Friday, May 9, 2014

Set Point Theory

Two days ago, I sat in my doctor's office waiting to see her for the first time in a month. I'd had my weight and vitals checked two weeks prior, of course, but never actually got to see my doctor. Finally, I heard the faint knock on the door which signaled her entrance into the exam room and saw her all-too-familiar smile as she opened the door. Before I could forget, I handed her paperwork and asked if she could fill it out so I could return to college in the fall. 

"Sure... As long as you get back into your weight range." 
"I'm not in my range?" 
"Nope. You're out just by a little bit... X pounds."
"I don't know. You tell me!" 

Inside I was pissed (and I still am)--how the hell am I out of my weight range? I've been following my meal plan for the most part... I don't understand. Followed immediately by the frustrations of doing everything 'right' and how I'm supposed to, yet still being 'wrong.'

Then there was the conversation with my doctor about what my dietitian said last week: 
I don't care what your weight is as long as you are following your meal plan.

My dietitian's rationale was that if I am eating and exercising appropriately, my weight is going to fall where it is supposed to be because there exists a weight my body naturally wants to be. My doctor's reasoning, on the other hand, has to do with my not having been in recovery long enough for my brain to be able to regulate things like my natural weight; she says it can sometimes take over a year for your brain to get back to normal once your body has been restored to an effective weight, which is why it is important to stay in a certain weight range. Going outside of one's range may make one more vulnerable to relapse. For example, when I returned to school this past fall, I was slightly under my weight range and I slipped and then relapsed--HARD. She said she wants me to have a bit of a buffer so if I start to struggle again, I won't fall as hard. 

My doctor and my nutritionist at first glance, appear to have conflicting professional opinions, which is why I did some of my own research when I went home. My research found that both my dietitian and my doctor are speaking to the same concept--this thing called 'set point.' 

Carrie Arnold defines set point weight as "the weight range (usually around 5 to 10 pounds) your body will maintain comfortably without any external input from you--that is, without calorie counting, food restricting, excessive exercise, or purging."

Mirror Mirror, an organization dedicated to educating about eating disorders, has a very good article on set point theory, which you can read in full here. I just want to hit some of what I found relevant--

"Everyone has a set point and just like you have no control over how tall you will be, or what color your eyes and hair will be, you also have no control over what your set point will be. Your body is biologically and genetically determined to weigh within a certain weight range. Set points vary for each individual person. That is why it’s not a good idea to go by the weight charts that you see in medical books or hanging in your doctor’s office."
Read: Weight is biologically and genetically determined; you can't change it. Also, BMI charts are crap.
    "When you go below your body’s natural set point, your metabolism will react and start to slow down to try and conserve energy. Your body will start to sense it’s in a state of semi-starvation and will try to use the few calories it receives more effectively. You may start to sleep more, your body temperature will drop, which is why you hear so many anorexics complaining of being so cold, and after too much weight loss many women experience the loss of their menstrual cycle. Basically their reproductive system shuts down because their bodies probably could not handle a pregnancy. Many people that are dieting also experience uncontrollable urges to binge. That is because your body is telling you that it needs more food than you are providing it to function properly.
    "Just as your metabolism will slow down when you go under your body’s set point, it will also increase if you go above it. The body will try to fight against the weight gain by increasing the metabolism and raising the body’s temperature to try and burn off the unwanted calories."
    Read: Your metabolism will adjust accordingly to keep your body as close to your set point weight as possible. 
    "If you have been dieting for years, it can take up to a year of normal eating for your body’s metabolism to function properly and return you to the weight range that is healthy for you."
    Read: It takes time for your body to figure out it will be regularly getting appropriate amounts of nutrition, so your metabolism will not start functioning properly as soon as your start eating. It takes time to adjust--sometimes up to a year!
    I guess what I took out of all of this is the idea that my body has already genetically and biologically determined what the most effective weight is for me. There is nothing I can do to change my weight. And while what Julie said is true--as long as I am following my meal plan and getting adequate nutrition and exercise, my weight will take care of itself--however, I am in recovery from an eating disorder. In layman's terms, my brain and body are confused and unstable so even missing a single snack or getting in a 20 minute walk can cause my fragile metabolism to shift. Therefore, I need to trust my doctor and stay in my weight range until I am more stable, and then my body will be able to take care of itself. 

    (But really, someone remind me of this tomorrow. And today. And every other day. Because although writing about it helps me understand it, the writing doesn't make me believe it any more than I did before.)


    To read more about set point theory, check out these articles: 
    "Set Point Theory" by the Centre for Clinical Interventions
    "A Hunger Artist" by Emily Troscianko, published on Psychology Today
    "A Thigh of Relief" by Jenni Schaefer