There are very few people out there who would disagree that the challenge is more in keeping lost weight off than in losing it in the first place. While there are many reasons why sustaining weight loss is challenging, one of the most common theories presented is that bodies have a set point for their weights, and if weight is lost, they will strive to regain until that set point is re-reached.
•The Body's Response to Weight Loss
•Strategies for Effective Weight Management
•Weight Maintenance: The Long-term Journey
The most basic understanding of set point theory is that the body has a set point weight wise, and if weight is lost, the body throws into motion metabolic and hormonal processes beyond our direct control to lead us back up to its set point. This theory of course is challenged by reality however, and perhaps no reality is more easily illustrative than migration. If set point were the primary determinant of our weights, the common story of a migrant’s weight going up once they move to North America would be a rarity.
This latter phenomenon is perhaps better described as settling point whereby a person’s body may indeed have a range of weights within which it will settle, and where settling depends on the environment in which that body is living. Genetics of course are responsible for the vast majority of the range, while the food environment and a person’s social determinants of health are responsible for where in that range a person’s weight settles.
Debate about set point theory validity aside, there’s no question that the body’s changes in response to weight loss are conducive to weight regain. Broadly, we describe those changes as metabolic adaptation and the thinking is the adaptation occurs because in the grand scheme of millions of years of evolution during times of caloric scarcity, the body adapting to needing fewer of them to survive would be advantageous.
Generally, in response to weight loss, and perhaps most especially in response to weight loss through extreme behavioural interventions (for instance The Biggest Loser style weight loss), we see metabolic rate decrease, while hunger hormones increase. Perhaps most especially in response to extreme behavioural interventions because when compared with similar weight losses achieved by way of bariatric surgery, contestants in the Biggest Loser saw far larger metabolic adaptations.
As with all weight loss intervention, the key to sustaining them long term doesn’t fail consequent to metabolic adaptation, but rather consequent to choosing dietary and behavioural strategies that themselves aren’t sustainable. Meaning that even with adaptation, though weight loss may be lesser than hoped for as a consequence, sustaining it depends plainly on liking one’s lifestyle enough to maintain it.
People don't regain most or all of their lost weight because their bodies effectively tell them to, they regain most or all of their lost weights because when they quit whatever diets they were on, they revert back to the diets they were consuming beforehand, and by diets, I also mean lifestyles.
For instance, they might stop packing their lunches and head back to their cafeterias, food courts, or drive thrus. They might resume their regular nights out with friends and go back to drinking more alcohol and/or sugar-sweetened beverages. They might bring back some (or more likely all) of the snack foods and indulgences that they'd cut out while "being good". They might return to their older pre-established automated portion sizes and of course their older pre-established dietary staples.
In short, people regain their lost weights when they regain their lost lifestyles, as doing so brings them directly back up to their pre-weight loss average daily caloric intakes which in turn supported their pre-weight loss weights.
The people who regain all of the weight they've lost with any given effort tend to be those who for various reasons, are unable to continue with their change efforts. Instead, likely, not all at once, their efforts wane, then end, and those people find their way back to all of the original behaviours, factors, and choices that they were living with prior to their changes. In turn, this brings back all of their old calories, eventually bringing their weights back to that same place where they were before (or perhaps even slightly higher consequent to metabolic adaptation leading them to burn fewer calories at a comparable weight than prior to their weight loss effort).
Why does this happen?
I think for a significant percentage of people it happens because the changes they employed were too severe. Maybe they were perpetually hungry, or denying themselves foods they loved and enjoyed, or they cut out entire food groups, or they found themselves unable to enjoy a meal out with friends, or regularly having to cook multiple meals (one for them, and one for their family). In short, the efforts many people undertake aren't by definition sustainable. They're for-now efforts, not for-good efforts. And I think the reason so many choose those types of approaches is that society (including the public health and research communities) generally describe total weight loss as the goalpost, and so people take on extreme efforts, because that's pretty much the only way to get there.
On the other hand, those individuals who lose weight and keep it off? Looking at those in the National Weight Control Registry, while they nearly never are people who lose every last ounce that some stupid table says they should, there are huge numbers of them who've managed to lose a subtotal amount of weight and keep it off. Knowing these people, reading about these people, their most common denominator is that they enjoy the new lifestyles they've crafted sufficiently so as not to perceive them as suffering.
If you want to lose weight, you're going to have to change some of those things that are within your control, but you're also going to have to pick changes that you can honestly enjoy if you want to keep the weight off. And different people, for a whole host of reasons, will have fewer things they're able to change, not to mention the fact that life and circumstances will also have a say as time goes by. But for everyone, change generally means embracing imperfection, still eating food for comfort and celebration, still socializing with friends and family, and more. And the degree of changes you'll be able to sustain will undoubtedly be impacted by many things beyond your control, and your physiology will undeniably limit your losses and the amount you're able to change without suffering. But that doesn't mean that physiology will prevent you from ever making any changes.
Maybe, if we all aimed for smaller, more realistic, less extreme, but all the while plainly sustainable changes, and as a society we stopped with Biggest Loser style efforts, and we redefined success, we'd see a great deal more of it.
Embracing imperfection is key. While no doubt there are changes all of us can make that will help us to lose weight, there’s also no doubt that life circumstances will come around that will derail them. Learning to be comfortable that may mean the difference between a temporary set back and a total regain.
Perhaps it’s easier to see with exercise. Everyone who has ever taken on an exercise routine has seen it interrupted. Whether by tragedy, illness, travel, injury or more it’s inevitable that strength and endurance don’t follow a straight line of increase, but rather see times where we lose the strength and endurance we once had. What we don’t do though is extrapolate a life led loss in strength or endurance to failure, but rather we understand that sometimes we need to regain strength and endurance we once had but which was understandably lost. The same of course is true for weight, where sometimes we need to repose weight that was already lost.
Set point theory is the notion that our bodies are intrinsically tuned to be a certain weight - a flawed notion which for some leads them to give up on their efforts to sustain change
Absolutely. Meaning rather than a single weight point, think instead of our weights being in a range where our genes may influence the range itself, but where lifestyle dictates where on that range we fall
Set point theory or not, there’s no denying metabolic adaptations occur consequent to weight loss - metabolism slows, the thermic effect of food is lessened, hunger grows. This may help to explain why sometimes it may seem that our weights are higher than our lifestyles should dictate.
The key to long term weight management is the adoption of strategies that allow a person to enjoy life with fewer calories. Working with a registered dietitian with expertise in weight management may help you to find those strategies
You need to like the life you’re living. That means having a relationship with food that still allows its use for comfort and celebration rather than the adoption of a highly strict diet that you know is only “for now” rather than for good.
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