Let’s talk about weight.
One of the most enlightening moments of the Health At Every Size conference in Seattle last June was when we discussed the numerous factors that contribute to one persons weight. I think we’ve all heard that changing your weight is just a matter of calories in calories out. I certainly thought so. But the dieting cycle of loss & gain seemed to be an inevitable outcome and, as an RD, I felt like I’d failed my patients. My patients, on the other hand, felt like they’d failed me. Learning just how much affects weight, and the futility of the dieting cycle, has been incredibly eye opening and has forever changed my practice as a dietitian.
I truly believe that we should take weight out of the health equation; that you cannot judge a persons health based solely on their weight. Research demonstrates that every person has an “optimal healthy weight” for them, but that this weight may/not fall within the rigid constructs of the BMI. I believe that rather than focusing on weight, rather, we should focus on balanced eating, movement, stress reduction, getting enough sleep and other factors that promote health. Further, focusing on weight as the problem produces stigma, bias, discrimination, misrepresentation of health, disordered eating, mental and physical disease.
In the Name of Health
Have you ever heard that weight loss is 80% diet and 20% exercise? I honestly have no idea where that little factoid came from, but if I had a nickel… The assumption, here, is that we ultimately control our weight; that if our weight is above “normal” it’s our fault. And it’s a-okay for society to let us know if our weight is a problem in numerous, vicious, and often discriminatory ways.
One issue with this is that “shaming” someone into change isn’t effective, beneficial, loving, or Christ-like. Shame begets isolation. Compassion provides room for change. Shaming someone tends to make us feel better about ourselves, but isn’t typically in the interests of the person being shamed. It’s quite plausible that health practitioners that shame people into weight loss are doing so out of a deeper place of fear and personal anxiety with their own food & body.
It’s increasingly rare in our society that we condone telling someone to change who they are (race, gender, class, ethnicity, religion) to avoid discrimination and hate. But this does not seem to extend to weight. On the contrary, the pressure to change one’s weight to avoid ridicule, rejection, isolation, bullying, or a concerned lecture is socially acceptable and often encouraged – all under the guise of “concern for health”.
One of the most liberating and wonderful things I’ve discovered is that, after a review of the literature, the ‘lose weight for your health’ argument falls apart (see previous posts and webinars). Even still, thin remains a culturally accepted ideal; dieting a socially praised practice. As I often see with my college students, the fear of weight gain is much more tightly wrapped up in the perceived fear of social rejection, loss of control, and the ‘moral’ aspects we are taught that fat and thin signify (thin =smart & righteous; fat= dumb & sinful) rather than possible health consequences.
It begs the question, which are we truly more afraid of: the disease risk associated with fatness, or of the discrimination associated with fatness? Are we open to the significant health risks associated with dieting/weight cycling and disordered eating rather than risk the emotional turbulence associated with living in a fatter body? All questions to ponder as you continue reading.
Factors Involved in Weight
What is the biggest factor that controls our weight? Twin studies reveal that weight is largely controlled by genetics; in fact, around 75-80% of what your body wants to weigh is likely genetically determined.
So, what makes up the remaining 25-20%? Factors like epigenetics, socioeconomic status, access to food, access to medical care, stress, sleep, dieting history, disease, medication, trauma, nutrition and exercise, socio/cultural attitudes about food, biological environment, lifestyle habits and more…
Did you know that factors like your mom’s lifestyle habits while she was pregnant with you plays a role in your current weight today? Studies have shown that moms who diet during pregnancy are likely to bear children predisposed to higher weights. From a ‘survival of the species’ perspective, that is pretty cool. If the body thinks we are in a time of famine, it protects our offspring by writing genetic instructions for weight retention. For more, see this post on pregnancy & weight.
