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"setpoint" vs healthy BMI and intuitive eating with PCOS

Raegold
Raegold Posts: 191 Member
edited 1:28PM in Debate Club
Curious people's thoughts on these...
Is it possible to accept a setpoint weight that you are genetically determined to have even if it's not a healthy BMI or body fat percentage? I'm a nurse so I know there is a lot of scientific evidence about the detrimental effects of obesity on CV disease and endocrine effects. But also lots of confounding factors.

Also seeing a lot about "intuitive eating" around... But can this apply when you have PCOS or another issue where your hunger signals are adversely affected by your hormones?

Replies

  • psychod787
    psychod787 Posts: 4,099 Member
    Raegold wrote: »
    Curious people's thoughts on these...
    Is it possible to accept a setpoint weight that you are genetically determined to have even if it's not a healthy BMI or body fat percentage? I'm a nurse so I know there is a lot of scientific evidence about the detrimental effects of obesity on CV disease and endocrine effects. But also lots of confounding factors.

    Also seeing a lot about "intuitive eating" around... But can this apply when you have PCOS or another issue where your hunger signals are adversely affected by your hormones?

    oh btw.... I'm a nurse like thing.... err yeah a nurse.... Love your black and white photo... looks classy!
  • Geneveremfp
    Geneveremfp Posts: 504 Member
    I think people do have different weights where they are happy. I lost weight and felt I needed to be in the middle of my healthy range. I felt really unhealthy there and I didn't feel comfortable or happy so I gained a little bit until I was at the top of my healthy range and felt much better. I have broad shoulders big hands, big feet etc so maybe that's a part of it. Maybe I've just become so used to friends and family being overweight that being skinny felt wrong? Although both my weights were in the "normal" bmi range so not sure if I'm answering directly.

    I can't intuitively eat. I have been obese since around 9 years old and I don't have normal hunger or satiation signals. This coupled with some anorexic spells to try to lose weight I don't think my idea of eating is close to normal. I could eat an entire tray of doughnuts and just feel a bit sick and stuffed. I don't really feel hungry very often either so if I only ate when hungry I wouldn't get enough nutrition. I know what is healthy though and as long as I think and plan my diet I can eat well and feel good. It just takes more effort than intuitive eating.
  • Diatonic12
    Diatonic12 Posts: 32,344 Member
    I concur with @magnusthenerd. The only intuitive eaters I've witnessed restrict their food. They'll tout the scale doesn't matter, calories don't count all the while eating OMAD. It usually consists of some lettuce, a sprinkle of protein and a splatter of secret sauce over the top. They'll spend the rest of the day trying to outexercise the OMAD with hyperawareness of everything that goes into their mouth while pretending they don't.
  • netitheyeti
    netitheyeti Posts: 539 Member
    ok, anything I'm gonna say is personal experience only (short 30 yo woman with PCOS here): I don't think there's a "set point" as such, but I've found there's certain weight ranges I find easier to maintain (and harder to get out of) than others - for me it's two points - slightly overweight around BMI 26.5, and then roughly BMI 22-23. It's not impossible to get past those ranges tho, it just means I hit a point where I need an extra push/diligence to progress.
    In terms of intuitive eating - the one thing I HAVE managed is breaking the habit of eating "because I'm supposed to/because it's lunch time", and only eating when I'm genuinely hungry. But I still need to keep an eye on portions and *what* I eat.
  • MostlyWater
    MostlyWater Posts: 4,294 Member
    no do not agree
  • rosegreen12
    rosegreen12 Posts: 35 Member
    I wonder if what we call set-points aren't partially the fat cells we've previously acquired, either genetically or in previous personal history. Our bodies then feel the need to fill up those fat cells, even if we want them empty.
  • Diatonic12
    Diatonic12 Posts: 32,344 Member
    @sijomial We've simply travel in different packs and run with different herds. I've known many and they actually wear it like a badge of honor. They eat one bowl of food akin to dog food and call it freedom. But really, all of that meticulous food restriction is a self-induced food prison.
  • AnnPT77
    AnnPT77 Posts: 34,620 Member
    rosegreen12 wrote: »
    I wonder if what we call set-points aren't partially the fat cells we've previously acquired, either genetically or in previous personal history. Our bodies then feel the need to fill up those fat cells, even if we want them empty.

