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."
"Why?" 
"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.)

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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

Winning > Losing

I avoided Facebook for much of yesterday, which is a problem. Not in the sense that taking a time out from technology like Facebook is bad, but because I've been avoiding it for another reason.

Tuesday night was the finale of The Biggest Loser, as I'm sure most everyone is aware by now due to massive media coverage of it and all the critiquing that has been done post-reveal. I personally do not watch the show nor do I care to begin. I actually hate the show and secretly (I guess it's not much of a secret now) judge every person who watches that show--I mean, seriously, who spends their time watching a show that encourages people to engage in self-starvation and overexercise?! How is essentially teaching eating disorders entertainment? I literally have no idea. But what I do know is that my Facebook yesterday was flooded with articles about the controversy over how much weight the winner had lost... And that a lot of people were calling her anorexic and saying she looks sick and way too thin.

(First problem. Making judgments about another's body. Just stop. None of us know if that is a healthy weight for her. None of us know her medical history or how she's feeling. Also, stop with the criticism! Seriously. Just stop it. You have no right to stick labels on someone for how much they do or do not weigh.)

I had a conversation with friends I met at the NEDA Conference in October about it. One said, "Just looked at some of The Biggest Loser stuff (I never pay any attention to that crap)... So infuriating! She's not a winner, she's sick!" followed by, "I hate the show. I hate Jillian Michaels. I hate it all!" Another friend from the conference advised me against looking into show and even writing a blog post on it.

I've tried to avoid reading most of the articles because I've generally found them to be triggering, but I'll share a few of the good ones that I've skimmed here (trigger warning for numbers in these articles):

The Biggest Loser and a Bigger Hypocrisy by Carrie Arnold
The Biggest Loser and the Eating Disorder Epidemic by Lee Wolfe Bloom
Freaked Out by Rachel Frederickson's Biggest Loser Win? Read This by Golda Poretsky
The Biggest Losers by Timberline Knolls' CEO and Medical Director (Not specifically about last night's show, but worth the read)
Why Her 'Biggest Loser' Win Left Me at a Loss by Meredith Turits

I'm not writing this to express my concern over Frederickson's weight loss. I'm not writing this to chime in on the same chords so many of these articles have touched on--that the loss of 60% of your body weight and a BMI of 18 are medical criteria for anorexia. I'm not writing to warn against the dangers of extreme dieting and self-starvation and how that can lead to binge eating. I'm not even writing this to talk about the fat- and thin-shaming that is going on as a result of this show.

I'm writing this because I disagree my eating disorder disagrees with all the people who have called her too thin and sick looking. My eating disorder idolizes how she looks.

Yes, I said it. I want My eating disorder wants to look like that.

But here's the thing, my body is not built to look like that. It's genetically not wired to look that way. In fact, if I looked like that, I would probably be in the hospital because my organs would be eating themselves, I'd be severely bradycardic and orthostatic, and I generally just wouldn't be able to function. That's why it is so important in eating disorder recovery to get to your set point weight--not a 'healthy' BMI, like many believe, but set point weight. Set point weight is the weight that your body genetically is programmed to be at. It does not follow BMI charts--it could be under or over what is considered to be normal. It does not follow societal standards for what is acceptable. But is is what is best for your body.

I don't like my set point weight. I'm not sure that anyone with history of eating disorders actually likes their set point weight. But instead of getting angry and turning to ED behaviors in order to be less than what my body wants naturally, I'm working on trying to accept it. Trying to radically accept the fact that my body and genetics want me to weigh X pounds instead of the X pounds that I my eating disorder would prefer to weigh.

So here's what I'm trying to focus on--all the wonderful things that my body, at it's healthy, set point weight, can do. What's important to me, in this moment, is respecting my body's limitations. If it's tired, I sleep. If it's hungry, I feed it. If it's restless, I go for a walk. If it's craving intellectual nourishment, I read and write and study. But I'm learning to be fully present in my body, not to just inhabit it. And if I am fully present in my body, that means I am listening to it. I am taking care of it's needs and wants and not forcing it to do things that it doesn't want to do.

Our society is good at telling us exactly the opposite. It's good at telling us that we need to be less, take up less space, weigh less, be thinner. It's good at telling us that when exercising, no pain means no gain. It's good at telling us to not eat the carbohydrates, the proteins, and the lipids, the basic macronutrients required for survival, that our body so desperately needs and craves. And shows like The Biggest Loser only reinforce these things.

And after reflecting on all of the outcry about The Biggest Loser finale, I have questions. Why are we so concerned with Rachel Frederickson, her weight loss, and her health? Why are we not this concerned when our sisters, mothers, friends, relatives, etc engage in similar unhealthy behaviors in order to lose weight? Why are we so concerned with losing weight instead of creating healthy and strong bodies? Why are we so concerned with being the biggest loser?

If I look only at the number on the scale, the size on my clothes, the calories I am consuming and burning, I will always be unhappy because there will always be someone who weighs less, who is a smaller size, who ate less and exercised more. My focus becomes so zeroed in on these things that I forget about everything else.

Through my recovery process, I'm learning to not focus on them. My dietitian asked me a couple days ago if I wanted to know anything regarding my weight range--if I was in it, above it, below it, what end of it I was in. And I simply told her no. I know I will never be satisfied with a number on the scale because what satisfies me is having a healthy body and a healthy soul. This means nourishment, rest, and moderate exercise for my physical body. It means listening to it when it tells me to take a break or slow down or that I'm pushing too hard. But it also means realizing that I am so much more than my body and that I am not defined by a number nor am I defined by what I look like on a particular day. It means cultivating relationships, feeding my intellect, expressing my interests and regularly doing something "just because."

It means living my life and not caring whether or not I am the biggest loser. By accepting my body as it is, at it's set point weight, in it's rightful, healthy state, I am the biggest winner because I'm winning my life. Not a smaller dress size or a ton of money or more confidence, but a life full of adventures and possibilities.

My friends, winning is always better than losing. May we all try to be the biggest winners of life and not the biggest losers of weight.

For more information about set point weight, see Kelsi's posts here:
Set Point
Overshooting Set Point Weight
Overshooting Set Point & Kristi's Story