This week I attended an international scientific and nutritional advisory board meeting in Toronto. The hosting company invited me to speak about issues related to cooking in my patient population, but topics of weight loss, weight maintenance, weight cycling, and set-point theory were also on the agenda.
Set-point theory and weight control
Regarding set-point theory (a theory related to energy balance), the idea is one of automatic regulation through feedback control. Think thermostat, except that instead of temperature what’s being regulated is energy stored in the body (mostly as fat).
When stored energy gets low, internal systems compensate by signaling for more fuel (i.e., we get hungry) and also by signaling to limit expenditure (e.g., we feel tired). Conversely, when energy stores are replete, there are signals to stop eating and to use fuel. The idea is that our bodies have negative feedback mechanisms to keep energy balance stable—around a “set point”—over time.
Such regulation can seem apparent in real life, to real people, in real situations. For example, let’s say you exert yourself (e.g., you do a workout). Do you feel like resting afterwards? Do you wind up eating more subsequently than you otherwise would have? Conversely, when you try to eat less than your body needs, do you become pre-occupied with thoughts of food? Do you feel disinclined to move?
Partly for these reasons, even when people are ultimately able to achieve some degree of weight loss in the short term, they often find themselves regaining weight in the long run. A common pattern is one of weight cycling (i.e., lose weight, then regain, then lose again, and repeat).
Of course, there are other reasons that people may gain or lose weight, or consume or exert energy, that may have little to do with “set points”. In fact, other theories of energy balance more comprehensively consider additional factors like social and environmental influences (e.g., your colleague’s birthday party with cake in the break room at work). Moreover, a relatively stable level of stored energy over time may be less “set” and actively defended than settled into and passively achieved.
Nonetheless, for many of my patients, and for many audience members from talks I’ve given both domestically and internationally, the idea of a “set point” in body weight resonates with their lived experience. Trying to eat less and move more against apparent automatic compensation seems futile. People lose weight and then gain it back despite great effort, determination, and resolve.
Not weight, think health
As a physician I’d like to help patients be more successful. Part of that job is convincing people that despite a near-universal focus on body weight, weight is not at all what matters. Success can’t be measured by pounds on a scale, and body weight consistently fails to reflect health (in study after study after study … after study after study after study).
I have seen patients grow heavier while becoming fitter, leaner, more muscular, and healthier. This is not a bad thing. I have also seen patients lose weight while becoming fatter and sicker. This is a tragedy.
Importantly, people can look great, feel well, and be healthy at almost any weight!
Again, the focus should not be on weight. Part of the focus should be on fat thought, particularly the fat in our bellies around our vital organs. Such intra-abdominal fat may not only be displeasing in terms of physical appearance, it leads to metabolic dysfunction and ill-health.
How do we avoid accumulating such fat? Sleep, exercise, and stress management are important. But what we eat is a principal concern and when it comes to improving the quality of our diets, there may be no single strategy more effective than cooking.
The challenge of cooking for better health
Unfortunately, cooking can be a challenge for many of my patients. My patients have always predominantly been individuals of lower income and of African, African American, or Caribbean descent. While such patients face several unique challenges to cooking and healthy eating, I suspect many challenges may be common to other individuals and groups.
Some of these challenges differ by generation and by gender. For example, for many of the young people I see, convenience and time considerations (within the context of busy personal schedules) matter a lot. As such, there is a troubling reliance on ultra-processed convenience fare among younger individuals, and many of my young patients are essentially growing up on fast food.
For my older patients, health is a more important concern than convenience. My older patients (often immigrants) frequently come from agricultural traditions and value organic farming, home gardening, and scratch cooking. Unfortunately, these older individuals often lack the financial means, transportation, and/or personal mobility to procure or prepare foods themselves.
Who does procure and prepare foods, in most cases, is women (usually women of middle age). My female patients tend to be self-reliant in the kitchen. They value family meals, using high quality ingredients, and preparing meals that are nutritious and complete. Sadly though, I have recognized an atrophy of cooking skills over the generations among my patients, with pre-prepared and processed items increasingly replacing fresh whole foods in the diet. This is bad news not only for women, but also for men, who are often happy to eat whatever their wives, girlfriends, mothers or other female household members provide them. It is also bad news for families, who likewise rely on female heads.
Regardless of who does the cooking though, a primary concern in food preparation is taste. In fact, in order to encourage people to eat healthier, patients have suggested strategies like “try it different ways’’, ‘‘dress it up’’, and make it flavorful. There is reluctance to give up cultural traditions like frying but there is also a desire to learn new ways to prepare foods, to allow for dishes that are healthy but also savory and satisfying.
Financial considerations are of course a concern too. Overall, my patients want meals that are affordable, easy-to-prepare, flavorful, and filling.
Don’t we all? If those of us in the food world can figure out ways make healthy foods meet these criteria, we would go a long way towards improving individuals’ health at any weight.