"Get The Skinny."   by Caroline J. Cederquist, M.D.

Understanding your setpoint; 
learning to STOP

   The human body is a wonderful, complicated machine. 

   Your digestive system, your brain and your fat 
stores all work together through a highly complex 
biochemical interaction to help you maintain a stable 
weight. These different parts of your body 
communicate with one another through various 
feedback mechanisms in an effort to coordinate the 
various activities that maintain your weight at a 
specific level. That level is known as the setpoint. 

   Think of your setpoint as a thermostat. In your 
home, you set your thermostat at the temperature 
you most enjoy and expect your heating or air 
conditioning system to respond to outside conditions 
and maintain your home at that temperature. By the 
same token, your setpoint raises or lowers your 
appetite and metabolism-the rate at which your body 
burns calories-in response to how much you eat. 

   You may now ask the obvious question: "If my 
body is designed to maintain a stable weight, then 
why did I gain weight and why is it so darn hard to 
lose it? 

   Back to our thermostat analogy. Let's say that 
the outside temperature is 85 degrees and you want 
your home's cooling system to maintain an indoor 
temperature of 72 degrees. No problem. Your air 
conditioner won't have to work too hard to cool the 
outside air by only 13 degrees. 

   But let's throw in a heat wave when the outside 
temperature climbs to a sweltering 110. No matter 
how hard your ASC struggles, it won't be able to 
maintain that desired 72 degree temperature. The 
gap is just too big. So what does it do? It maintains 
the lowest temperature it can-but it will still be 
higher than 72 degrees! 

   That's what happens with your setpoint. If, over 
a long period of time, you develop a greater gap 
between the calories you eat and those you use up 
in exercise, your body's weight regulation system will 
adjust your setpoint upward. Your body then settles 
in to maintain that higher weight. 

   That answers the first part of your question, but 
what about why it's so hard to the weight back off? 

  When you start to lose weight, your body's 
metabolic alarm goes off. It alerts your body-which 
strives for equilibrium or that stable status quo-that 
you are not eating as much as usual. In turn, your 
body demands more food. It's a survival mechanism, 
built in eons ago, and not easily reprogrammed. 

   For years, I have reassured my patients that 
dieters don't fail for lack of willpower but because of 
cravings! As long as your setpoint remains elevated, 
you will be assaulted by those blasted cravings every 
time your body senses that you are not eating 
enough to maintain your present weight. 

   Those physiological hunger alarms thus make it 
extremely hard for overweight people to lose weight, 
and even harder for them to keep it off. Your body is 
fighting to hold on to whatever excess fat it has 
become accustomed to, and it does its best to 
replace any weight you lose. 

   Last week, I offered a number of strategies for 
dealing with cravings, but here's a little framework 
for bringing them into play. 

   People who know the phrase "lead us not into 
temptation" grow up thinking of temptation as the 
first step down a slippery slope into some kind of 
disaster, and it often is, if you yield to it. 

   But you can also think of temptation as an early 
warning system. Sure, there are times when it just 
doesn't bother you to be around a lovely plate of 
brownies, or French fries, or some other treat that's 
just not on your dietary program. But sometimes you 
are tempted. But instead of regarding that craving as 
the first step toward actually eating the off-limits 
treats, regard it as the signal to pull in reinforcements, 
just in case. Even before you start to feel really compelled 
|to go for the goodies. 

   If you feel tempted, STOP! 

   STOP is an acronym for a four-step process that 
you can use to good benefit. 

   S-Stop! Visualize a stop sign and hear the 
word "stop." Immediately stop whatever it is you're 
doing. 

   T-Take a deep, cleansing breath. This creates a 
window of opportunity during which you can 
recognize and assess the temptation you're faced 
with, and take appropriate action. 

   O-Observe your situation, yourself, and and your 
options. Analyze what's going on. How are you 
feeling? What do you want? What do you need? In 
your observation, use the HALT analysis. Am I 
Hungry, Angry, Lonely or Tired? That's because we 
often react automatically, sometimes inappropriately 
to these stimuli. Of these, only true hunger is a good 
reason to eat. If there's something else playing into 
your temptation, then eating is not the correct 
response, plain and simple. 

   P-Plan your correct action. You've got choices, 
so what are they? What's really important to you? 
What actions will help you move toward what 
matters, toward an appropriate response, and away 
from the temptation and reactionary eating. 

   Go ahead and let yourself hear whatever voices 
inside you are suggesting that you abandon or 
sabotage your healthy intentions, and pause long 
enough to acknowledge and respond to those voices. 
A good response might be, "Thanks for sharing, now 
move along." 

   Then shift the focus away from food by doing 
something else: sit quietly for five minutes and let 
your attention rest on your breathing; phone a 
friend; review a list of your motivations for getting 
healthy (you have made that list by now, haven't 
you?) or take a walk. 

   And encourage yourself as you would a friend or 
loved one. We're often too willing to let ourselves fail 
without offering the support we would give to even a 
casual pal. Remember that sometimes, if you're not 
hearing what you need to hear, it might be because 
you're not saying it yourself. 

   The more often you use the STOP method to 
manage cravings, the more easily and effectively 
you'll be able to resist temptations and overcome 
your body's natural tendency to push you back to 
your setpoint. 

   But the more frequently you do it successfully, 
the easier it becomes, just as with anything else that 
takes practice. After a while you get good at it, and 
it just becomes a habit. A good habit. 

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Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physician (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center, her Naples, FL private practice. You can also get more information about Dr Cederquist and her 
weight management plan by visiting www.DietToYourDoor.com