External Forces Trump Inner Balance

You may be thinking if your body is so good at defending your set point, how did your set point become too high? Ultimately, your behavior—how you respond to the environment—trumps your physiology, or your body’s inner workings. Eating is complex behavior that is affected by many different factors, including genetics. How food tastes, how hungry we feel, and even how we respond to social cues around food (for example, whether we eat more at a party or while alone) are all affected by our genes. And these genetic differences affect how we respond to our environment. Over the past few decades, changes in our society have altered our environment dramatically. Oversized portions of high-calorie (and often inexpensive) foods are readily available, day and night. And modern conveniences—everything from electric toothbrushes to leaf blowers to cars—mean we don’t have as many opportunities to exercise. These and other factors, which are detailed in the next chapter, are the driving forces behind our rising set points.

On a fundamental level, we eat to survive. Leptin and other hormones regulate this unconscious drive. But we also have a conscious desire to eat, which is clearly affected by the smell, taste, and appearance of foods. Your emotional state also comes into play. Some people eat more (or less) when they’re upset, angry, or depressed (For more on breaking these patterns, see Chapter 9). We also eat out of habit, simply because it’s time for lunch (or a snack or dinner) or because people around us are eating. As in most cultures, Americans often plan their work and social schedules around eating rituals.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Vermont Prison Overfeeding Study

Whereas the Keys study explored the body’s response to a minimal number of calories, another intriguing study looked at the opposite end of the spectrum: calorie overload. In 1964, researchers at the Vermont College of Medicine asked volunteers to gain 15% to 25% of their body weight in less than three months.

The impetus for this study was to better understand exactly what happens to the body during weight gain. For instance, do fat cells increase in number or simply grow larger? At first, the scientists sought volunteers from a usually reliable source of guinea pigs: graduate and medical students at the college. But the study design, which required the volunteers to eat four large meals a day at the nutrition lab, proved far too time-consuming for busy students. So the researchers turned to a more captive crowd: inmates at the Vermont State Prison. They hired a cook to prepare the meals and served the food on china plates instead of tin. The prisoner’s ample diets included standard American fare: cereal, eggs, and toast for breakfast, sandwiches for lunch, and dinners of meat, potatoes, and vegetables. The fourth meal, which the men ate just before bedtime, was similar to breakfast.

The volunteers started out at normal weights, which ranged from about 135 to 185 pounds. During the ten-week-long study, the men managed to gain between 15% and 25% of their body weight, which amounted to an average of nearly 36 pounds. To do so, they had to eat 8,000 to 10,000 calories a day—more than three times the normal number of calories they would have needed to maintain their weight. The weight changes were largely due to gains in body fat. By taking small samples of fat from the men’s bellies, thighs, and arms before and after the overfeeding, the researchers demonstrated that this excess fat didn’t create new fat cells but rather expanded the existing ones.

This study and similar ones on the prisoners revealed other interesting phenomena related to body weight and the set point. Researchers found that the prisoner’s metabolic rates went into overdrive after the overfeeding period. These changes provide further evidence of the body’s drive to restore balance and return to its set point. When the experiment ended and the men went back to eating regular amounts of food, they lost weight quite quickly—not just because they were eating less but because their metabolic rates were still racing. Note that the prisoners did not remain at the new, higher weights for very long, so they did not reset their set points to new, higher levels. That contrasts with people who have been overweight for long periods of time.

The rapid weight loss these prisoners experienced is the mirror image of what happens when overweight people try to lose weight. If your set point is too high and you try to lose weight quickly, your body will fight to defend that weight and slow down your metabolism. But if your set point is within a normal range, your metabolism will speed up when you gain weight quickly.

In recent years, many studies have reaffirmed the observations from these historic reports. One pivotal 1995 study, by Jules Hirsch and colleagues at the Rockefeller University in New York City, used sophisticated techniques to carefully measure the metabolic rates of forty-one obese and nonobese volunteers who followed strict diets that caused them to either lose or gain 10% of their body weight. The researchers found that when people gained 10% of their usual weight, their bodies focused less on conserving energy and more on wasting it. But when people lost more than 10% of their usual weight, the opposite occurred: their bodies fought to save energy rather than expend it. This explains why it’s so difficult to lose more than 10% of your weight at a time.

