I continually read a great many books, articles, blogs, and forum posts on the subject of obesity. No one,…. not even the most qualified medical doctor or scientist, … knows everything or holds only beliefs that are absolutely correct. However, I am often amazed by the vast amount of existing misconceptions, myths, and wishful-thinking that gets spread and promoted by people who present themselves as obesity “experts” or “gurus”. One thing that Scientists know for sure about obesity management, is the sad fact, that no diet, exercise, medication, not even bariatric surgery, will permanently reset the body’s tendency to defend and regain its body weight to its set point .... this generally being the highest weight that has been achieved and maintained for a notable length of time. Thus, any effective long-term treatment MUST OFFSET the complex neurobiology which is designed to eventually doom every weight-loss attempt to ultimately "fail". A comprehensive review recently published in Endocrine Reviews describes the complexity of the biological system that regulates our body weight. The 30+ page research paper, backed by about 350 scientific citations, was written by the undisputed leaders in the medical field of Endocrinology (Michael Schwartz, Randy Seeley, Eric Ravussin, Rudolph Leibel and colleagues) and is actually a “Scientific Statement” from the Endocrine Society. In other words, these Scientists know that they are talking about when they speak about the Science of Energy Balance, and in this paper they outline in excruciating scientific detail just how complex the biological system that regulates, defends, and restores body weight actually is. From the Abstract of this research paper:
We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained. A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time. Growing evidence suggests that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight.
Their position is that, despite all we have learned about this system, we are still far from fully understanding it. Science knows about one of the pathways, but there are many pathways in a complex network of multiple interacting pathways that involve virtually every part of the brain. They say that the medical field currently needs a great deal more information about the specifics of this issue:
The identification of neuromolecular mechanisms that integrate short-term and long-term control of feeding behavior, such that calorie intake precisely matches energy expenditure over long time intervals, will almost certainly enable better preventive and therapeutic approaches to obesity.” To be viable, theories of obesity pathogenesis must account not only for how excess body fat is acquired, but also for how excess body fat comes to be biologically defended. Answering this question requires an improved understanding of the neuro-molecular elements that underlie a “defended” level of body fat. What are the molecular/neuroanatomic predicates that help establish and defend a “set point” for adiposity? How do these elements regulate feeding behavior and/or energy expenditure, so as to achieve long-term energy balance? By what mechanisms is an apparently higher set point established and defended in individuals who are obese?”
They conclude that:
Given that recovery of lost weight ... (the normal, physiological response to weight loss irrespective of one’s starting weight) ... is the largest single obstacle to effective long-term weight loss, we cannot overstate the importance of a coherent understanding of obesity-associated alterations of the energy homeostasis system.”
So, in essence, this scientific paper shows why no simple solution to obesity is in sight; details the existence of an enormous Problem; and raises Questions for which Science still needs to find answers. To get a simple explanation of the basic concept, see: Set Point. Any “health & wellness” professional, medical doctor, or guru who claims that any particular Diet, Behavior, or LifeStyle can fundamentally change the part of the body’s biology which acts to protect and restore body fat in the long term is Simply Wrong. They are either spreading a Lie, sharing a Myth, or offering a hypothesis for which no proof or reasonable evidence exists… which means that they are simply sharing their own Wishful-Thinking. At this point, all credible Scientific Research indicates the following:
No matter how much weight gets lost, or is maintained for the short-term, … No matter whether that weight loss was slow or fast, ... No matter when food intake occurs ... No matter whether “unprocessed” or “healthy” food is eaten, ... Ultimately NO diet or behavior manages to “reset” the body-weight set point to a lower level, in order to biologically “stabilize” weight loss for the long-term.
NOTE: Originally posted on 7/23/2017. Bumped up for new viewers.
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