Think back to high school biology class. We all learned how we pump blood with our circulatory system and how we breathe with our respiratory system. But there is another major system that didn’t make it into our high school biology textbooks. This system, at the heart of our weight and health struggles, has been widely ignored by health and fitness experts. It is what scientists call the homeostatic control system, lipostat, adiposity negative feedback system, or more simply, the set-point.
We already understand the idea of the set-point intuitively—we just call it metabolism. We see someone who eats a lot and looks like a beanpole and say, “Sam’s so lucky to have a fast metabolism.” Or we notice that we’re not eating any more or exercising any less but seem to be gaining weight and think, “My metabolism must be slowing down.” Little do we know that our intuition is reflecting the last seventy years of biological investigation. What we call a fast metabolism is what researchers call a “low set-point” and what we call a slow metabolism is what researchers call a “high set-point.”
Simply put, our set-point is determined by a series of hormonal signals released from our gut, pancreas, and fat cells, which travel to the hypothalamus in the brain. The brain then regulates how much we eat, how many calories we burn, and how much body fat we store long term through various hormones and neurotransmitters, such as serotonin, leptin, and ghrelin.* Our “set-point weight” refers to the level of stored fat our body automatically works to maintain regardless of the quantity of calories we take in or burn off. Our set-point explains why it’s so hard to keep fat off through traditional diet and exercise techniques. It also explains why obese people do not keep getting heavier and heavier until they explode.
I know that last part sounds silly, but seriously—why don’t obese individuals gain weight forever? If their eating and exercise habits got them to weigh 450 pounds, why won’t they eventually weigh 4,500 pounds? These individuals somehow automatically stop gaining weight. How does that work with conventional calorie counting?
It doesn’t.
Long-term fat gain works like this: a person’s hormones go haywire, causing his set-point weight to rise, and then his body fights to keep him storing more fat. “Obesity is not a disorder of body weight regulation,” says David S. Weigle, MD, of the University of Washington School of Medicine and Harborview Medical Center.10 Most obese people hold a stable weight around their elevated set-point weight. Obesity is simply the result of the body defending this elevated weight—but in a very regulated way. A heavy person’s higher set-point prompts the body to store more fat in just the same way that a thin person’s lower set-point prompts the body to burn more fat.
We all have a set-point—and that’s what determines how slim or stocky we are long term. Not calorie counting.
I know this is a huge departure from what we’ve been told over the past few decades, but look where that information has taken us. Keep in mind that nobody even knew what a calorie was—let alone about counting them—until the concept was introduced to the chemistry community in the mid-1800s. Then it wasn’t until the mid-1900s—ironically, just before the beginning of the obesity epidemic—that the concept of calories made it into mainstream diet and health literature. If calorie counting is required for long-term health and fitness, why were the rates of obesity, diabetes, and heart disease so much lower before we even knew what a calorie was?
The explanation is that up until a few decades ago we ate foods that maintained our body’s ability to balance calories automatically around a slim set-point weight. In other words, for the past forty years, we’ve been told to eat things that prevent our body from doing what it did for the entirety of human history—stay healthy and fit, automatically.
To be clear, this isn’t controversial. Only two things need to be tested to prove that our body works to automatically regulate our body weight around a set-point:
1. If a healthy person eats less of her existing diet, does her body automatically take steps to prevent fat loss? Most simply, does her metabolism slow down?
2. If a healthy person eats more of his existing diet, does his body automatically take steps to prevent fat gain? Most simply, does his metabolism speed up?
Studies have consistently and clearly answered yes to both of these questions. The biochemical fact that the body unconsciously regulates body-fat levels within a set range is no more debatable than the fact that the body unconsciously regulates blood sugar within a set range. The days of the set-point “theory” are as long gone as the days of the “theory” that the earth revolves around the sun. We can now overcome obesity by healing—rather than fighting against—the proven biological system that balances our weight.
Do calories count? Of course. But can we really count them—even if we wanted to? As Randy Seely, PhD, director of the Diabetes and Obesity Center at the University of Cincinnati, cleverly tells us: “You couldn’t find a scale [sensitive enough to count calories accurately], and if you did, the crumbs you accidentally dropped on the floor would completely throw off your calculations.”11
Do Calories Count or Not?
Calories count. However, counting them can’t be necessary for health, considering that before most people knew what a calorie was about 90 percent of the population avoided obesity and over 99 percent of us avoided type 2 diabetes.
STARTLING SET-POINT STUDIES
In a series of fascinating studies testing the set-point, University of Cincinnati researchers surgically removed and added body fat to various animals. Animals with body fat surgically removed then replaced “exactly the mass of fat which was taken.”12 Animals with body fat surgically added automatically burned more body fat until their body fat returned to its set-point.
In other studies, scientists had human subjects intentionally overeat. The results showed that the participants gained less weight than was predicted by calorie math, stopped gaining weight completely at a certain point, and then eventually returned to their original weight when they stopped overeating. You can see the pivotal role that the set-point plays in our metabolism.
Knowing that our initial set-point is determined by our genetics (studies show 40 percent to 70 percent of weight is genetically determined), researchers also tested twins to prove the power of the set-point. Identical twins share the same genes and therefore the same initial set-point. One study tested two sets: let’s call them the Smith twins and the Thomas twins. Given 1,000 excess calories per day, would the Smith twins and Thomas twins all gain the same amount of body fat as predicted by conventional theory, or would the set-point for the Smiths produce a weight gain different from the Thomases’?