So no matter where you start (overweight, thin, or somewhere in between) and no matter how you manipulate your diet (eating too much or too little), your metabolic rate will automatically adjust in an effort to keep you at the same set point.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Minnesota Starvation Study

Just a few years before the Framingham study began, a very different type of experiment was already underway in Minnesota, led by Ancel Keys. Dr. Keys is known for his pioneering work on the link between saturated fat and heart disease and for the development of K-rations, the balanced, portable meals given to soldiers during World War II. But his study involving a group of thirty-six conscientious objectors who volunteered to starve for the sake of science ranks as his most intriguing yet controversial work. Today, ethical regulations would never allow this type of study to take place.

The purpose of the study was to understand the physical and mental effects of starvation, anticipating the need to learn the best ways to re-feed people who had experienced extreme starvation (namely, civilians throughout Europe after World War II). The men endured six months of semistarvation, eating a diet similar to that in war-torn Europe—lots of potatoes and turnips and very little meat or dairy products. During the study, the men had to continue exercising, walking at least 22 miles a week, or about 3 miles a day. They were rationed about 1,600 calories per day—approximately three quarters of what these healthy young men needed to stay at their previously normal weight levels.

The men lost an average of about 25% of their body weight over six months, which caused them to resemble the concentration camp survivors they were hoping to help. They became sluggish, uncoordinated, depressed, and irritable. Keys documented the study in a two-volume tome, The Biology of Human Starvation, which includes this description penned by one volunteer:

I’m hungry. I’m always hungry—not the hunger that comes when you miss lunch but a continual cry from the body for food. At times I can almost forget about it but there is nothing that can hold my interest for long.

These feelings may be familiar to veteran dieters who’ve tried very low-calorie diets. Even among people who are overweight or obese (unlike these normal-weight volunteers), the very same mechanisms kick in during the self-imposed starvation of a diet. Faced with the physical and emotional strain, the body fights back to stay alive. Keys calculated that the men’s metabolic rates had decreased by about 40% by the end of the starvation period. One volunteer said it was as if his "body flame [was] burning as low as possible to conserve precious fuel and still maintain [the] life process."

After six months of starvation, the men entered a rehabilitation phase, during which they gradually received increasing amounts of food over a three-month period. Perhaps not surprisingly, the men’s response to this relative abundance provoked some unusual behaviors. Some ate until they vomited and then asked for more. Others ate until they weren’t physically capable of eating another bite of food, yet they still claimed they were hungry. Again, these behaviors may sound familiar to people who’ve tried so-called crash diets designed for rapid weight loss.

The take-home lesson is that it’s extremely challenging to try to lose a lot of weight over a short time period. Your body will rebel against these efforts, helping you regain the weight you’ve lost and possibly triggering strange (and potentially unhealthy) eating behaviors.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Framingham Heart Study

One line of evidence comes from people involved in the Framingham Heart Study, which dates back to the 1940s. Back then, very little was known about why people had heart attacks. This landmark study, which continues to this day, sought to answer that question. In 1948, researchers recruited more than fifty-two hundred men and women between the ages of 30 and 62 who were living in the Boston suburb of Framingham, Massachusetts. They recorded their height, weight, family health history, and gave them a physical exam every other year.

Over the years, scientists began collecting more data from the participants, such as measuring their blood pressure and cholesterol levels, and asking them about their eating, exercise, and smoking habits. In 1971, the Offspring Study, which includes the children (and their spouses) of the original group, was launched. And researchers began recruiting the third generation in 2002. Among the most important discoveries from the study was that cigarette smoking and obesity increase the risk of heart disease, and physical activity could lower that risk.

