I hear it over and over again–the hardest part about losing weight is keeping it off. But is this really true? Or is it a myth that is put out by the multi-billion dollar weight loss industry to keep you from trying? Can you beat the undefeatable “set point weight”?
The set point theory states that the human body “gets stuck” at a certain weight and stays there for a prolonged period of time. Many experts believe that set point is the highest weight you have achieved. But why is this?
The Hormonal Conspiracy of Weight Regain
Several studies have shown that there is a “hormonal conspiracy” taking place that fights against maintaining weight loss. The most recent of these have been what is referred to as the Biggest Loser Studies. To put it simply, when you lose a considerable amount of weight, your metabolism drops, your hunger increases, and your ability to stay full decreases. Here are some reasons why:
- Metabolism is driven largely by muscle mass. When you lose 30 pounds, you are no longer carrying around a bag of dog food on your body every day so your muscle decreases with weight loss.
- Losing weight causes our primary hunger hormone (Ghrelin) which comes from the stomach to rise. Unfortunately, it never returns to previous levels even if you gain the weight back. This is one reason why yo-yo dieting can be so dangerous.
- There are many hormones that help keep us full (Amylin, Insulin, Leptin, GLP-1, PYY, and CCK are a few). When you lose weight, these hormones drop, and never return back to their former levels, making it harder to stay full.
So losing weight causes you to burn fewer calories, have increased hunger, and have a decreased ability to get full and stay full. Yes, this is disturbing information to share, but this is not the end of the story.
Lowering Your Set Point
To effectively combat this “conspiracy”, we need to fight fire with fire! It can be done. Here are some ways that are proven to work:
Increasing Your Metabolism
- Phentermine – Phentermine is a medication that has stood the test of time in the medical weight loss world. It’s been around since the 1950s and despite misinformation campaigns against it, has proven itself safe, effective, and is easily tolerated by the majority of patients I see. Phentermine increases metabolism by increasing heart rate slightly. It also simultaneously decreases hunger. It comes in a very low dose of 8 mg all the way up to 37.5 mg. The key to its effective use, like many medications, is to start low and go slow. It is meant for long-term use, and is on care algorithms for all the medical fields with expertise in treating obesity.
- Testosterone – Testosterone is not just for men! Women need it too. Due to increasing obesity rates, many men are walking around with low T and don’t even know it. For women, testosterone is made mostly in the ovaries, and levels start to drop as early as their late 30s. Since testosterone is responsible for muscle mass (and muscle drives metabolism), it makes sense to monitor it in men and women over the age of 35. Testosterone replacement makes a huge difference. At our clinic, we offer Bioidentical Hormone Therapy which uses tiny pellets sourced through yam sterols to increase hormone production.
- Consistent exercise – Both cardiovascular exercise and strength training can increase your metabolism in the short and long term. However, be careful not to overdo it, as too much exercise can cause you to overeat the benefits. I always tell my patients, “Titrate your exercise to your hunger levels.”
- A high protein diet – Protein feeds muscle, and muscle drives metabolism, so having adequate protein in your diet is essential. For weight loss, aim for at least half your weight in protein. During maintenance, it is best to have two to three 30-gram servings of protein per day to build muscle.4
Decreasing Your Hunger and Improving Satiety
- Anti-Obesity Medications (AOMs) – There are many AOMs out there that work beautifully to help control appetite during weight loss and are equally important during maintenance. We have already discussed Phentermine above and its many benefits. The class of medications called GLP-1s such as Wegovy, Ozempic, and Mounjaro are excellent examples of appetite-controlling medications. They are meant to be taken long-term and work beautifully during maintenance. Contrave and Qsymia are older drugs that work on suppressing appetite with the added benefits of controlling cravings.
- High protein/high fat meals – Protein and healthy fats help keep you full, causing you to have fewer cravings and consume less calories. Since protein is the key component to support muscle mass, it functions both to improve metabolism and promote satiety. Fat is satisfying as well and was unfortunately vilified in the 1980s by flawed data leading to the low-fat craze that sent our obesity rates skyrocketing. Eating healthy fats will keep you full, and promote good health!
- Getting adequate sleep – If you follow us on social media, you have undoubtedly heard me mention the importance of sleep and hunger. In fact, one of the best ways to get someone “unstuck” on their weight loss journey is to get them sleeping soundly. A four-year joint study by the University of Wisconsin and Stanford University found that adults who regularly slept for only five hours a night increased their levels of hunger-inducing ghrelin by 14.9% and lowered their levels of appetite-suppressing leptin by 15.5%. Work on sleep hygiene by getting off electronics early, using white noise, keeping your room cool, sticking to a healthy routine, and avoiding excessive alcohol and caffeine. Sleep IS everything!
So as you can see, it IS possible to reset your set point weight! It can be a challenge and it’s important to be persistent, but implementing the right strategies will help you reduce your set point weight in no time. Be sure to talk to your weight loss doctor and if you are in the Central New York area, come see us! At Medical Weight Loss, we are dedicated to supporting our patients through this process.