    It seems like there may be some hormonal affects along those lines (hunger/appetite hormones, not sex hormones :lol: ), but I think that aspect gets oversold somewhat in the diet blogosphere. (It's probably more applicable at extremes, such as bodybuilders trying to lean out to competition weight. It's a standard fitness/health blogosphere tactic to seize on something that's meaningful at the margin to elites, and pretend it's meaningful to regular people, because it's just so much cooler to be special. 🙄)

    FWIW, I'm with Magnus on at least one point: My body doesn't go around doing things with my mind as a hapless victim-passenger, generally. I have control over my behavior, if I choose to exercise it (and am lucky enough to be in circumstances where I can . . . by which I mean, no amount of decision-making will prevent me starving in a total absence of food, for example).

    In practical terms, I feel like NorthCascades is right (as he so often is):
    NorthCascades wrote: »
    Set point weights aren't determined by your genes, they're a result of comfortable behaviors (eating and moving).

    Some things that IMO are influences on body weight, and perhaps its tendency to settle in particular places:

    * The habits of eating and exercise that we individually enjoy
    * The mix of hedonism, self control, and other such relevant psychological and personality factors in our personal way of being
    * Ideas of what's "a normal amount to eat" that go back all the way to childhood, and are influenced by our social context
    * Tendencies (or not) to use food as a surrogate (to self-soothe, for example, or to exercise control of self or others)
    * Coincidences of occupational choice or other lifestyle equivalents
    * Cooincidences about what kinds of hobbies we personally enjoy
    * Sure, maybe some hormonal appetite stuff
    * Sure, maybe some genetics
    * Body composition (declining fitness/muscularity makes activity less doable, enjoyable, likely; increasing fitness does the reverse - this above and beyond just the calorie impact of body composition or exercise activity per se).
    * . . . and much much more.

    Virtually all of this is stuff we personally can control or at least influence, in typical fortunate first-world lives, if we choose to. Even the things we can't control, we can strategize our way around in many cases, if it's important to us.

    Advice: Don't give up personal power or a sense of agency to pop-science concepts . . . or even to real-science concepts without considering the context in which they exercise influence, and how strong that influence is.

    Personally, I intuitively maintained my weight around BMI 30-point-something, just over the line into class 1 obese, for most of my adult life. It was a summation of my habits and outlook, and even at the time I recognized that a lot of it had to do with choice.

    Now, I wouldn't trust my intuition to guide eating unless I totally had to, having found another approach that takes little time, works great, and that avoids uncertainty about getting adequate nutrition even if I have some treats. I've been in the BMI 21-23 kind of area - normal, healthy weight - for nearly 5 years now. It's not a big struggle with hunger or anything else (well, maybe a tiny struggle with hedonic behavior ;) ). I don't have PCOS, but I'm old-ish (64), obviously post-menopausal, and hypothyroid . . . all factors that some people claim are weight-management doom.
  • ExistingFish
    ExistingFish Posts: 1,259 Member
    It's really complex.

    Then again, I lost weight to right between my high school and college weight, I mean exactly. Probably what I weighed when I stopped developing. I'm having a hard time losing weight from here, but a super easy time maintaining.

    DH has lost weight back to what he was at in his early 20s, but is having a hard time losing any more, despite being overweight still.

    I can't help but think it has something to do with growth and development. When you are young and overweight, you gain new fat cells. If you are old and gain weight, your fat cells expand. When you lose weight, they just shrink - you don't lose them. So I've read. So if you were overweight as a child, you may have a harder time maintaining a lower weight.
  • lemurcat2
    lemurcat2 Posts: 7,885 Member
    janejellyroll wrote: »
    sijomial wrote: »
    Diatonic12 wrote: »
    I concur with @magnusthenerd. The only intuitive eaters I've witnessed restrict their food. They'll tout the scale doesn't matter, calories don't count all the while eating OMAD. It usually consists of some lettuce, a sprinkle of protein and a splatter of secret sauce over the top. They'll spend the rest of the day trying to outexercise the OMAD with hyperawareness of everything that goes into their mouth while pretending they don't.