Different. Very different.
The Smiths both gained the same amount of weight because they had the same set-point. So did the Thomases. But weight gain varied by nearly four times between the two sets of twins because they had different set-points. For example, while the Smiths each gained two pounds, the Thomas twins each gained eight pounds.
Exercise works the same way. In studies where pairs of twins are put through the same exercise program and have their diets held constant, each pair of identical twins sees the same changes in body composition, but the amount of fat lost varies between the pairs thanks to the varying set-points. Same diets, same exercise, same set-points, same results. Different set-points, different results.
Our set-point determines our long-term weight. If our weight is elevated, it’s because our set-point is elevated thanks to what I call a “hormonal clog.”
AN ELEVATED SET-POINT IS LIKE A CLOGGED SINK
When our hormones change, our set-point changes. This is why we gain weight as we age. We aren’t becoming lazier and hungrier with each passing year (well, maybe a little). As we age our hormones change. The technical term for this is metabolic dysregulation, but it’s easier to think of as a hormonal clog.
When we become hormonally clogged, our body can no longer respond to signals from our hormones and brain that otherwise enable us to burn body fat automatically. However, when we increase the quality of our eating and exercise, we can heal our hormones, “unclog,” lower our set-point, and get our body to burn fat instead of store fat.
An easy way to understand how this hormonal clog elevates your set-point is to think about your body as being like a sink. When a sink is working properly, more water poured in means more water drains out. The water level may rise temporarily, but the sink will automatically take care of that. The sink is balancing water in and water out at a low level. The sink has a low set-point.
A hormonally healthy body works similarly, doing its best to automatically keep excess fat from sticking around. That’s why we each haven’t gained the 1,333 pounds we should have gained since the 1970s. A healthy body, like a “healthy” sink, responds to more in with more out, and to less in with less out. Water builds up in sinks, and fat builds up in bodies, only when they become clogged. The key question then is: what causes clogs?
Sinks and bodies become clogged and break down when the wrong quality of things are put in them. This is why we don’t worry about washing our hands as quickly as possible, but we do work to keep hair out of our drains. We know no quantity of the right quality will ever cause our sink to clog. Low quality, not high quantity, causes clogs.
Now, once clogs happen, any amount of water in will cause the water level to rise and stay high. We have a sink with an elevated set-point. What do we do next?
We could use less water for the rest of our lives, or we could use the same amount of water but spend an hour or two per day bailing excess water out of the sink. But why go through all that hassle when we could fix the underlying problem by unclogging the sink and let it balance things out for us automatically around a lower set-point?
Think of our body the same way. When we put the wrong quality of food into it, our body becomes hormonally clogged, causing it to automatically balance us out at an elevated level of body fat. Like a backed-up sink with stagnant water sitting in it, we end up with a bunch of stangnant fat sitting in our body. These clogs can eventually lead to obesity and diabetes.
Once we’re clogged and our body is balancing us at an elevated set-point weight, we could eat less of our existing diet, and that would temporarily lower our weight. But why struggle through starvation? That’s just like turning the faucet down. It doesn’t actually fix anything and it’s tough to keep the faucet down forever. We could also do more traditional cardiovascular exercises such as jogging. But why? That’s like bailing water out of the sink. It’s time consuming and doesn’t fix anything long term. The underlying cause of our fat gain persists.
Consider a startling long-term weight-loss study published in the New England Journal of Medicine. Fifty men and postmenopausal women forced themselves to eat less for ten weeks and lost weight.13 Success!
Not so fast. We’ve all lost weight—the issue is losing it healthfully and keeping it off practically. In response to the study participants’ attempts to override their biology, the hormones that regulate their set-points* changed. The result? Their appetite increased and their calorie burn decreased. Biology was trying to return them to their set-point.
Fascinating, but not novel—this finding has been demonstrated in studies for decades. What sets this study apart is what the researchers discovered one year after the starvation diet: many of these alterations in appetite and calorie burn persisted for twelve months after weight loss, even after the start of weight regain. Researchers suggest that the high rate of relapse among obese people who have lost weight has a strong physiological basis and is not simply because they went back to their old habits. Participants who were below their set-point weight still showcased a body engaged in multiple compensatory mechanisms to do everything it could to restore its set-point weight a full year after the calorie-counting “success.” Appetite was still increased and “greater-than-predicted” drops in energy expenditure were still observed—the body was “vigorously resisting” the weight loss and trying desperately to regain the weight.14
We can avoid this unnecessary hassle and hunger by healing our hormones and restoring our body’s ability to balance us out at a lower level of body fat. “If the goal is substantial and sustainable weight loss . . . a more promising approach would be one based upon a strategy of directly altering the set-point. . . . The physiologic adjustments that ordinarily act to resist weight change . . . would instead facilitate the achievement and subsequent maintenance of a lower weight.” says Richard Keesey, PhD, of the Department of Psychology at the University of Wisconsin–Madison.15 By focusing our efforts on restoring the natural set-point, we can stop obsessing over diet and exercise and allow the body to do what comes naturally.
Lose 135 Pounds in Twelve Months without Counting Calories or Being Hungry: Robert’s Story
Robert was fed up: “If you think the medical issues that come along with weighing 360 pounds are a challenge, they pale in comparison with the ostracism and low self-confidence that tag along for the ride.” Robert had been active and heavy his whole life. He was surrounded by slimmer friends and coworkers who ate more and exercised less than he did.