Researchers also found that over about a thirty-year period, the average participant gained about 20 pounds. This typical, slow gain is healthy and normal. The number of calories these participants ate balanced the number of calories they burned within a tiny percent during those years. If you figure that the average person eats about one million calories per year and you calculate the energy cost of those 20 pounds (that is, how many extra calories would a person have to eat each day, on average), it comes out to about 10 additional calories per day. That’s less than The amount of calories in a single jelly bean! The body’s internal control system is very is precise.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

Obesity as a Metabolic Disease

The reason weight-loss medications can’t provide any real results is that we have a complex, overlapping system of checks and balances that help "defend" our body-weight set point. Many different genes contribute to your body weight, and thus it’s impossible to manipulate it by focusing on just one hormone (or other substance). Others will jump in to compensate. The brief explanation of leptin and the other major players in this defensive strategy barely skims the surface of this intricate system. The take-home message is that these factors are beyond your conscious control. Our broader understanding of these factors has dramatically changed the framework of how we view the problem of weight gain and obesity. Instead of thinking of obesity as the consequence of a lack of restraint or willpower, it’s now increasingly recognized as a disease that results from a breakdown in the body’s normal system of checks and balances.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

WATCHING THE SET POINT AT WORK

Now that we know how the set point works, let’s step back and take a look at some of the other evidence in support of the set point theory. These observations include both short- and long-term studies and anecdotes from people in a variety of different settings.

The Framingham Heart Study

The Minnesota Starvation Study

The Vermont Prison Overfeeding Study

Movie Stars

External Forces Trump Inner Balance

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Sensing Stomach

The stomach communicates with the brain through the ANS, and the nerve of interest to our story is the vagus nerve (see illustration). In Latin, vagus means "wandering," an accurate description of how this vitally important nerve travels from the brain to the stomach. When filled with food or liquid, the stomach’s stretch receptors send a message via the vagus nerve to the brain that says, "I’m full!" Have you ever noticed that eating a large, heavy meal can cause you to perspire? That’s the vagus nerve working overtime. As discussed, the autonomic nervous system prepares the body for fight or flight by raising your heart rate, increasing your blood pressure, and causing you to sweat. So by eating too much, you’ve made your body ready for fight or flight, even though you’re just sitting at a table eating dinner!

Not surprisingly, most weight-loss aids (in addition to surgeries) focus on fooling the body’s natural tendency to hold on to weight, mostly by manipulating levels of brain chemicals. Back in the 1950s and 1960s, dieters took amphetamines, which speed up metabolism by boosting the activity of the sympathetic nervous system. But they’re also addictive and have many unpleasant side effects, including paranoia and heart problems.

(For more information on weight-loss medications, see the Appendix).

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

Sending Signals: A Host of Hormones

A wealth of research has helped us understand more about the signals that talk to the hypothalamus to control body weight set points. They include the hormones insulin, leptin, adiponectin, ghrelin, and others. The pancreas, an organ the size of a small banana that lies near the stomach, secretes insulin. Insulin controls the amount of glucose in your blood by moving it into the cells, where this fuel can be used by your body for energy. Leptin, which is produced mainly by fat cells, contributes to long-term fullness signals by gauging the body’s overall energy stores. Yet another hormone, adiponectin, is also made by fat cells and involved in body-weight regulation, apparently by helping the body respond better to insulin and ramping up metabolism. Ghrelin, the so-called hunger hormone, tells the brain the stomach is empty, prompting hunger pangs and a drop in metabolism. Gastric bypass surgery (in which surgeons convert a person’s stomach to the size of a small egg, effectively bypassing most of the stomach) doesn’t just help people eat smaller amounts of food. The procedure also triggers a sharp drop in ghrelin levels, which lessens hunger and apparently contributes to the weight-reducing effects of gastric bypass. Traditional dieting, however, tends to boost ghrelin levels.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Hypothalamus: Headquarters of the Set Point

About the size of an almond, your hypothalamus sits atop your pituitary gland at the base of the brain, just above the roof of your mouth. This well-protected location speaks to the vital importance of this brain region. In addition to controlling hunger and satiety, the hypothalamus keeps the body in balance, a process known as homeostasis (from the Greek homeo, meaning "like" or "similar," and stasis, meaning "standing still"). This internal balancing mechanism regulates your body temperature, as well as the amount of sugar, salt, water, and other substances in your bloodstream.

