The Set-Point Theory

Welcome to the science posts, which are designed to help provide some foundational information and understanding of how our bodies function and how implementing The Livy Method optimizes our health, wellness and mindfulness by providing an environment where our bodies no longer feel the need to store fat.

We will begin this journey by discussing the Set-Point Theory and other theories of weight loss that might help us explain how The Livy Method works and why it is different from other diets that involve deprivation and calorie restriction. Let’s dive into this.

The History of Dieting

It may be assumed by some that obesity and dieting is a concern of more recent times. But upon delving deeper into this subject matter, it is interesting to note that the concept of dieting or “slimming” has been around for centuries. The Ancient Greeks and Romans already understood that food and physical exercise influence our health and our weight. The Greek word ‘diatia’ (from which the word ‘diet’ is derived) referred to a whole way of living focused on self-control and eating in moderation. Interestingly, the first best-selling diet book was written in 1474 by the Italian humanist, Bartolomeo Sacchi, aka Il Platina. Advances in printing techniques meant that his De honesta voluptate e valetudine was read throughout Europe, and high society became obsessed with his recommendations regarding the relationship between gastronomic pleasure (voluptate) and health (valetudine).

Throughout the ages, humans have been in pursuit of fitting the criteria of what was deemed beautiful or accepted by the society they lived in. For many cultures, and in different eras, being thin has been one of the main measures of beauty. Although this can be problematic for many different reasons, there is a distinction that needs to be made between weight loss and overall health, as opposed to seeking it to fit societal norms.

Hippocrates, who was born in 460 BC and is considered the founder of medicine, was one of the first to document the association between weight and health with the statement, “Those by nature overweight, die earlier than the slim.” Today, we know that obesity-related conditions, which include heart disease, stroke, type 2 diabetes and certain types of cancer, are among the leading causes of preventable, premature death.

Many health issues can be preventable by some degree of weight loss. From the ancient Greeks to present day, many of us have had some struggle with our weight and have likely tried many different diets in order to lose and gain the same weight, many times. There needs to be options for those who are looking to lose weight in a healthy, sustainable way. This is why The Livy Method is designed with overall health in mind, which includes not only a physical focus, but also the mental, emotional and for some, even their spiritual health. Let’s talk more about the impact of obesity on health and why one might consider trying to lose weight.

What are some health risks of being overweight and obese?

Type 2 Diabetes

Type 2 diabetes is a disease that occurs when your blood glucose (or blood sugar) is too high. Your body cannot make enough insulin (a hormone that helps control the amount of glucose or sugar in your blood), or does not properly use the insulin it makes. Diabetes Canada (2022) reports that type 2 diabetes is caused by several different risk factors and accounts for 90% of diabetes cases in Canada. According to the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases, 2018), about 8 out of 10 people with type 2 diabetes are overweight or obese. Over time, high blood glucose can lead to issues, such as heart disease, stroke, kidney disease, eye problems, nerve damage and other health problems.

If you are at risk for type 2 diabetes, losing 5 to 7 percent of your body weight and participating in regular physical activity may prevent or delay the onset of type 2 diabetes. (NIDDK, 2018) There is more discussion regarding the precursor to diabetes in the science post, Hormones Important to Weight Loss & Digestion Part 1-Insulin.

High Blood Pressure

High blood pressure, also called hypertension, is a condition in which blood flows through your blood vessels with a force greater than normal. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack, stroke, kidney disease and even death. Being overweight and obese may raise your risk for high blood pressure.

Heart Disease

Heart disease is a general term used to describe several problems that may affect your heart, such as those that have suffered a heart attack, heart failure, angina, an abnormal heart rhythm (also called arrhythmia) or sudden cardiac death.

High blood pressure, abnormal levels of blood fats (blood lipids) and high blood glucose levels may increase your risk for heart disease. Blood lipids include HDL cholesterol, LDL cholesterol, and triglycerides. Review the science post on The Science of Fat and Fat Loss for a more detailed description of fats in the body.

According to the NIDDK (2018, February), losing 5-10% of your weight may lower your risk factors for developing heart disease. Weight loss may improve blood pressure, cholesterol levels and blood flow in the body.

Stroke

Stroke is a condition in which a blockage or the bursting of a blood vessel in your brain or neck prevents blood flow from getting to the brain. A stroke can damage brain tissue, affecting your ability to speak or move parts of your body. According to the NIDDK (2018, February), high blood pressure is the leading cause of strokes. As discussed above, even a 5-10% reduction in weight can improve blood pressure, which could decrease the risk of stroke.