    Never met a single person like this!
    This seems to be more a reflection on the current woo and hype currently surrounding intuitive eating as some sort of peculiar quasi religion.

    The heathy weight intuitive eaters I've known mostly tend to eat erratically according to their needs over an extended period of time not day by day, not tied to eating at certain times or frequencies, don't restrict their food choices but stop when they have had enough or balance over-eating with under-eating. They also tend to be very active and exercise for enjoyment not calorie burns. They also seem to have a good awareness of their body and make gentle and natural corrections if their weight starts to drift.
    Can't think of any completely intuitive eaters that have been significantly overweight in the past.
    (I can't do that, I have to eat thoughtfully as my intuitive level is a significant surplus.)

    I also known healthy weight intuitive eaters that simply aren't interested in food, get no particular enjoyment from it, don't appear to get hungry if they miss meals and just eat because they have to.

    Rather outweighed (excuse the pun!) in terms of numbers by fat intuitive eaters though.

    My husband (who is normal weight), as far as I can tell from his statements and actions, is a intuitive eater. He eats when he's hungry, skips meals when he isn't. He rarely eats just because something looks good and he doesn't much like the sensation of being very full. He likes high calorie foods, but then might skip a subsequent meal or not eat very much at all (unlike me, who could easily eat thousands of calories more than I need unless I applied specific strategies to limit myself). He couldn't even begin to tell you how many calories he burns with exercise, he just likes to walk around and play basketball (but will also spend a lot of time sitting for his work or to play video games). And he's terrible at estimating how many calories his food has. His body just seems to "know" how much he needs. He has times when he usually eats, but sometimes he'll just skip a meal completely because he doesn't feel hungry enough to eat. But then on the weekend, he might eat a whole pizza after being more active. He's been doing this the whole time I've known him (35-50) and his weight has stayed in a pretty tight range.

    My sister has always been a healthy weight intuitive eater, in the bottom half of the healthy range, but it's hard to say how much it's really intuitive vs her being much more mindful in general. She pays attention to clothes getting uncomfortable, is very dedicated about exercise, has pretty standard meals she eats (and isn't all that interested in food for food's sake), and weighs regularly. She had a huge sweet tooth when we were growing up (I did not), but not much of one now, although she likes crackers and chips more than I do still (and probably tends to eat somewhat higher carb). She's not that into restaurants, so they are a rarer thing for her than me.

    Like your husband, I think it would be hard for her to eat many more cals than she needs, she tends to naturally regulate after a higher cal meal. I do that too, but I have to have strategies -- I can mindfully (without actual counting) maintain a healthy weight, but it requires more awareness than I think it does for my sister.
  • ritzvin
    ritzvin Posts: 2,860 Member
    sijomial wrote: »
    They also tend to be very active and exercise for enjoyment not calorie burns.

    Actually, a pretty good thing to point out... There are lots of people who are successful intuitive eaters until they are no longer extremely active in some chosen sport. ..And then the weight starts piling on (they're used to eating a certain way, and a change in activity level very frequently requires a conscious adjustment to how one eats).
  • psychod787
    psychod787 Posts: 4,099 Member
    magnusthenerd wrote: »
    Well there is set point, which may be an actual weight your body senses and acts on, and then there is settling point, which would be a combination of the set point if exists and the lifestyle you live in.

    It seems that individuals with obese BMI's tend not to exist in any of the hunter-gatherer cultures normally - it is becoming harder to view the actual practices the more industrial cultures make contact and trade with these cultures, changing their eating habits. So settling point without agriculture seems to be always or close to always within a healthy BMI range - even with the hunger signals of something like PCOS, the work required to obtain more calories might still feel not worth it.

    There may be exceptions when people have some of the truly rare and very off hunger signal issues such as people with leptin signaling issues.