Most of the time, your temperature stays right around normal, or 98.6 degrees Fahrenheit, because the hypothalamus sends and receives a series of chemical messages that regulate your body temperature. It’s somewhat similar to the thermostat that controls your home’s heating system: When the temperature drops, the thermostat sends a signal to turn on the furnace. Likewise, if you’re cold, the hypothalamus checks in with other sensors in your body to see how it compares with the set point. If your temperature is lower than the set point, it sends a signal to your muscles, telling them to contract. That causes you to shiver, which helps you warm up. Conversely, if you’re too hot, you sweat, which helps you cool down. The body reactions happen involuntarily, without you even having to think about them. They’re perfect examples of your autonomic nervous system at work, which also plays a key role in homeostasis and your set point.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Autonomic Nervous System

All the nerves in your body that extend beyond your brain and spine belong to the peripheral nervous system. The autonomic nervous system (ANS), which controls the organs and muscles inside the body, is part of that network. Most of the time, we aren’t aware of the workings of the ANS, since it usually works in an involuntary, reflexive manner, widening or constricting your blood vessels, raising or lowering your heart rate, or prompting your intestines to move and digest your food.

The ANS is most important in two situations: It responds immediately in emergencies that cause stress, requiring us to "fight" or "take flight" (that is, run away). The ANS also works during nonemergencies, relaying messages that allow us to "rest and digest." Of course, this system is constantly acting to maintain the body’s normal internal working, which is why it’s an integral part of the set point.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Internal Speedometer

The remaining 25% to 30% of the calories you burn are from any physical activity you do, from simply fidgeting in a chair to taking a walk or doing vigorous exercise. It’s the only aspect of your total energy metabolism (or total daily energy expenditure) you can control. Think of your metabolic rate as your own internal speedometer. Say you burn 1 calorie per minute lying down. Sit up, and you’re now burning 11/2 calories per minute. Stand, and you’re up to 2 calories per minute. The more you move, the more you burn. These seemingly trivial increases can make a difference over time. You need to burn more calories than you take in to lose weight. That’s why it’s so important to be active throughout the day. Just 100 of the 2,000 to 2,500 calories you consume each day can mean a difference of 10 pounds of body weight from one year to the next!

What about all those advertisements for dietary supplements that promise to boost your metabolism? Don’t waste your time or money believing these false promises. There is absolutely no scientific evidence that any substance can significantly rev up your metabolism. The only safe and effective way to boost your metabolism is to burn more calories by picking up the pace and moving around more.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Thyroid Connection

The thyroid, a butterfly-shaped gland that wraps around your windpipe, secretes hormones that regulate your metabolic rate. If you’ve gained weight recently, someone may have told you to have your thyroid level tested. It’s true: low thyroid levels, a condition known as hypothyroidism, can cause symptoms such as fatigue and weight gain. But this problem, which can be diagnosed with a simple blood test, is rarely the underlying cause of weight gain.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

Making Sense of Metabolism

Metabolism refers to the basic chemical processes within the body that keep you alive. It’s also vital to understanding weight control. During the periods of the day when you are not eating, proteins, carbohydrates, and fats are broken down into their building blocks, creating energy to fuel all your body’s functions, while other processes consume these substances. Your metabolic rate is a measure of how fast your body uses that energy, or burns calories, when you’re at rest, just lying quietly and not doing anything. Also known as your resting energy expenditure (REE), this number accounts for about 70% of the calories you burn each day. On average, this comes out to about 10 calories per pound of body weight.