Sleep Apnea

Sleep apnea is a sleep disorder in which your breathing can be affected while sleeping. Sleep apnea may present as irregular breathing patterns or where your breathing stops (apnea) altogether for short periods of time. According to Jonathan Jun, M.D. (Johns Hopkins Medicine, 2022), a pulmonary and sleep medicine specialist at the Johns Hopkins Sleep Disorders Centre, sleep apnea happens when upper airway muscles relax during sleep and pinch off the airway, which prevents you from getting enough air. Your breathing may pause for 10 seconds or more at a time until your reflexes kick in and you start breathing again. This results in decreased oxygen to the body and vital organs. If left untreated, sleep apnea may raise your risk of other health problems, such as type 2 diabetes and heart disease.

Jun discusses that sleep apnea occurs in about 3% of normal weight individuals but affects over 20% of people with obesity. In general, sleep apnea affects men more than women. However, sleep apnea rates increase sharply in women after menopause.

There are two kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea happens when air can’t flow into or out of the nose or mouth, although you’re trying to breathe. Central sleep apnea happens when the brain fails to send the right signals to your muscles to make you start breathing (this type is less common).

Symptoms of sleep apnea can manifest in the following ways:

• Pauses in breathing or snoring (both of which may be noticed by a partner). Snoring is the sound caused by the vibration created by airway resistance. Snoring can be caused by the relaxing of the airway as described above, so snoring as an isolated symptom does not mean you have sleep apnea. Also, you may have sleep apnea without much snoring, so if you suspect sleep apnea may be an issue for you, further testing may be necessary.

• Unexplained fatigue and mood swings due to the prevention of settling into the deep stages of restorative sleep. This may lead to increased tiredness and grogginess resulting in decreased productivity, impacting focus and attention. This can also result in dire consequences if one participates in activities that require attention, such as driving a car or operating machinery.

• Waking up with a dry mouth, as those with sleep apnea tend to breathe with their mouths wide open. This leads to the saliva in their mouths drying out.

• Headaches upon waking, which may be caused by low circulating blood oxygen or high carbon dioxide levels during sleep due to inadequate breathing.

• Although one can have sleep apnea independent of being overweight, evidence suggests a link between sleep apnea and diabetes, as sleep apnea can cause an increase in blood sugar levels.
  

• For those who are overweight or obese, weight loss is key for treating or avoiding sleep apnea. People who accumulate fat in the neck, tongue and upper belly are especially vulnerable to developing sleep apnea. This weight reduces the diameter of the throat and pushes against the lungs, contributing to airway collapse during sleep.

Metabolic Syndrome

Metabolic syndrome is a group of conditions that put you at risk for heart disease, diabetes and stroke and is related to obesity. These conditions include high blood pressure, high blood glucose levels (pre-diabetes and type 2 diabetes), high triglyceride levels in your blood, low levels of HDL cholesterol (the “good” cholesterol) in your blood and the accumulation of fat around the abdomen.

As discussed in the science post, Hormones Important to Weight Loss & Digestion Part 1-Insulin, experts believe obesity, especially too much fat in the abdomen and around the organs (called visceral fat), is a main cause of insulin resistance. Insulin resistance may lead to pre-diabetes and type 2 diabetes. A lack of physical activity may also be a factor.

Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and are not able to easily take up glucose from your blood. As a result, your pancreas increases the production of insulin to help glucose enter your cells, a condition called hyperinsulinemia. However, as long as your pancreas can produce enough insulin to overcome your cells’ weak response to insulin, your blood glucose levels should stay in the healthy range.

Having a waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance. This is true even if your body mass index (BMI) falls within the normal range. However, research has shown that Asian Americans may have an increased risk for insulin resistance even without a high BMI (the discussion of BMI is used in reference to this study, although the concept of BMI is problematic as a measure of obesity).

Studies have also shown that belly fat produces hormones and other substances that can contribute to chronic, or long-lasting, inflammation in the body. Inflammation may play a role in insulin resistance, type 2 diabetes and cardiovascular disease. Since excess weight may lead to insulin resistance, this also is a contributing factor in the development of fatty liver disease.

Fatty Liver Diseases

Fatty liver diseases are conditions in which fat accumulates in the liver that can, over time, affect liver function and cause liver injury. Fatty liver diseases include non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Fatty liver diseases may lead to severe liver damage, cirrhosis (late-stage scarring or fibrosis of the liver) or even liver failure.

People who drink too much alcohol may also have fat in their liver, but that condition is different from fatty liver disease.