    I think some of the advocacy of intuitive eating is overhyped and some of the people pushing it are overzealous coming from backgrounds where they tended to have under-eating restriction issues. In our modern food environment and activity levels some people will actively have to manage their intake, and people trying to pretend whatever weight someone settles at without effort is right are promoting poor health and putting unfair expectations on others.

    I also think intuitive eating is built on a bit of a contradictory concept. I've heard many advocates for it say the goal of intuitive eating is to eat at a level your body wants - well that's silly, as far as I'm concerned, my mind is a product of my brain, which is all produced by the body, so what weight I want to weigh is what my body wants.

    Agreed, we actually only have evidence of obesity in post agriculture in the elites of a society. Those that has the resources to afford very calorie dense foods in abundance. Even when dealing with pre industrial tribes, some will have a few specific obese members... ei the chief, head priest, ect ect
    Now the only evidence from pre agriculture I know of that points to an obese state would be the "Venus'"
    If they were just ritualistic over exaggerations of fertility goddesses or actually individuals is up or debate
    NorthCascades wrote: »
    Set point weights aren't determined by your genes, they're a result of comfortable behaviors (eating and moving).

    I would argue that the "Set point" is not controlled by genetics, but appetite, cognitive dissidence, and NEAT levels, and impulse control are influenced by genetics.


    kimny72 wrote: »
    My problem with the idea of a physical set point is that it's only ever used as a reason why a person can't lose more weight.

    If your body has a predetermined set point weight, why was it so easy to get heavier than that? Why does it only stop you from getting slimmer? If you get down to 150 and feel like your body is keeping you from getting down to 140, why did it let you get up to 175 in the first place?

    IMHO set point is a psychological and lifestyle thing. The activity level and diet you are comfortable with will keep you in a specific weight range, and due to our current convenience culture that weight range might be higher than healthy.

    There can also be underlying untreated hormonal issues that mess with your energy level, focus, and hunger cues that make it seem impossible to get below a certain weight.

    I'd guess people who never become overweight and never have to monitor their diet to stay a healthy weight are simply naturally (or professionally) more active or fidgety, and perhaps grew up accustomed to a way of eating that subconsciously limits overeating.

    I would agree with body weight being controlled to a point by environment, but when coming from an obese state maintaining a lean weight is going to be hard. Evidence... https://pubmed.ncbi.nlm.nih.gov/19401758/
    Notice that a chronic elevated weight was maintained in the rats switch to a standard control diet even when they were only in-taking 1cal a day difference. Lead me to think that previous diet and weight history may play a role in an elevated body weight. Their environments were identical. As far as psychological issues. I agree, but we see a trend for energy dense foods most likely due to the dopamine release. https://pubmed.ncbi.nlm.nih.gov/19401758/
  • galadrielandme
    galadrielandme Posts: 3 Member
    I haven’t read everyone’s responses, but my first thought when I saw your original post was “oh, that’s me.” I mean, I know nothing about “set point” or the specifics around “intuitive eating,” but I do have PCOS, and I’ve spent the last 10 years specifically *not* dieting or subscribing to a specific eating routine, and I’ve been the same weight pretty much the entire time. I’ve been about 5-10 pounds overweight, according to the official BMI range.

    I stopped trying to base all my eating around losing weight as part of recovery from an eating disorder, which I’m imagining is what you’re calling “intuitive eating.” I’ve pretty much been eating what I felt like for 10 years, with weeks where I was voracious and weeks where I did something in the realm of what they are now calling intermittent fasting.

    On the one hand, I haven’t officially been a healthy weight, and I am trying to eat better now (with the help of a newfound understanding of macros), but at the same time I think it’s very interesting looking back on the last decade and having no idea why my voracious eating habits didn’t lead to massive weight gain (by all accounts I have been eating a *lot*). I have lost weight as I’ve been eating a pretty restricted diet, and this past week I noticed I gained weight even though I was eating at a deficit. Who knows what all that means. Bodies are perplexing. But I wanted to throw in my two cents.
  • threewins
    threewins Posts: 1,455 Member
    If you define set point as a weight you are where your weight is stable, without weighing yourself or trying to lose/gain weight. I was an example of that before the age of about 24. I had no idea what I weighed. I didn't try to lose weight, I would over eat on special occasions. My clothing never got tighter. Not looser.