REE varies from person to person and changes throughout life. It is mainly influenced by several things you can’t control: your genes, your age, and your sex. Your energy metabolism slows down as you age, a natural consequence of the body’s cells wearing out and not functioning quite as efficiently. Men tend to have a slightly higher metabolic rate than women, although a woman’s will (not surprisingly) rise temporarily during pregnancy.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

HOW YOUR BODY SETS YOUR SET POINT

To appreciate how your body works to maintain your weight, it helps to understand a little bit about the internal controls that govern this complex process. These controls include a tiny structure deep within the brain, nerves that run between the brain and the stomach, and a host of hormones. Central to this entire system is your metabolic rate, which automatically adjusts in an effort to maintain your set point. (But, as you’ll learn later, external forces can override these internal controls.)

Making Sense of Metabolism

The Internal Speedometer

The Thyroid Connection

The Hypothalamus: Headquarters of the Set Point

The Autonomic Nervous System

Sending Signals: A Host of Hormones

The Sensing Stomach

Obesity as a Metabolic Disease

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

Easy Come, Not-So-Easy Go?

Researchers who study weight control have discovered that people who gain weight easily find it hard to lose extra weight, but people who struggle to gain weight find it easy to lose excess weight. A slow, gradual weight gain will fool your body into thinking that your set point should be higher—and, in fact, that does reset your set point. For instance, a 20-pound weight gain over several decades moves you from silhouette 2 to 4. Then when you try to lose weight, your body defends that higher weight, making weight loss more difficult. On the flip side, a rapid, short-term weight gain doesn’t fool your body and therefore does not reset your set point. Your body will work to defend its lower, normal set point, and shedding those excess pounds will be relatively easy.

But just as it’s possible to reset your set point to a higher point, it’s also possible to lower it. The secret is to work with, not against, your body’s natural tendencies and lose weight slowly, one silhouette at a time.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

What’s My Silhouette?

In addition to a body-weight set point, everyone has a silhouette that closely parallels their body shape. A chart developed in the early 1980s depicts a range of body sizes, from slender to obese. Used as a research tool to examine people’s perceptions of their own body image (both actual and desired), the silhouettes provide a close approximation of a person’s body weight. In effect, your silhouette is a visual representation of your set point.

I will use eight of these images for each gender as a simple way to help you see how you can change your silhouette to a healthier profile by resetting your set point. Take a close look at these silhouettes and circle the one that most closely resembles your body now. What about your silhouette at age 18? (Note that these silhouettes were developed using Caucasians, so they may not accurately depict your body if you have a different racial background. But overall they provide a close approximation for most people).

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

The Science of the Set Point

"It is one of the great wonders of the brain that body weight stays remarkably fixed (as a "set-point") most of the time in most people." (Christian Broberger, M.D., Ph.D., Department of Neuroscience, Karolinska Institute, Stockholm, Sweden)

"The drive to regain is mainly in the brain." (Barry E. Levin, M.D., professor of neuroscience, New Jersey Medical School, East Orange, New Jersey)

WHAT IS A SET POINT?

Your body weight set point is the number on the scale your weight normally hovers around, give or take a few pounds. Your heredity and your environment—starting back at the moment of your conception— determine your set point. Most people’s set point is "set" around age 18. Before that age, your body is still growing, and you need to eat more calories than you burn to encourage growth and development. Girls may reach their set point a little before age 18, and boys may reach theirs a bit later. But soon after you stop growing in height, your body weight tends to settle at a fairly stable number.

Your set point doesn’t necessarily remain the same throughout your lifetime. Few of us weigh the same as we did when we finished high school, and that’s perfectly normal. As you age, your metabolism slows down a bit, which is why most people put on a few pounds. Additionally, women normally gain about 25 to 35 pounds during pregnancy. If they don’t lose most of that extra weight within about a year of giving birth, they’re likely to raise their set point, especially if that trend continues during future pregnancies.

Gaining just under a pound or so per year from about age 20 to age 50 is common and not necessarily bad for your health. People get into trouble when they gain more pounds more quickly, ending up at an unhealthy body weight. Over the long term, excess food and insufficient exercise will override your body’s natural tendency to stay at its set point and lead to a higher, less healthy set point.

What’s My Silhouette?

Easy Come, Not-So-Easy Go?