There are 2 types of fatty liver disease. If you just have fat accumulation but no damage to your liver, the disease is called non-alcoholic fatty liver disease (NAFLD). If you have fat accumulation in your liver plus signs of inflammation and liver cell damage, the disease is called non-alcoholic steatohepatitis (NASH). According to Johns Hopkins Medicine, about 10%-20% of Americans have NAFLD and about 2%-5% have NASH.

Fatty liver disease is sometimes called a silent liver disease because it can occur without causing any symptoms. Most people with NAFLD live with fat in their liver without ever developing liver damage, whereas a few people develop NASH. Symptoms of NASH may take years to develop and can potentially cause cirrhosis. Symptoms from NASH may include severe tiredness, weakness, weight loss, yellowing of the skin or eyes (jaundice), spider-like blood vessels on the skin and long-lasting itching.

NASH that turns into cirrhosis could cause symptoms like fluid retention, internal bleeding, muscle wasting and confusion. Over time, people with cirrhosis may develop liver failure and need a liver transplant.

The exact cause of fatty liver disease is unknown, but it is thought that obesity is the most common cause. Obesity in the U.S. has doubled in the last decade, and health care providers are seeing a steady rise in fatty liver disease. Although children and young adults can get fatty liver disease, it is most common in middle age.

Risk factors include:

• Being overweight

• Having high blood fat levels, either triglycerides or LDL (“bad”) cholesterol

• Having diabetes or prediabetes

• Having high blood pressure

Fatty liver disease can happen without causing any symptoms. It’s usually diagnosed when you have routine blood tests to check your liver. Your health care provider may suspect fatty liver disease with abnormal test results, especially if you are obese.

If you have NAFLD without any other medical problems, making some lifestyle changes can control or reverse the fat buildup in your liver. However, you will want to work alongside your health care provider as you work through this process.

This may include:

• Losing weight (losing just 3-5% of your weight can decrease the amount of fat in your liver)

• Exercise

• Lowering your cholesterol and triglycerides

• Controlling your diabetes

• Avoiding alcohol

• Reviewing our science post on Detox for some suggestions on how to support your liver

Osteoarthritis

Osteoarthritis is a common, long-lasting health problem that causes pain, swelling and reduced motion in your joints. Being overweight or obese may raise your risk of getting osteoarthritis by putting extra pressure on your joints and cartilage.

According to the Arthritis Foundation in the US (2022, May), maintaining a healthy weight can ease the pain of arthritis and help your medication(s) work better. The CDC also reports that 31% of obese Americans have doctor-diagnosed arthritis.

The Arthritis Society of Canada (2022, November) discusses that excess weight can contribute to the onset and progression of knee and hip osteoarthritis. Furthermore, what we eat can be a key factor in the prevention/reduction of disease progression, as well as an identified risk factor for the development and management of gout.

Here are some reasons that the Arthritis Foundation suggest why reaching and maintaining a healthy weight can help ease your arthritis:

REDUCE PRESSURE ON YOUR JOINTS 

A key study published in Arthritis & Rheumatism of overweight and obese adults with knee osteo-arthritis (OA) found that losing one pound of weight resulted in four pounds of pressure being removed from the knees. In other words, losing just 10 pounds would relieve 40 pounds of pressure from your knees. This is so impactful when you think about what weight loss means for the joints in your body. Even a small amount of weight loss can make a big difference on your joints.

EASE PAIN

Multiple studies show that losing weight results in arthritis pain relief. A 2018 study published in Arthritis Care and Research went further to find that losing more weight – to an extent -- results in more pain relief. The study of overweight and obese older adults with pain from knee OA found that greater weight loss resulted in better outcomes than losing a smaller amount of weight. Losing 10–20% of starting body weight improved pain, function and quality of life better than losing just 5% of body weight.

REDUCE INFLAMMATION 

The tissue fat itself is an active tissue that creates and releases pro-inflammatory chemicals. By reducing fat stores in the body, your body’s overall inflammation will go down. An article published in 2018 explained that obesity can activate and sustain body-wide low-grade inflammation. This inflammation can amplify and aggravate autoimmune disorders, such as rheumatoid arthritis, psoriatic arthritis, lupus and their associated comorbidities (like heart disease).

REDUCE DISEASE ACTIVITY 

Losing weight can reduce the overall severity of your arthritis. A 2018 study reviewed the records of 171 RA (rheumatoid arthritis) patients and found that overweight or obese people who lost at least 5 kg (10.2 pounds) were three times as likely to have improved disease activity compared to those who did not lose weight. A smaller 2019 study found that short-term weight loss in obese people with psoriatic arthritis (PsA) yielded “significant positive effects” on disease activity in joints, entheses (an enthesis is the site of attachment of tendon, ligament, fascia or capsule to bone) and skin.

