Why Weight Loss is So Hard: Understanding the Obesity Set Point Theory

 In this episode of Your Checkup, we dive deep into the obesity set point theory—an often overlooked reason why losing weight and keeping it off can feel like an uphill battle. Learn how your body’s natural mechanisms may resist weight loss, why diets often fail, and what science suggests about overcoming these challenges. Whether you’re struggling with weight loss or simply curious about the science behind it, this episode will shed light on why it’s not just about willpower. 

Takeaways

Obesity is recognized as a chronic disease with serious health implications.
The metabolic set point theory explains why weight loss can be difficult.
Homeostasis plays a crucial role in maintaining body weight.
Lifestyle changes are essential for effective weight management.
80% of individuals who lose weight tend to regain it.
Eating plans should focus on long-term sustainability rather than short-term diets.
Mindful eating can help prevent mindless consumption of calories.
Understanding nutrition labels is vital for making informed food choices.
Weight management is influenced by various life events and environmental factors.

Keywords

obesity, metabolic set point, weight management, homeostasis, lifestyle changes, nutrition, calories, health education, chronic disease, mindful eating

Transcript

Ed Delesky, MD (00:02)
Hey, welcome back to your checkup. We are the patient education podcast where you bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky a family medicine resident in the Philadelphia area. And we are so excited that you can be here with us again today. Please forgive us if you hear Ali gnawing in the background on a bone. He's, but he is still working on getting updated on the source material.

Nicole Aruffo, RN (00:16)
and I'm Nicole Aruffo.

making his shank.

Ed Delesky, MD (00:33)
Were you guys a ShamWow family growing up?

I really like to hit you with these hot takes so that you don't really have time to prepare. No Sham Wows.

Nicole Aruffo, RN (00:44)
No, Mary wasn't, she's not into like the gimmicky things. Okay. She doesn't like a lot of stuff in the house. Okay.

Ed Delesky, MD (00:52)
Right,

fine. Were you guys a paper towel or towel family?

Nicole Aruffo, RN (00:57)
Both. I mean, they both have separate purposes.

Ed Delesky, MD (01:05)
Like big catastrophic spills for a towel and then minor ones for paper towels. OK. So we're sitting here drinking Ollipop. No, we're not sponsored at all by them, but they have some good fiber. But it brings to mind that I was called out in the office this week by one of the medical assistants that I work with. Apparently, last episode, we said that we don't drink soda at all.

Nicole Aruffo, RN (01:15)
It was so random.

Ed Delesky, MD (01:34)
which I suppose was a falsehood.

Nicole Aruffo, RN (01:37)
Yeah, because you're out here in the office drinking soda. Soda. diet soda.

Ed Delesky, MD (01:42)
Well, when I said

I meant like full caloric girth.

Nicole Aruffo, RN (01:48)
You

know, she was right to call you out. think it's the kind of girl you want to work with, you know?

Ed Delesky, MD (01:53)
So it turns out that diet soda is soda. So I'm a liar and I do drink soda. And I don't know if you would qualify this ollie pop as a soda. A new kind of soda. That's what they brand it as. So that's something fun. I think it's delicious. I'm drinking a lemon lime one.

Nicole Aruffo, RN (02:10)
We

were talking to go back to the soda thing. We were talking so did specifically it's sugar content. Right. And then the whole sugar thing and a diet soda is another whole thing that we're not going to talk about. But people also have their opinions on that. My mom's like itching to tell her opinion on fake sugar. I'm sure we're going to get a comment about it.

Ed Delesky, MD (02:29)
That's true.

I know she's so interested that like she'll leave these paragraph messages and maybe we just get her on.

Nicole Aruffo, RN (02:45)
She's one of those people that will show like sometimes drink a diet soda I think but she's one of those people like I feel like are like hyper sensitive to like that fake sugar taste She's not about it

Ed Delesky, MD (02:58)
We met the, you know, at the party this weekend, you met the voices and I believe Patty Boyce mainstreamed, ow, that was my knee, mainstream diet coke for a while there. But I'm unsure of her current habits, but that's one diet coke person that I'm really aware of. You got any other diet coke people that you know of? We swear we're gonna get talking about things soon, but we've heard that people like this initial part. So we just wanna chit chat in front of you guys.

So what are we going to talk about today, Nick? Speaking of sugar and all that jazz.

Nicole Aruffo, RN (03:33)
Today we're talking about the obesity metabolic set point.