Epigenetics, as I understand it, is the way life choices can alter our genome. If the genome is a computer, the epigenome is the software that tells the computer what to do. The epigenome can be altered. Identical twins start out precisely the same genes, but as they age, their appearance and their health can diverge. As twins age, their epigenomes change remarkably based on their lifestyle. It’s not uncommon for one identical twin to develop a dreaded disease like cancer, while the other twin doesn’t. We can (and do) alter epigenetic tags in ourselves and in our children by our lifestyle choices, diet, exercise, exposure to pollutants, stress, medications, and more.
Studies suggest that, as twins age, epigenetic differences accumulate especially when their lifestyles differ. As the chemical tags that control our genes change, cell expression changes. Yo-yo dieting, disordered eating, and food deprivation are all ways we can alter our epigenetic tags. When the body is exposed to the severe stress of food-scarcity, it adapts in a variety of ways.
Set Point Weight Theory
When we restrict calorie intake (pick a diet, any diet), and the body perceives weight going down, or even the threat of weight going down… it reacts in some very interesting ways. We begin to produce more ghrelin, aka ‘hunger’ hormone. We produce more neuropeptide-y, and we also produce less leptin, or ‘fullness’ hormone. In very restrictive, long-term dieters, leptin levels can become virtually untraceable. Meaning, the drive to eat is high, and the body may not produce signals ‘fullness’ until long after the body’s weight has returned to a normal level.
(I like to note, here, that the human body doesn’t understand dieting. The body doesn’t comprehend that food is around; for all the body knows, it’s in a 3rd world country in a time of severe famine. And the fear of food-scarcity is one of the most primal fears a person can experience.)
The body also reacts when pushed above its natural set point weight. Leptin (fullness hormone) goes up, ghrelin (hunger hormone) goes down. As food/activity behaviors return to normal, weight normalizes as well. Studies have shown that patients who force-feed themselves beyond their caloric needs are able to gain weight; however, when the study ends and behavior normalizes, so does their weight.
Those who have struggled with eating disorders, weight cycling, or restrictive eating can attest to the discombobulation of hunger/fullness signals. It becomes nearly impossible to accurately gauge these signals until the body’s perceived threat of restriction or weight loss is gone. Someone with a chronic dieting history may have to maintain their healthy set point weight for many months, before they can accurately hear hunger/fullness signals.
The Minnesota Starvation Study
Ancel Keys discovered exactly this in his famous Minnesota Starvation Study. This experiment was conducted in 1944 and involved healthy young men with no history of disordered eating. Ancel Keys was specifically looking for a way to help survivors of the holocaust refeed and return to robust health.
The trial involved a period of time of watching the participants eat normally, followed by a three month period of extreme starvation (decreasing their calorie intake by about 2/3rds), and finally a three month period of refeeding & weight restoration. What surprised Ancel Keys was just how much starvation impacted the patient’s psychological function. Patients developed extreme amounts of anxiety, paranoia, social isolation, preoccupation with food, dis-regulation of hunger/fullness signals, and in some cases psychosis and self-harm. All of these symptoms can be attributed to the extreme stress of being underfed.
In the refeeding stage of the Minnesota Starvation Study, participants were allowed to eat as much as they wanted. The men reported eating until their ‘sides were splitting’ and still feeling intensely hungry. In some cases, binge-eating continued until well after participants had restored weight back to a healthy set point. Some men reported dis-regulation of hunger/fullness signals up to 2 years after the experiment concluded.
All of the participants restored weight back to their pre-study weight (not above, not below), with the exception of a few who appeared to maintain restrictive behaviors beyond the study’s conclusion.
We can learn so much from this study. A few points of interest: (1) the brain endures a high degree of psychological stress when the body is starved (2) that hunger/fullness signals can be discombobulated for years after someone has entered recovery from a restrictive eating disorder (3) the body has a remarkable way restoring/maintaining a homeostatic set-point weight.
Weight Over the Decades
“Then why are humans fatter now then we were 100 years ago?
Research suggests that the average American has gained about 1-lb per year since 1990 (Mokdad, AH JAMA. 282: 1519-1522).