IMPROVE THE CHANCE OF REMISSION 

Several studies have shown that being obese reduces your chance of achieving minimal disease activity or remission if you have RA or PsA. A 2017 review article analyzed data from more than 3,000 people with RA and found that obese patients had lower odds of achieving and sustaining remission compared with non-obese people. A 2018 article analyzed several studies totaling more than 3,800 patient records. The authors found that obesity “hampered the effects of anti-TNF agents” and showed that the odds of reaching a good response or achieving remission were lower in obese than in non-obese patients taking anti-TNF medications. TNF or tumour necrosis factor is a protein that is produced by the body that causes inflammation. In healthy individuals, TNF is blocked naturally but is elevated in the blood of those with rheumatic conditions (rheumatology.org, 2022). These medications help inhibit TNF in order to reduce inflammation.

LOWER URIC ACID LEVELS AND CHANCE OF GOUT ATTACK 

Gout is a common form of inflammatory arthritis that is very painful. It usually affects one joint at a time (often the big toe joint). There are times when symptoms get worse, known as flares, and times when there are no symptoms, known as remission. Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis. Gout is caused by a condition known as hyperuricemia, where there is too much uric acid in the body. The body makes uric acid when it breaks down purines, which are found in your body and the foods you eat. When there is too much uric acid in the body, uric acid crystals (monosodium urate) can build up in joints, fluids and tissues within the body. Hyperuricemia does not always cause gout, and hyperuricemia without gout symptoms does not necessarily need to be treated.

A 2017 analysis of 10 studies found that weight loss was beneficial for obese or overweight people with gout. Overall, people who lost weight had lower serum uric acid levels and fewer gout attacks.

The following make it more likely that you will develop hyperuricemia, which can cause gout:

• Being male

• Being obese

• Having certain health conditions, including: congestive heart failure, hypertension (high blood pressure), insulin resistance, metabolic syndrome, diabetes and poor kidney function

• Using certain medications, such as diuretics (water pills)

• Drinking alcohol - the risk of gout is greater as alcohol intake goes up

• Eating or drinking food and drinks high in fructose (a type of sugar)

• Having a diet high in purines, which the body breaks down into uric acid (purine-rich foods include red meat, organ meat, and some kinds of seafood (such as anchovies, sardines, mussels, scallops, trout and tuna)

SLOW CARTILAGE DEGENERATION IN OSTEOARTHRITIS 

A 2017 study assessed magnetic resonance images (MRIs) of osteoarthritic knees in 640 overweight or obese people. Participants who lost weight over 4 years showed significantly lower cartilage deterioration. The more weight lost, the lower the rate of disease progression.

For those navigating arthritis living in Canada, the Arthritis Society Canada has some excellent resources to help support you in your learning and managing your diagnosis. This can allow you to better focus on reducing certain risk factors, such as weight loss, in order to help alleviate symptoms and disease progression.

https://arthritis.ca/

Gallbladder Disease

According to the NIDDK (2017, November), being overweight or obese may make you more likely to develop gallstones, especially if you are a woman. Researchers have found that people who are obese may have higher levels of cholesterol in their bile, which can cause gallstones.

People who are obese may also have large gallbladders that do not work well. Some studies have shown that people who carry large amounts of fat around their waist may be more likely to develop gallstones than those who carry fat around their hips and thighs.

Losing weight very quickly may raise your chances of forming gallstones. When you don’t eat for a long period of time (fasting) or you lose weight too quickly, your liver releases extra cholesterol into the bile. Fast weight loss (associated with very low-calorie diets) can also prevent the gallbladder from emptying properly. Weight loss surgery may also lead to fast weight loss and a higher risk of gallstones.

Weight cycling, or losing and regaining weight repeatedly, may also lead to gallstones. The more weight you lose and regain during a cycle, the greater your chances of developing gallstones.

Your chances of developing gallstones may depend on the type of weight loss treatment you choose. A program like The Livy Method, which supports the body and helps people lose weight in a healthy way, is a good option when trying to lose weight.

Regular physical activity, which will improve your overall health, may also lower your chances of developing gallstones.

To improve health or prevent weight gain, aim for at least 150 minutes a week of moderate-intensity physical activity, like brisk walking or fast dancing. Also, muscle-strengthening activity, like lifting weights or using your own body weight (calisthenics), can be beneficial. The science post, Issues of Digestion discusses the gallbladder in further detail and options for those who have had it removed.