Ed Delesky, MD (03:38)
Yep. So we've got this little course that we're building here about obesity as a chronic disease. And we've got one episode so far about what it means and why weight is important. Right. And then the next one was about

Nicole Aruffo, RN (03:54)
changing habits and tings.

Ed Delesky, MD (03:57)
Yep, habits and behaviors.

Nicole Aruffo, RN (04:00)
Yeah. And then the nutrition one that we just.

Ed Delesky, MD (04:02)
And

then we just did our basic balanced nutrition episode. So on this episode, what I'm hoping that we can kind of outline for you is why it's so darn hard. I don't know if damn is a word that I can include on here without making this explicit. Why it's so damn hard to lose weight. And it turns out that there's, it turns out that there's a really good reason for it. But let's set the table a little bit first.

Nicole Aruffo, RN (04:29)
Okay, so let's get started with a statistic because we love them. And it's estimated that by 2030, which is only six years away, which is kind of gross, that about 78 % of Americans will be overweight or obese. Jesus. boy.

Ed Delesky, MD (04:50)
Hopefully that doesn't happen. This is a projection but that

Nicole Aruffo, RN (04:53)
Honestly, feel like that number's a little low. Like honestly, I expected it to be more if it's not already there right now.

Ed Delesky, MD (05:03)
I think right now the number kind of hovers in the forties. Really? Yeah. That might be for obesity. I don't have that written down right here in front of me, but I think that's what I've been reading recently. So what we're trying to highlight here on this little mini series is that obesity is a chronic disease and it's associated with several comorbidities or diseases that happen with another disease. And that includes cancer, sleep apnea, stroke, arthritis, liver disease, cardiovascular disease, diabetes and hypertension.

all really commonly co-occur with obesity. I just wanted to reiterate those things to explain why it's important that we think about this. so obesity has been proven to be very, very hard to manage. And there are a few different theories about why this happens. And they're mainly theories because they are so molecular and down at this very minor, tiny level that it's very hard to prove.

Nicole Aruffo, RN (06:03)
He's really going at his own bone.

Ed Delesky, MD (06:05)
He's gonna have a whole shank by the end of the night. man. So what's the name of this theory that we're talking about today?

Nicole Aruffo, RN (06:12)
the set point theory. Do you want to tell us about it?

Ed Delesky, MD (06:16)
Sure. So the set point theory is based around a principle called homeostasis.

Nicole Aruffo, RN (06:24)
Why don't you let the people know what homeostasis is because a lot of them may not have heard that since like their seventh grade science class.

Ed Delesky, MD (06:32)
sure. Homeostasis is a scientific explanation of how systems in a body work together to maintain the delicate balance of life. And so when you relate homeostasis to the obesity set point theory, it explains that the human body has a predetermined weight or fat mass set point range in the environment that you're living in.

Nicole Aruffo, RN (07:01)
Hmm. Tell us more.

Ed Delesky, MD (07:05)
So the idea behind this is that in essence, when an individual, say they try to lose weight and they accomplish that, the body triggers appetite through increasing hunger hormones and it decreases the metabolism or your resting metabolic rate to drive the body back to its old weight to maintain homeostasis, which is that delicate balance of systems to maintain life. What do you think about this?

Nicole Aruffo, RN (07:35)
What do I think about it? I mean, it's pretty interesting. It like makes sense. I Like when people, I mean, we all know that, you know, like to lose weight, if you lose weight, quickly, this is probably like the biggest example. Like you lose weight quickly. You're probably going to gain it back. And a lot of that, a lot of that has to do with like lifestyle and doing something that's like sustainable and realistic and blah, blah, blah. But I mean,

Ed Delesky, MD (07:40)
I feel like it's really good.

Nicole Aruffo, RN (08:03)
feel like this also would play into it too. Especially if it's like a drastic weight change in a short amount of time.

Ed Delesky, MD (08:10)
Exactly. And about 80 % of individuals eventually regain the weight that they lose. And this set point theory includes, you know, when people gain weight and losing weight, but that mechanism isn't as strong as when people lose weight and the body's desire to get back to that old weight. Evolutionarily, there was a reason for this is that when people were, when food wasn't as abundant around,

it was a survival benefit to have more fat stores because people would live longer because you were able to maintain extra energy when there was a caloric restriction. Like, I mean, we're talking.

Nicole Aruffo, RN (08:50)
We

can blame the cavemen here for this one.