    For those who don't believe in the set point, why was my weight stable? I always used the same hole for my belt.
  • psychod787
    psychod787 Posts: 4,099 Member
    It has actually been a source of fascination. SOOOOO... here we go. Human body weight is almost simple as calories in and calories out, but not quite. As we gain weight our tdee goes up and appetite generally goes down. Its all according if someone is at a set range for their environment. So, lets say you eat 5000 calories one day, your appetite may not be as high a few days later. Generally not the next day in humans. That activity is seen more in rats. So, you might eat 5000 today and balance it mostly out over a few days. The body is pretty good at balancing calories in most folks, but not perfect. So lets say your tdee is 2000, your appetite goes down by only 2900 calories over the course of the week. That's only a 100 calorie surplus for the week. Repeat that over a month and that is 400 calories a month. That's 1-2lbs gained in year, which is almost the average weight gain for a woman from the age of 20 to 40 in the USA. The same happens when most people under eat. There will be a hyper compensation effect the next day or a few days later, this one has not been studied as well as the former. So, as fat cells get larger they produce more of a hormone called Leptin. If the fat cells get smaller, they produce less of it. Leptin is sensed in the hypothalamus and controls our energy expenditure and appetite So, as one loses weight, tdee decreases until a new equilibrium is reached.
  • Raegold
    Raegold Posts: 191 Member
    edited July 2020
    OP here- so happy for all of the responses.

    Definitely makes sense, what many have said.... How can you define "set point" when you aren't in a vacuum and have varying environmental factors that would affect your food choices, activity level, etc.

    The other day I was looking through some YouTube videos and there are a lot of body positivity vlogs, and people who stopped dieting. While I'm on board with body positivity in general, I kinda think it's doing a disservice to some of these young girls who will statistically be at higher risk for multiple health problems. That's the weird part about it to me- like where is the line between body positivity and being healthy, especially when factoring in real medical problems (PCOS, high cholesterol, etc).

    I was convinced that my hunger signals are WAY out of sync with my actual needs ... But having read some of the responses, I feel like in a hunter gatherer situation where I didn't have access to the foods I have now, maybe it would be different. I do remember reading somewhere that PCOS does lead to disordered leptin, but I read that a while ago and don't remember the details.
  • amusedmonkey
    amusedmonkey Posts: 10,330 Member
    I can only share my experience as someone with PCOS and who has experienced what it's like to have hormonal hunger (the kind that can't be sated even after a large meal). I used to be super morbidly obese and now I've settled on an overweight weight I'm happy with and maintaining.

    I have never been "body negative" even at my highest weight, so thankfully, I did not need to work on that part. You can be body positive and still choose to diet. It's a matter of perspective. Dieting is not a punishment, and losing weight doesn't mean your worth is defined by your weight anymore than it is defined by your haircut.

    Yes, intuitive eating can be helpful when someone is dealing with certain mental issues, but it's not the intuitive eating that solves problem nor dieting that causes it, healing the mental pain is what solves it and prodding it is what makes it worse. If someone doesn't work on their mental hurdles they're only replacing one set of rules with another and intuitive eating becomes just another dieting (or anti dieting) practice, and the pain remains.

    I used to maintain my super morbidly obese weight with ease, now I'm maintaining my overweight weight with relative ease because my current weight is relatively easy to maintain with my current set of habits. I chose this weight because that's as far as I'm willing to go with habit changes (plus I like the overweight look). Either my setpoint has changed, if that's what you prefer to call it, or the whole theory is a cop out.

    Of course, there are genetic, physical, environmental, developmental...etc factors that make a certain weight harder to achieve or maintain, but almost anyone can realistically stop being obese without running themselves into the ground while working on their mental health.
  • threewins
    threewins Posts: 1,455 Member
    Some people may find this article interesting on why some people don't gain weight

    https://www.livescience.com/llm-never-gain-weight.html
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