Some Cancers

Cancer is a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues. Being overweight or obese may raise your risk of developing certain types of cancers.

Kidney Disease

Kidney disease is a generic term that means there is damage to the kidneys and they are not able filter blood of wastes like they should. This is a vital process for the body. Obesity raises the risk of diabetes and high blood pressure, which are the most common causes of kidney disease. Even if you do not have diabetes or high blood pressure, obesity itself may promote kidney disease and quicken its progression.

Pregnancy Problems

Being overweight or obese raises the risk of health issues that may occur during pregnancy. Pregnant women who are overweight or obese may have a greater chance of:

• Developing gestational diabetes

• Having pre-eclampsia, which presents initially as high blood pressure during pregnancy and can cause severe health problems for the mother and baby, if left untreated.

• The need for a Cesarean section (C-section), which can come with increased risks and a longer recovery after giving birth

Being overweight or obese are also associated with mental health problems such as depression. People who are overweight or obese may also experience the stigma of weight bias from others, including health care providers. This can lead to feelings of rejection, shame or guilt, which can further worsen some mental health issues.

The Rise of Obesity in The World

According to the World Health Organization (WHO), being overweight or obese is defined as having “abnormal or excessive fat accumulation that presents a health risk.” Although BMI can be a problematic assessment of obesity, it is still widely used to categorize a person’s weight. As per the WHO, a body mass index (BMI) over 25 is considered overweight and over 30 is obese. A report from the global burden of disease describes that this issue has grown to epidemic proportions, with over 4 million people dying each year as a result of being overweight or obese in 2017.

The estimated annual medical costs related to obesity in the United States were nearly $173 billion in 2019. The medical costs for adults who were diagnosed with obesity were $1,861 higher than medical costs for people with a healthy weight.

In the US, the CDC discussed in their report from 2017-2020 that the prevalence of obesity was 41.9%. They also reported that from 1999-2000 through 2017-March 2020, the prevalence of obesity had increased from 30.5%-41.9%, and the prevalence of severe obesity increased from 4.7%-9.2% in this same time frame.

According to the Government of Canada, statistics gathered from the Canadian Risk Factor Atlas (CRFA) using pooled data from the Canadian Community Health Survey, 2015-2018 determined that:

• About 1 in 4 Canadian adults (26.6%) are currently living with obesity.

• Obesity rates in Canadian adults are higher in men compared to women (28.0% versus 24.7%).

In Canada, a health report released on October 20, 2021 from Statistics Canada found that chronic diseases account for 89% of all deaths and more than $80 billion in annual health care costs. Adopting healthy lifestyle behaviours, such as healthy eating, has the potential to prevent 80% of type 2 diabetes and cardiovascular disease, 40% of cancers and other chronic diseases. Despite healthy eating recommendations issued by Health Canada, eating habits continue to deteriorate, and overweight prevalence rates continue to increase.

Rates of those who are overweight and obese continue to grow in adults and children. From 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5–19 years increased more than four times from 4%-18% globally.

The WHO describes obesity as one side of the double burden of malnutrition and states that today, more people are obese than underweight in every region except sub-Saharan Africa and Asia. Once considered a problem only in high-income countries, being overweight and obese is now dramatically on the rise in low-income and middle-income countries, particularly in urban settings. The vast majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30% higher than that of developed countries. This can be attributed to the lower cost of calorie-dense, but nutrient-poor foods that are widely available all over the world. Decreased physical activity is also a factor.

Interestingly in Canada though, the rate of obesity is higher for adults living in rural areas compared with those living in urban areas, regardless if one identifies with being male or female. Living in an urban setting is defined as living in areas with a high-density concentration of population (i.e., areas with a population of at least 1,000 and a population density of at least 400 persons per km2). Living in a rural setting is defined as all areas outside urban areas, or embedded in urban areas.

• In rural areas, about 1 in 3 Canadian adults are living with obesity (31.4%).

• In urban areas, about 1 in 4 Canadian adults are living with obesity (25.6%).

This means that there are, on average, 5.8 more cases of obesity per 100 adults living in rural areas compared with urban areas. *Note: Not all provinces or territories show higher rates of obesity in rural compared to urban areas.

Check out https://health-infobase.canada.ca/datalab/canadian-risk-factor-atlas-obesity-blog.html?=undefined&wbdisable=true for more details on the Canadian demographics!