Ed Delesky, MD (08:52)
Yeah,

blame the cavemen. So there are multiple there's an understanding that various factors can change the set point, because you don't have one set point throughout your entire life, according to this theory. So there are different things, like big moments in people's lives that change the set point, including things like childbirth, menopause, aging, and an obesogenic environment, and other diseases. Explain how

People have multiple set points in their life.

Nicole Aruffo, RN (09:24)
Hmm.

Ed Delesky, MD (09:25)
I recently had someone come in who said like, yeah, I was 220 for so many years. Her lightest was 180.

Nicole Aruffo, RN (09:34)
was gonna say, you sound like my dad.

Ed Delesky, MD (09:36)
She said she was at 220 for so many years. And then when COVID happened, she went up to 280. And now she's at her heaviest of 300. But she said that for a year she was at 220. But this kind of gets at that point that her environment changed. And maybe parts of her lifestyle became obesogenic, where then her body became accustomed to this new weight. What other, can you think of any others? Childbirth?

Nicole Aruffo, RN (10:04)
childbirth specifically? You mean like after you have a baby and everyone's like, my god, I can't lose the baby weight. Yeah.

Ed Delesky, MD (10:14)
that could be a set point changing event.

Nicole Aruffo, RN (10:18)
Yeah. But the set point isn't like this like end all be all thing like sucks for you. This is the way that your body's pre-programmed to be at. Like there are things you could do, right?

Ed Delesky, MD (10:31)
There are so many things you can do and we're going to talk about them on our upcoming episodes.

Nicole Aruffo, RN (10:36)
But this is just more of a theory to possibly explain why losing weight could be difficult.

Ed Delesky, MD (10:41)
Yeah,

why it's so damn hard. There's a concept called recidivism, which is the the rate at which something or a behavior returns back to its old way. And so there's a lot of recidivism in weight weight loss. 80 % of people regain the weight that they lose. And that's why weight changes from diet control and exercise may be short lived if they aren't long term lifestyle changes.

And when I was doing a lot of reading about this, they're starting, they're calling them eating plans rather than diets because it's, it has to be long-term that you fight the fight. So to continue the conversation a little bit, tell us how calories and weight relate. This isn't in here. This is just, well, cause it's, kind of gets at the point I'm trying to get at the point that these little changes don't have to be drastic.

but rather just little decisions like a bag of chips or that soda with calories. That is the difference.

Nicole Aruffo, RN (11:45)
Yeah, so this is very relevant to you specifically because Eddie just learned how to read a nutrition label.

Ed Delesky, MD (11:54)
I just completely ignored the nutrition label.

Nicole Aruffo, RN (11:56)
Actually, probably after we recorded the last episode because Eddie has a predilection for the nacho or the tortilla chip. Chips and salsa. The guy loves them. And so he was we were looking at like the specific one that he often buys and like seven chips was like 150 calories and, you know, whatever the macronutrients are after that.

He was kind of disturbed at the rate at which he eats the chips and the calories because he definitely ate more than seven chips each sitting.

Ed Delesky, MD (12:32)
Totally. No, I'll be the first to tell you. Yeah, two days. That's it. Two days. There's our intern.

Nicole Aruffo, RN (12:33)
killed half the bag.

There he is. Is he under me again?

Ed Delesky, MD (12:45)
think so.

Nicole Aruffo, RN (12:47)
under in between both of us that's so cute

Ed Delesky, MD (12:51)
Put it.

Nicole Aruffo, RN (12:52)
Don't worry, Ali. We're not cutting your calories. We had to though because someone was giving him too many cookies.

Ed Delesky, MD (13:01)
Right. So there's another example. I was giving him so many cookies and he became a little tubby boy and he was having a lifestyle change in the opposite direction. So all of these calories were coming up. So the point I wanted to make about the nachos, though, is that in the two days that I was eating the nacho bag, I was eating essentially calories over a caloric pound, if you will.

Nicole Aruffo, RN (13:15)
Back to the point.

which is what, 3,500, right? Yeah.

Ed Delesky, MD (13:31)
Which I would do without any concern or anything like that. I actually didn't even think it was that bad.

Nicole Aruffo, RN (13:39)
You didn't? No. That didn't concern you that you ate a half a bag of tortilla chips in one sitting?

Ed Delesky, MD (13:44)
No,

I just turned off the brain and just started chewing. Yeah. But like that added to. And that.