Factors that can cause weight gain:
- Dieting: The number of Americans dieting has also increased dramatically. As we’ve discussed, several long-term studies have demonstrated that dieting and weight cycling increases likelihood of subsequent – and significant – weight gain. UCLA researchers reported,People on diets typically lose 5 to 10 percent of their starting weight in the first six months. […] However, at least one-third to two-thirds of people on diets regain more weight than they lost within four or five years, and the true number may well be significantly higher.Studies consistently find that dieting is a predictor of future weight gain, and as a culture obsessed with weight loss this may be a major factor in why our average weight has increased.
“…contrary to frequent medical insistence on the desirability of dieting, there are many undesirable facets, for there is an almost inevitable weight gain after dieting so that ‘the major treatment for obesity may also be the major cause of obesity.” [S. Wooley, O. Wooley, 2004]
Our cultural obsession with weight loss is undoubtably affecting the younger generations. Parental conversations with teens focused on weight statistically produces more dieting/weight control behaviors, as well as binge eating. This prospective study of 496 girls demonstrated that dieters in the study had a 3.24 times greater chance of “obesity” onset than non-dieters. The risk was no greater for girls who started overweight than those who were underweight or normal weight at baseline.
- Chronic stress
- Sleep deprivation
- Chronic disease
- Exposure to endocrine disruptors in our environment
- Low SES (socioeconomic status)
- Poor prenatal/maternal health, and more…
Remember how we talked about epigenetics (the software in our computers)? For whatever reason, when we experience some of the above stressors, the message our software puts out is, “accumulate fat.” Could this be a protective mechanism on the part of the body? Maybe so. Fat is a complex endocrine organ in our body, and having enough fat is essential for health and longevity. There is current research that demonstrates that people in the “overweight” BMI category have a greater longevity than those of “normal” BMI. There is also current research that shows “overweight/obese” persons with diabetes, heart disease, kidney disease, and hypertension actually show a greater longevity and decreased risk of death from disease. (See the “Show Me” tab for cited studies).
What is my set point weight?
Simply put, it’s where your weight falls when you are eating competently, joyfully, and in accordance with hunger/fullness. It’s how your body adjusts when you are doing sustainable and meaningful activity/exercise. Your natural set point is flexible. It will change with age, with life events, with pregnancy, with hormones, and with health. Let me re-emphasize, here, that your body weight will change; it’s meant to change as we get older. It is unrealistic for a 40-year-old to strive for the body they had when they were 20. Fat is shown to be protective in epidemiological studies; participants with higher body fat tend to have greater longevity and decreased risk of dying from chronic diseases like diabetes, heart disease, metabolic syndrome, and kidney disease.
Can I Change My Set Point Weight?
Yes and no.
Yes because, as we’ve talked about, lifestyle choices can definitely alter weight – but maybe not the way you’d hope. The goal of a diet is often weight loss, but the long-term effects of weight cycling are paradoxically weight gain and increased waist circumference. Is this altering set point weight- yes. Our body adapts to cycles of restrictive dieting by suppressing metabolism and thereby increasing our set point weight. Some case studies suggest that, given enough time and complete cessation of restrictive behaviors, the body may be able to return to an original set point weight.
It’s OKAY not to know…
Did you know you can decline to be weighed at the doctors? If the doc reeeeally needs to know your weight, you can be weighed backwards, aka “blind-weights”? You don’t have to know. If knowing your weight is unpleasant, stand up for yourself. You do not need to be weighed. Weight is not a measure of health. Read that again: weight is not a measure of health.
In the vast majority of cases, a person need not know their weight. (Heresy! you might think…) Yes, there are some illnesses that involve keeping a close eye on weight, congestive heart failure being one example (a sudden increase in weight can be a sign that heart failure is getting worse). But for the vast majority of us, we get by just fine (and may be better off) not knowing.
Work on implementing healthful habits and trust that your body will take care of the rest: eat food that you enjoy and that nourishes you, do activity that you find joyful and life-giving. Reduce your stress and get enough sleep.
Resist the notion that thinness is the path to happiness.
Chuck your scale in the trash.