Obesity Affects Some Groups More Than Others

According to the CDC, in the US, Non-Hispanic Black adults (49.9%) had the highest age-adjusted prevalence of obesity, followed by Hispanic adults (45.6%), non-Hispanic White adults (41.4%) and non-Hispanic Asian adults (16.1%). The prevalence of obesity was noted to be 39.8% among adults aged 20 to 39 years, 44.3% among adults aged 40 to 59 years, and 41.5% among adults aged 60 and older.

In the Morbidity and Mortality Weekly Report (MMWR), it is discussed that the association between obesity and income or educational level is complex and differs by sex and race/ethnicity.

It was found that:

• In the US overall, men and women with college degrees had lower obesity prevalence compared with those with less education.

• This same obesity and education pattern occurred among non-Hispanic White, non-Hispanic Black, and Hispanic women and non-Hispanic White men. However, the differences were not all statistically significant. Although the difference was not statistically significant among non-Hispanic Black men, obesity prevalence increased with increased education.

• No differences in obesity prevalence by education level were noted among non-Hispanic Asian women and men and Hispanic men.

Socio-Economic Impacts on Obesity

In the MMWR report, it was noted that the prevalence of obesity was lower in the lowest and highest income groups compared with the middle-income group. Researchers observed this same pattern among non-Hispanic White and Hispanic men. However, the prevalence of obesity was higher in the highest-income group than in the lowest-income group among non-Hispanic Black men. This can be attributed to how socio-economic and culture influence food choices and lifestyle. In many cases, those with more education tend to have access to healthier food choices and tend to be more active.

Although interestingly in some cultures, greater affluence leads to more indulgent choices and activities leading to obesity (PRB, 2013).

Historically, urbanization was considered one of the most important drivers of the rise in obesity in industrialized countries. However, in Canada, it has been more recently shown that the urbanization of rural life has contributed to a larger increase in rural obesity.

This change in the geographic distribution of obesity can be partly explained by the growing economic and social disadvantage that rural communities experience compared to urban cities. In particular, rural communities experience lower education and income, lower availability of healthy and fresh foods at a reasonable cost, less access to public transportation and a lack of supportive environments to promote walkability, sports and recreational activities.

In Canada overall, adult obesity is more prevalent among disadvantaged population groups, such as those unemployed or with lower household income and education levels.

Recent global trends show that the prevalence of obesity is rising faster among people living in rural areas than those living in urban areas. When looking at cities in Canada:

• The lowest rates of adult obesity were observed in the largest urban census metropolitan areas.

• In general, obesity rates in adults tend to be higher in smaller cities.

• Although adult obesity rates in the territories are among the highest in Canada, there were no urban-rural disparities.
  

Having access to and understanding this data on how obesity rates in rural and urban populations are changing, as well as the socio-economic and cultural demographics, may assist policy-makers and local communities in targeting policies, programs and services aiming to promote healthy weight appropriately. This is where implementing a program like The Livy Method, and access to healthy food and activity, could incite real change.

The Livy Method

To understand weight loss better, it’s important to understand the problem of obesity and the impact it is having on society. After looking at these statistics, one thing is very clear - the way we approach our health at a global level needs to change. A big part of this would be having access to real nutritious food, clean water and sanitation, housing, fresh air and feeling physically and psychologically safe, amongst many other things. The other factor is understanding how the issue of obesity impacts our health, along with our food and lifestyle choices.

As you can now see, The Livy Method is VERY different from many of the diets and weight-loss methods that are out there or that you may have experienced. The diet and food industry are profit-driven industries with a focus on sales and retaining consumers. At Weight Loss by Gina, some of the core missions are to help people change their lives by improving their health, their relationship with food, the quality of food that they eat and the way in which they eat it and to promote people prioritizing themselves. This all ultimately leads to weight loss.

However, many question, how does this Program work? How can I lose weight when I am eating more than I ever have? I have always been taught to count macros and/or calories.

These are all great questions and points, so let’s dive into this deeper.

The set point theory

According to Ghoshal (2020, March), set-point theory in relation to weight loss states that we have a pre-set weight baseline that is hardwired in our DNA and specific for our individual bodies. Based on this theory, our weight and how much it changes from that set point might be limited. The theory states that some of us have higher weight set points than others and our bodies fight to stay within these ranges.

Recent studies point to body weight being affected by a combination of factors. Weight can be determined by inherited traits, the environment, and by hormonal, psychological and genetic elements.

The set-point model relies on the concept of a genetic pre-set weight range that’s controlled by biological and physiological signals in our bodies (NIDDK, 2011). The body has a regulatory system that keeps you at a steady-state level, or set point. You may have also heard this called homeostasis.

