Ready, SET, Go.....

Are you Ready?

Get Set for another interesting proposal. It's the idea of "Set Points".

The above picture I took from our workbooks.  The image depicts the wide variety of "Zones of Opportunity" in the setting of natural variation of the population.  I know, I know.  If I was to stop there, I would get a failing grade describing this as an essay response to actually detail the above concept.

But wait, there's more.  No, there's no Ginsu knives...

The above graph of sorts shows just how much an individual (represented by a single stripe of color from blue to red, representing the range of potential effect) may respond to an intervention, in this case, to Bariatric Surgery.

They may do as well as the blue response (lower BMI), or as poor as the red area of the stripe (higher BMI).  Some individuals have a wide range of possibility or opportunity, and some have a much smaller window.  When they studied rats, they noticed that there was a genetic predisposition that was very strongly linked to the degree of response an intervention was to exert.

It does go without saying, environment (and behavior!) has a significant say in the short term and long term results as well, but there is much more to it than just behavior alone. These limitations are referred to as set points.  Bariatric surgery, especially Bypass and Sleeve Gastrectomy, have been shown to positively effect set points, in a way that not only makes the body think it should be reset to a lower BMI, but it will in turn defend it at that point as well.

The researchers made the analogy to Blood Pressure and Cholesterol, in which set points there are "reset" with the use of medicines in a way to reduce risk of disease, or treat a disease state.

Interestingly enough, again in their rat studies, they showed that the set points that were artificially high (likely based on diet and genetic influences), but can be temporarily reset to a lower level by a traditional diet and exercise program and a loss of let's say 10% of excess weight.  They did see, however, that an exaggerated weight loss under durress, say 80-100# in a patient of 300#, done again with non-surgical means, caused a significant rebound effect and reset the set point back to where it was originally, or in some cases even higher than before the diet and lifestyle changes were undertaken!

 This is a process that in other circles has been dubbed "metabolic adaptation", and has been seen and studied in participants after their "Biggest Loser" appearances.  Some participants on the show tend to regain significant amounts of weight within weeks of being home.

The benefit we see from Bariatric Surgery is different.  We will discuss in the next installment, how it acts a "Super Drug" in exerting its numerous weight and metabolic effects.

This is a place where 'polypharmacy' is a good thing!