Nicole Aruffo, RN (13:47)
Wow, that makes sense.

He went on the stings like my mindless eating and my tortillas

Ed Delesky, MD (14:00)
I had no idea. then every every week I would go back and get them. there was an extra like an extra caloric pound. like this, this definitely hits it like the moderation thing. But right now I just don't we don't even keep them in the house because I can't.

Nicole Aruffo, RN (14:14)
I went to Trader Joe's the other day when you were at work and I said I got salsa and you were like you didn't get chips No, sorry. Certainly did not

Ed Delesky, MD (14:25)
But that was a lifestyle change. So then I've removed those and some I've noticed some changes. But they may be short lived. Like I may find my way back to the tortilla chip and I may fall back into my old ways. And if a 3500 calories is a caloric pound, what people will often say is they'll pick a number like they'll pick like if I can come up with but 500 calories a day for one week, I'll lose a caloric pound.

and eating 500 calories less burning or burning 500 more or somehow splitting that difference. But that's an old way of thinking, I think. And a lot of people will say that you'll go to the doctor, you'll be like, how can I lose weight? And they'll do this math right in front of you. But this set point theory, I think it exists to some degree. Yeah. Where one reason or another.

Nicole Aruffo, RN (14:56)
Do you mean eating 500 calories less?

I don't think it's very, what am I trying to say? I don't think it's very straight, I guess, straightforward, guess, calories in versus calories out. There's more that goes into it.

Ed Delesky, MD (15:35)
Well, cause say that even like your resting metabolic rate slows down because of the set point theory, then that calorie deficit that you were either making or creating by.

Nicole Aruffo, RN (15:46)
I

never paid attention to that until we talked about it the other night. No, the resting metabolic thing.

Ed Delesky, MD (15:50)
What, the set point theory or the?

Yeah. So just to say, mean, we might've said it in the past, but resting metabolic rate is the amount of calories that you burn if you were to do absolutely nothing. And that's dependent on age, sex and baseline activity level, essentially. But with the set point theory, the thought that is that might go down. So it might change how your body reacts to food. So you might need to even eat less or exercise more. And so it's not as simple as calories in calories out, but these lifestyle changes have to

happen and they have to have longevity.

Nicole Aruffo, RN (16:28)
I think mine's gone up.

Ed Delesky, MD (16:29)
I think it also goes up with increase in lean mass because muscle burns more energy than fat does. So one of the things that we're trying to get home here is that in our next couple of episodes, we will be talking about eating plans that you can use to center yourself on a goal of weight loss for clinical benefit, not for vanity or looks sake, but for clinical benefit. And

why using medications also may be challenging, although useful and necessary, because of this theory of the obesity or metabolic set point. The references for this episode here were from another one of those Stat Pro articles, which is openly available to anyone who looks them up. Do you have any other thoughts?

Nicole Aruffo, RN (17:19)
Mmm.

I don't think so.

Ed Delesky, MD (17:24)
Okay, well thank you for coming back once again for this episode of Your Checkup. Hopefully today you were able to learn something for yourself, a loved one, or...

Nicole Aruffo, RN (17:33)
neighbor.

Ed Delesky, MD (17:36)
And we really appreciate that you log back in or you tune back in to listen to us. You can visit our website or you could share us with a friend or someone else you might think that might benefit from this. Some patients have been coming back and saying they really like it. They've been showing their aunts and they've been showing their friends. And I mean, we're so blessed that people are the words getting out and we just want to continue the fact that sometimes conversations about your health, not even sometimes.

All the time conversations about your health and wellness and disease that you go through don't just have to be limited to the doctor's office, but they can happen elsewhere. And that's what we want to be for you here on your checkup. If you were interested in supporting the show, you can visit our website. You might find a link or two there, or you can go online and buy us a coffee. Nikki's posture is really suffering because of the lack of a bull bar. And we really could use some help if anyone is able to give it.

But we appreciate it and we're willing to give this service for free anyway, because we have a blast and it's a great time and place for us to have fun. So all that to say, thank you for coming back. Stay healthy, my friends. And until next time, I'm Ed Delesky Thank you and goodbye. This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health.

Nicole Aruffo, RN (18:43)
I'm Nicole Aruffo Bye.

Ed Delesky, MD (18:55)
It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor.

Nicole Aruffo, RN (19:23)
I am not your nurse.

Ed Delesky, MD (19:24)
and make sure you go get your own checkup with your own personal doctor.