The hypothalamus, a small region of the brain located at the base of the brain near the pituitary gland, is involved in the integration of signals directed to it from hormones like leptin (from adipose or fat cells), ghrelin (from the digestive system), insulin (the pancreas), along with many other hormones that regulate our hunger and satiety. Your metabolism also constantly adjusts up or down based on a variety of signals. The set-point theory also suggests that your weight may go up or down temporarily but will ultimately return to its normal set range. The signaling system we have in place helps to maintain our weight.

The science post, Hormones Important to Weight Loss & Digestion Part 2- Hormones of Hunger and Satiety and Timing of Digestion, takes a much deeper dive into how our hormones influence our hunger and satiety and how The Livy Method helps to support these hormones, which can help influence weight loss and a drop in set point.

Check out this video to see a detailed breakdown of the important role the hypothalamus plays in our body:

https://www.youtube.com/watch?v=xCXtcoUxJZc

This model is consistent with many of the biological aspects of energy balance, but struggles to explain the significance that environmental, economical and social influences play on obesity, food intake and physical activity. More on this later.

However, why does our weight climb beyond a few pounds if we have a set point?

Some researchers (Jung, C.H. & Kim, M.S., 2013) believe that the reactive signal system stops working efficiently over time and leptin and insulin resistance develop, causing us to gain weight. Although not a human study, Dalvi et al. (2017), found that when mice were fed a mostly high-fat diet, it led to inflammation of the hypothalamus. However, a different study in mice that same year, concluded that a diet high in both fat and sugar, caused inflammation of the hypothalamus (Gao et al., 2017). The thought is that foods that are high in fat and sugar, like many processed foods available today, lead to not only inflammation in the body, but also in the brain. Because the hypothalamus is so important in regulating and interpreting the signals involved in hunger, satiety and metabolism, inflammation can lead to a disruption in the pathway of these signals and even in how fat is stored. This can lead to weight gain.

It is also important to note that adequate sleep is also important to keep our hypothalamus healthy. The anterior region has an important role in regulating our circadian rhythm (which are physical and behavioural changes that occur on a daily cycle). An example of a circadian rhythm is being awake during the day and sleeping at nighttime, which is influenced by the presence or absence of light (Seladi-Schulman, J., 2022, Jan). Adequate quality sleep has a great positive impact on many aspects of our weight and health.

Other influences also contribute to weight gain over time. According to the NIDDK (2018, February), weight gain can be influenced by: family history and genes; race or ethnicity; age; sex; eating and physical activity habits; where you live, work, play and worship; stress; lack of sleep; medical conditions; and medications.

Gradually, according to set-point theory, the normal body set point keeps adjusting upward over time if there is any disruption in our signaling system. Many factors influence this system and can lead to weight gain if the balance is interrupted. Factors include: lack of good sleep; poor digestion; lack of nutrition and vitamin/mineral deficiencies; increased stress; inadequate hydration; the development of insulin resistance; lack of movement/exercise; or any health/medical issues.

When we try to lose weight, our body fights to maintain the higher set-point weight by slowing down our metabolism. This can ultimately limit weight loss. This is also when strategies, such as eating less and/or exercising more, begin to backfire by feeding into that negative feedback loop that further affects our hormones, stresses our body, and an even further lack of nutrition/vitamins/minerals causing our bodies to hold onto our fat stores even more. This can also lead to mental and emotional duress as implementing what we thought would help us lose weight sets us up for further weight gain and a sense of failure.

The Settling Point Model

However, there is a secondary theory for weight called the “settling point” model that is an enhancement to the set-point theory. This concept suggests that our weight is influenced by more than just physiological factors. How we navigate our food choices, together with our biological traits and our energy balance, affects weight shifts over time. This model can help us further understand obesity, especially in its rise, as it incorporates the influence of family/social dynamics of food, how the food itself has changed (food science and big business), environmental (chemicals/obesogens), socio-economic (having access to healthy food or alternatively living a more indulgent lifestyle) and the kind of lifestyle you lead (active or inactive).

Overall, there is an abundance of different theories out there, as well as groups researching obesity, that have widely different views. However, what seems clear is the evidence that our weight is influenced by a complex set of internal and external signals — a combination of environmental and biological factors. The good news? The Livy Method helps us address all of these influences, including giving us the tools to do so.

Can we change our set point weight? According to set point theory, yes!

