more than you can, do you FEEL better when you eat smaller amounts? And do you physically feel better now than you did when you weighed more? That may seem like a dumb question, but some people actually feel fine when they're bigger, if they don't feel judged for it. Tx.

On Jul 14, 2017 Dr. Collins wrote:
             Hi oolala, Yes, I've become accustomed to eating small amounts, both physically and psychologically, and I do feel much better eating small amounts of food. My ongoing struggle is to avoid eating small amounts FREQUENTLY. I know that psychologically, I feel much better around a normal weight than I ever did when my body was morbidly obese. Physically.... that's a harder call. I've been in good health for my entire life. 25 years ago, when I was morbidly obese, my body was a lot younger and in better physical condition than it is here at age 72. I remember that my feet and my back hurt, I got tired easily, and my body size got in the way of some of the things I wanted to do... but Physically... I was basically okay. I worked hard at my job, and around my house, and even though very fat, was in pretty good condition.. Now, as an elderly lady, at times some of my joints ache. I don't have a lot of energy, and I tend to get tired quickly , but I'm very fond of my inactive lifestyle, and there's nothing that I don't do that I wish to do. Thanks to years of Therapy in my younger years, I learned to like myself while I was still fat, and I feel the same about myself now. For ME, maintaining a "normal" weight is more of a vanity issue; together with a desire to avoid continuing to be a victim to our culture's fat bias; and as well along with a feeling of personal accomplishment due to the achievement of a life-long difficult goal. I can identify with, and admire, those fat people who allow their bodies to dictate how they eat and have learned to be comfortable living at their body's very high Set Point. However, I have not been able to accomplish that, and I don't believe that I have enough "healthy" years of life remaining for me to ever do so. For ME, maintaining my large weight-loss is worth the constant ongoing struggle. If I were 25 or 35 years old... with a great many years left to live... I might not feel the same way. One thing different about ME, I'veI never bought into our culture's hype about "Dieting for Health". ... or Working to BE HEALTHY". I see it differently. Personally, I don't believe that people have the kind of Control over their Health that our Culture's teaches, and I don't think that the way people eat, or the way they exercise has very much to do with getting or being or staying "Healthy". I think that this was B.S. even 150 years ago, when Kelloggs etc. first marketed their cereal etc with lots of claims about how eating their food would make people healthy or healthier, and I think it is B.S. now. Eggs were healthy, then not healthy, then healthy again. Lard and Bacon and salt and coffee etc. etc. etc. the same. My personal opinion... which is based on quite a lot of convincing evidence.... is that in general... Health has almost nothing to do with one's body size.

On Jul 14, 2017 gnelson651 wrote:
Have you seen the research that shows that those of us who are 65 and over require a higher BMI of between 23-33. The current BMI of 18.5-24.9 does not apply to seniors at this age group. These recent studies have found that seniors with a BMI of less than 23 have a shorter live span than those at the above 65+ BMI recommendations. For seniors it is more important to maintain proper nutrition and exercise than to maintain the normal BMI as recommended. Seniors are prone to malnutrition and it is better for those 65+ to maintain this higher BMI.

On Jul 14, 2017 Dr. Collins wrote:
             Yes, gnelson. I am very familiar with this research, and I agree with it. As I said in my answer above, I am PERSONALLY, not concerned about my health or my life span, and I never have been. For ME, maintaining my weight at or near my normal BMI is a psycological issue, not a physical one.

On Jul 15, 2017 TexArk wrote:
Thank you for continuing to post your personal evidence. You have been the bright light for me as we have discussed this issue over the years. I have never been morbidly obese but if I am not on a very restrictive low cal regime I will very quickly be up to my all time high (50 lbs overweight). This has happened to me for decades! Now at 70 (I still claim 5'7" although I am sure I have shrunk) I am having to eat even less. I am losing again averaging 900 calories. My past experience was that to maintain I would need to average 1200. We shall see if I can go that high this time around. But here is what I appreciate about what you have shared. In the past I believed that the reason I gained back what I had lost was because of the restriction and all the diets I had been on. I was training my body to eat less and was therefore resetting my metabolism and calorie needs. I resented the restriction and would binge. But the bingeing was not because of the restriction, it was because of the resentment about having to eat less. Not fair, etc.! This time around I am resigned for whatever time I have left on this earth to find ways like you have to restrict. Sometimes it will be up days, down days, but any overeating will have to be averaged in. Because I haven't had surgery, I can handle large volumes of food without ever feeling pain or indigestion. I am using that ability to fill up with vegetables. The volume is helping with time at the table as well as filling up. Of course two hours later I am hungry, but I am just trying to embrace that feeling. My health is also good and always has been. I have good genes. All of my relatives (with the exception of my mother who ate very healthy for her time...Adele Davis) lived up in their nineties. Actually the only obese aunt lived in good health until 102! I am having blood work done next week for a physical so we shall see. Anyway, just wanted to drop in to say thank you again for sharing.

On Jul 15, 2017 Dr. Collins wrote:
             TexArk, it's good to hear from you again. Thanks for your kind words, and for sharing what's going on with you. I place a high value on hearing from intelligent and thoughtful people such as you who have been part of my dieting world for quite a long time.

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