HOW YOUR BODY SETS YOUR SET POINT

Making Sense of Metabolism

The Internal Speedometer

The Thyroid Connection

The Hypothalamus: Headquarters of the Set Point

The Autonomic Nervous System

Sending Signals: A Host of Hormones

The Sensing Stomach

Obesity as a Metabolic Disease

WATCHING THE SET POINT AT WORK

The Framingham Heart Study

The Minnesota Starvation Study

The Vermont Prison Overfeeding Study

Movie Stars

External Forces Trump Inner Balance

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

Break Through Your Set Point: Introduction

You know the feeling: cranky, tired, and hungry—the telltale signs of another diet attempt gone awry. Whether you’re dealing with a recent middle-age spread or a lifetime of being too heavy, chances are you’re desperate to lose weight to look and feel better. But despite your best efforts, you aren’t succeeding. Perhaps you’ve hit a plateau and can’t seem to nudge down the number on the scale. Or maybe you’ve managed to reach your goal weight only to regain the pounds.

Failing at weight loss isn’t due to a lack of awareness, money, or effort. We know that being overweight can lead to health problems. Dieters join weight-loss groups, start and abandon diets out of frustration, and buy the miracle products pitched in magazines, on television, and on the Internet. Each year, Americans spend an estimated $50 billion on weight-loss products and services. Despite this enormous cash outlay, two out of every three people in the United States are overweight, and about half of those are seriously overweight or obese.

In our convenience-driven society, abundant food and fewer opportunities for physical activity make it easy to gain weight. Some of the blame also lies with the overhyped marketing of fad diets and dietary supplements that promise to melt fat away. Infomercials and Internet ads imply that you can lose weight with little effort. It’s hard to abandon all hope of a quick fix when new products and new diet plans continue to promise amazing results. If you’re reading this book, you may already know those claims aren’t true. And with more than thirty years of clinical experience in helping patients lose weight, I can say with certainty that there’s no such thing as a magic bullet.

I tell my patients that while it isn’t easy, it is simple. You don’t need to give up any of your favorite foods, and you don’t have to count calories. To lose weight and keep it off, you need to follow three steps:

1. Eat less food.
2. Eat healthful foods.
3. Be physically active.

Here’s the novel part: Set a reasonable goal to lose about 10% of your initial body weight. Then hold steady at your new weight without regaining any weight for at least six months, which will reset your body’s set point (or typical body weight). Once you’ve reset your set point, you can repeat the cycle to lose even more weight. Following this advice in the context of a structured daily routine will reap positive changes in your health, well-being, and appearance and prevent those extra pounds from coming back. I’ll show you how managing your time more effectively and getting more sleep can help you accomplish these goals.

I know you’ve heard the basic message many times before: eat less and exercise more. What’s different about Break Through Your Set Point is that it gives you specific tools and targeted advice to effect and sustain those changes. The book you’re holding includes all the tips and tricks I’ve prescribed to my own patients to help them restructure their eating and exercise habits and lose weight. Most importantly, I never give any weight-loss patient the exact same advice, because each person has unique reasons for gaining weight and making lifestyle or behavior changes. But whether you’re a busy parent with kid-food syndrome (you eat chicken fingers and sugar-coated cereals on a regular basis) or you’re a former athlete-turned-couch-potato (your exercise routine fell by the wayside after you left school), this book will help you devise a plan that works for you.

One of my mantras is find your own path and take the journey slowly. This easy-does-it approach isn’t a concession to laziness. My program is based on the proven scientific fact that the body resists losing weight after a certain point, which stems from the body’s innate tendency to protect itself against starvation.

This book is based on three decades of my own research and clinical practice, coupled with innovative findings from other experts in the field. My doctoral studies at Massachusetts Institute of Technology (MIT) identified the twenty-plus essential nutrients required in special formulas used to deliver nutrients through a vein. This type of feeding, known as total parenteral nutrition, nourishes and sustains people who are unable to eat normally because of gastrointestinal surgery or other problems. My expertise in this area prompted a request from a physician and a businessman to develop a formula for a good-tasting, nutritionally sound meal replacement that people could buy over the counter to help them lose weight. This became the SlimFast shake, which has proven to be a safe, effective weight-loss aid not just in clinical trials but also in a long-term study.