To reset our set point to a lower level, set-point theory proponents recommend going slowly with weight loss goals. A gradual 10% step-down weight loss approach, with persistent maintenance at each stage, can help prepare the body to accept the new lower set point. This further corroborates why it is so important to allow our body to settle into its new weight and set point and embrace plateaus or stabilizing periods as part of successful weight loss. This is also why it is important to allow adequate time for the body to adjust to maintenance by “solidifying your weight in Maintenance,” as Gina says. This is achieved by continuing with The Program for a few months upon achieving your goal before reintroducing foods back into your life. Then it’s about living your life, eating the foods that make you feel good and doing so mindfully.

What about calories in vs. calories out?

According to set-point theory, the reason typical diets don’t work is that after a time, your body will fight reduced-calorie intake by influencing your hunger hormones to leave you in a constant state of hunger and feelings of deprivation. It will then proceed to slow down your metabolism in an attempt to bring you back to your normal set point.

This can lead to binge eating and cycling through various diet programs, like so many of us have experienced in the past. Set-point theory believes your body and brain are in a struggle to regain a set-point weight. However, by following The Livy Method, which focuses on eating and feeding into your hunger signals and allowing your insulin levels to stabilize over time, your hormone feedback system will improve. The Livy Method also focuses on improving digestive health, hydration, sleep, stress management and eating nutrient-rich foods to satisfaction, rather than strict calorie restrictions with large energy burns from exercise. All of these factors will ultimately help lower your set point.

Finally, it is important to stop thinking about food as calories. According to Harvard Medicine (2016, November), looking only at calories, and comparing calorie to calorie, ignores the important fact that our body processes various foods differently. The calories in more nutrient-dense foods with higher fibre and water content, actually change how you digest and retrieve the energy from that food (metabolic effect). An example of this would be comparing a chocolate bar, and its caloric equivalent, to spinach or nuts. You would feel naturally full on less when eating the spinach and nuts. Also, your body would receive much more nutritional benefit in the form of vitamins, minerals and hormone stability. The chocolate bar would increase your blood sugar more than the spinach or nuts would, causing your body to release insulin to store the excess glucose. Increased insulin eventually leads to more intake and thus, the negative feedback loop has been stimulated.

Another consideration is that different foods go through different metabolic pathways. Some of these pathways are more efficient than others. According to Healthline (2018, May), the more efficient a metabolic pathway is, the more of the food’s energy is used for work and less is dissipated as heat. The metabolic pathways for protein are less efficient than the metabolic pathways for carbs and fat. Protein contains 4 calories per gram, but a large part of these protein calories is lost as heat when it is metabolized by the body.

The thermic effect of food is a measure of how much different foods increase energy expenditure, due to the energy required to digest, absorb and metabolize the nutrients. Sources vary on the exact numbers, but it’s clear that protein requires much more energy to metabolize than fat and carbs.

For example, when ingesting 100 calories of food, with a thermic effect of 25% for protein and 2% for fat, this would mean that 100 calories of protein would end up as 75 calories available; whereas 100 calories of fat would end up as 98 calories available to be used as energy or to be stored by the body.

Another example of this principle would be in how the body utilizes fibre. There are 2 different types of fibre: soluble and insoluble. Both are important for health, digestion and preventing diseases.

• Soluble fibre attracts water and turns to gel during digestion. This slows digestion. Soluble fibre is found in oat bran, barley, nuts, seeds, beans, lentils, peas and some fruits and vegetables. It is also found in psyllium, a common fibre supplement. Some types of soluble fibre may help lower risk of heart disease.

• Insoluble fibre is found in foods, such as wheat bran, vegetables and whole grains. It adds bulk to the stool and appears to help food pass more quickly through the stomach and intestines.

The higher the fibre in foods, not only the better for your health, but less caloric energy is extracted from it for storage in the body. An example of this would be corn. Corn on the cob is nutritious, delicious and high in fibre. It is very difficult for the body to process, requiring lots of chewing and work for the body to break down to use what it needs. However, if you take this same amount of corn and crush it into a flour and make a tortilla, the body doesn’t have to work as hard, as it is already ground down and processed. In fact, most of its caloric energy is made available to the body, as opposed to when eating it in its whole form. This means the body will utilize almost all of the calories from the processed form; whereas the body will only use some of the calories in its whole form. Furthermore, its processed form can also impact the hormones in the body very differently. This may lead to an increased release of insulin and other hunger and satiety hormones that can impact our hunger and satisfaction levels, which may lead us to eat more of it than we need. Hopefully, this makes sense when understanding why it is recommended to eat food in its most whole form as much as possible, and there is a much clearer understanding of the premise and science behind how The Livy Method results in weight loss.

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