Wednesday, March 25, 2015

The Nutrition Debate #299: The Set Point: Why Maintaining Weight Loss is So Hard

The excerpt from the Lancet Diabetes and Endocrinology comment in The Nutrition Debate #297, “Obesity in Remission,” brought to mind a segment from “Choices,” the 2nd of four hour-long videos reviewed in The Nutrition Debate #275, “Weight of the Nation,” published on 12/31/14. You might have missed it. But if you are having trouble losing weight or, having been successful in the past, are now putting weight back on (as I am), you should read #297, and this blog post.

Starting at minute 17:00 in “Choices,” Rudolph Leibel, MD, Co-Director of the New York Obesity Research Center at the Columbia University Medical Center, says, “Individuals losing weight are NOT metabolically the same as they were before they lost weight.” “The weight reduced individual will be requiring about 20% less (sic) calories per day relative to what somebody of that weight who’s never lost weight would eat…in order to keep at that body weight,” he says
“Consider two individuals – same gender, same age, exactly the same body weight – one of whom is at that body weight as a result of let’s say a 10 or 15% weight reduction, the other who’s been at that weight for their entire adult life. If that reduced weight individual goes out to lunch with her friend, and they both order the same meal, that will represent a 20% overeating for the weight-reduced individual, and be quite normal for the individual who’s not in that state. Twenty percent might seem like a little, but 20% excess calorie intake a year will account for the inexorable weight regain.”

“As far as we know, this phenomenon does not go away,” Dr Leibel says. “So, being successful for a year or two doesn’t mean that you’re going to be able to go back to eating what would be appropriate for a person who’s never lost weight.”

“Does that seem unfair?” an off-camera voice asks an overweight woman. “Sure, it does seem unfair. It’s unfair that, you know, I just can’t lose the weight and go back to the way a normal thin person lives their life, but that’s part of the price you pay for allowing yourself to get overweight in the first place,” the woman responds. Okay, that’s the thinking of this well-meaning and very well-funded, widely-viewed and deeply-flawed HBO series. Forget for a minute who funded it.

You can choose to blame yourself for following the Government’s Dietary Guidelines since 1977, and your doctor’s advice at least since 1961 when the American Heart Association started telling you to eat less saturated fat and cholesterol. That’s when Agribusiness starting making more “low-fat” manufactured foods with added sugars and processed carbohydrates.

Or you can choose to eat many fewer carbs and more fat – both saturated and monounsaturated, but not polyunsaturated fats (vegetable and seed oils). You will feel fuller when you eat fatty meats and fish and a few low-carb veggies. Fat satiates. Protein digests slowly. Your blood sugar will stabilize, your blood lipids will improve, your inflammatory markers will too, and as you lose weight, without hunger, your blood pressure should come down too. All these good things happened to me.

And when I regained some of the weight I lost, but continued to eat low-carb, high-fat – just too much of it – the only thing that went up was the number on the scale. Like many of my readers, I have a “biological predisposition for energy storage” and I live in “an environment that promotes high energy intake” (both carbs and fat). The RESULT: an obesity–promoting interaction between the two (weight gain). This condition is both chronic and, at times, treatment-resistant. I like to eat.


  1. Boy, do I know this story! I think you might add that as your weight goes down, your body also requires fewer calories to keep it going, so there are even fewer calories necessary in a day. If I go over 1000 a day, I gain weight. It has been easy for me to reach and maintain good blood sugar levels (A1C between 4.9 and 5.2 for 8 years now) but weight is constantly a challenge. A calorie restricted diet is a cheap one, though. My grocery bill is pretty low.

  2. You make my laugh. I know, I know. When I first started off (at 375 pounds), I lost 2lbs/week eating well over 2,000 calories a day. Now, like you, I must do much lower to lose at a steady rate. As you know my routine (if I stayed on it) is just 1,200 cal/day. But I have trouble sticking to it the way I used to when I originally lost, in 2 spurts, 170 pounds. Now, if I want to lose weight in an accelerated way, I eat 800-1,000 cal/day. I can do this pretty easily, but it makes my wife angry. She wants to prepare a supper that we can both sit down to. She doesn't care if I eat lunch. She married me, she says, for better or worse, but not for lunch. So, we eat breakfast together (me: 3 eggs, 1 strip of bacon, coffee with stevia powder and 4 Tbs H&H); then I don't eat again until I get hungry; maybe 5PM, when I eat a can of sardines in olive oil. Combined, that's 750 calories. Later, to feed my biome, I eat 1/2 bag of raw, cultured sauerkraut (10-11 ounces), including the juice. I've been having some difficuties for a few weeks since a routine colonoscopy prep with PEG stripped my colon of both good and bad colonies. I think I now have it under control, finally. Anyway, that's about 800 calories a day, leaving me just a little room to cheat. My cheats this week have bee butter and or mayo, on an ounce slab of cheese.

    Re cost, I agree. one of my favorite meals is a grass fed rack of lamb chops. A rack produces a couple of meals, since we each eat just 2 small lamb chops per meal. Good portion control, and very good, fatty, grass-fed meat.

    On Saturday we fly to Barbados for a week. I've already declared I'm going to eat fish every day for supper, specifically an appetizer portion only, and only if it's not fried. That might be tough. Every menu is full of fried stuff.

    As to blood sugar, my "pre-diabetic" FBGs of late have dropped again into the 90s when I eat the way I described above, but I'm afraid the days are long gone when I will ever see an A1c below mid 5s. My last was 5.9 as I recall. I guess I need to "do what I say" more consistently.

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