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Do we have a weight set point?

Executive Summary

* This week's note reviews a March 2021 report from a workshop, which set out to examine the concept of a weight set point. This is the idea that whether we gain or lose weight, we tend to gravitate back towards our previous ‘set’ weight.

* Evidence that I have reviewed previously (Franz et al 2007) and evidence presented in the workshop outputs confirmed that weight loss tends to occur (and not as much as we might expect) in the first six months and then regain occurs in the months thereafter.

* The workshop focused on four key areas: describing the weight-reduced state; understanding energy intake in this state; understanding energy expenditure in this state; and strategies to understand the weight-reduced state.

* A number of interesting observations emerged from the workshop areas of focus. Environmental and genetic factors impact the weight-reduced state. Weight loss and weight maintenance may be very different physiological states. Strategies may help with one and not the other.

* One of the workshop chairs, Dr Kevin Hall, has previously examined participants in the US "The Biggest Loser" programme. People who have lost weight with extreme calorie restriction and exercise have a sustained drop in energy needs (c. 500 calories a day) for years afterwards. This clearly does not help maintenance of weight loss.

* The workshop concluded that there is a weight set point, but workshop participants could only see this concept in the usual eat less/do more framework. This constrained thinking about ways forward.

* The evidence from The Minnesota Starvation Experiment to The Biggest Loser is that weight tends to be lost for approximately six months and then regains starts. The evidence from such studies suggests that calorie deficits become intolerable and unsustainable, but the person then needs to maintain substantially lower intake to avoid regain and this is also intolerable.

* These conclusions would be very discouraging for a would-be dieter, but we should remember that this is all for calorie deficit dieting. We can avoid the known harms from eat less/do more by not doing this. There are ways to lose weight and keep it off, but the evidence suggests that setting out to eat less/do more is not one of them.



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