During my surgical training at Kansas University, I witnessed and studied the dire complications of early weight-loss surgeries. With the help of Dr. Edward Mason, who developed the Roux-en-Y gastric bypass procedure—a vast improvement over the previous surgeries—I introduced this technique to the Boston area in 1975. It is now the most commonly performed surgery for treating severe obesity.

The most meaningful discoveries I’ve made deal with the range and rate at which people lose weight and how those factors affect their regaining the weight. My studies were the first to discover that most people can change their body weight by only 15 to 20 pounds at a time. I demonstrated that this modest loss will improve health, helping people to recover from weight-related problems such as diabetes, high blood pressure, and high cholesterol. Countless other studies by researchers around the world using a variety of different diets confirmed the same phenomenon, which has formed the basis for national guidelines now promoted for the treatment of overweight and obesity.

We know that the body imposes a natural limit on how much weight you can lose. It is governed by an internal balancing mechanism that works to keep your body weight at a stable point—or set point. My studies documented that people failed at weight loss only when they tried to lose too much weight too quickly and without long-term goals. They also showed that diet was only one facet of enduring weight loss. It took a multidisciplinary team approach with dietitians, behavioral therapists, and health care providers to enable patients to eat less, choose healthy foods, become physically active, and achieve a lifelong healthy body weight.

As you are introduced to the set point theory, you’ll learn how your genes affect your set point and explore the myriad of environmental influences that have caused Americans’ set points to creep upward over the past few decades. You’ll see how the 10% solution is governed by your set point, and more important, why this modest weight loss is enough for most people to become healthy and stay healthy for years. I will lead you through the lifestyle changes that will help you realize the three simple steps of eating less, eating healthy, and exercising more. The case studies will help you identify your own challenges around food, activity, time management, and sleep. By mastering a simple journaling technique that allows you to track your progress, you can figure out which areas to target and adopt strategies that resonate for you. In essence, this book provides the pragmatic program that will get you lasting results.

I’ve spent decades investigating the treatment of the diseases linked with both starvation and excess weight. I’ve helped thousands of patients. But there’s another reason you can trust me, which is that I really do know how you feel. I used to be 20 pounds heavier. I was not blessed with a naturally fast metabolism. I make choices every day that help me stay at a healthy weight. Nearly every morning, I take a brisk 2- to 3-mile walk around the pond near my home. Afterward, I leisurely spend twenty minutes enjoying a healthy breakfast of cereal, fruit, and skim milk, eating slowly to give my stomach time to tell my brain that I’m full and satisfied. My office is on the eighth floor of the hospital, and I walk up those flights at least once a day, often twice. My lunch usually consists of a big salad with dark, leafy greens topped with vegetables, nuts, dried fruit, and raspberry vinaigrette. These choices are now second nature for me, like brushing my teeth. I stick with these patterns not just because they prevent me from gaining back that 20 pounds but also because I know they’ll keep me healthy, fit, and feeling great.

Society as a whole—and doctors in particular—have become keenly aware of the need to prevent many diseases linked to excess weight. This book offers a holistic, lifelong prescription to address this need. Given today’s environment, resetting the average American’s inflated set point is a tall order. But by working with our families, workplaces, and communities, we can do better. I hope this book can help incite this transformation—one that I’m confident will lead to successful weight loss, better health, and happiness for all those who try it.

Source: George L. Blackburn, M.D., Ph.D., "Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off," 2008

Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off

by George L. Blackburn, M.D., Ph.D. 2008

Contents

Introduction

1. The Science of the Set Point
2. Set Point Sabotage: Our Toxic Environment
3. The 10% Solution
4. Getting Ready: Tools and Guidelines
5. Eat Less and Shed Pounds
6. Eat Well and Be Healthy
7. Move More and Feel Great
8. Synchronicity: Time, Sleep, and Weight Loss
9. Stress-Fighting Solutions and the