【Full text】

The conventional prescription that people with obesity should “eat less and exercise more” remains widely used as a standard approach to weight management, despite repeated reports of its low long-term success rate [1].

At the same time, recent findings from genetics, epidemiology, physiology, and related fields have increasingly shown that body weight and body fat are biologically regulated within a certain range. These findings are helping to establish a biological framework that may explain why long-term success with weight-loss dieting is so difficult to achieve.

Following weight loss, adaptive responses are triggered through coordinated changes in metabolism, neuroendocrine function, autonomic nervous system activity, and even behavior. These responses have been shown to resist the maintenance of weight loss [4].

In this article, I will briefly introduce the biological mechanisms that may promote post-weight-loss weight rebound—or, in some cases, further weight gain. I will also explain how these mechanisms relate to, and differ from, my proposed “intestinal starvation” theory.

【Related Article】
The Spread of Dieting May Be Fueling the Rise in Obesity

Energy restriction is associated with a reduction in resting energy expenditure (REE) [5]. Many studies have reported that behavioral weight loss leads to a greater decrease in both resting and total energy expenditure than would be predicted based on changes in body composition and the thermic effect of food [4,6]. 

However, regarding the timing of its onset, the evidence is inconsistent [9]. Some studies have detected adaptive thermogenesis (AT) within a week of energy restriction, which has been associated with rapid declines in insulin secretion, depletion of glycogen stores, and loss of intracellular and extracellular fluid [10].

In contrast, a growing body of evidence suggests that underfeeding-associated AT takes weeks to develop, in association with reduced leptin secretion following the loss of body fat, among other physiological adaptations [9,11,12].

   
Although the persistence of AT also remains a subject of debate [7], some studies indicate that this metabolic adaptation may continue for years even after energy balance has been reestablished at a lower weight [13]. 
       

A number of hormones secreted from the gastrointestinal tract and adipose tissue are known to play key roles in regulating appetite, food intake, energy expenditure, and body weight [14,15].

     
Leptin is a hormone secreted by fat cells that helps regulate body weight by suppressing appetite and influencing energy expenditure. High leptin levels signal to the brain that energy stores are sufficient, whereas low leptin levels indicate that energy stores are low [16].

It has been shown that leptin levels drop within 24 hours of energy restriction [17]. Interestingly, many studies have reported a greater reduction in leptin levels than would be expected based on the loss of body fat [18,19].

It has been suggested that the primary role of leptin may be the prevention of starvation, rather than weight regulation per se [15,20]. When leptin levels fall below a certain threshold—the point at which specific physiological responses are triggered (Note1)—starvation defense mechanisms are activated, even if substantial fat stores remain [17]. This leads to a reduction in metabolic rate and physical activity, as well as an increase in hunger [21,22].

       
Furthermore, in individuals who have lost weight, an increase in the appetite-stimulating hormone ghrelin, along with decreases in the post-meal satiety signals peptide YY (PYY) and cholecystokinin (CCK), has been observed [23]. As a result, diet-induced weight loss may simultaneously reduce satiety and increase hunger, potentially promoting overeating [15].

Note 1: It has been suggested that this threshold rises as fat mass increases [17].

Food reward refers to the brain's reward response to food, which generates pleasure and satisfaction from eating, as well as the motivation to eat again. This process involves activation of the brain's reward circuitry, where neurotransmitters such as dopamine are released, leading to feelings of pleasure and increased appetite.

Modern neuroimaging studies using fMRI have shown that both nutritional status (e.g. hunger vs. satiety) and different food stimuli (e.g. high- vs. low-calorie foods, appetizing vs. bland foods) can alter activity in the brain's reward circuitry [27–29].

Recent studies in healthy individuals indicate that short- or long-term caloric restriction, as well as fasting, may increase the reward value of food—especially high-calorie, palatable foods [27,30].

These findings may help explain why calorie-restricted diets often fail in the long term [28,30].

Food addiction: similarities and differences from drug addiction

While drugs and food share certain characteristics, they also differ in important ways.

Drugs of abuse, such as cocaine, act directly on the brain's dopamine circuitry, whereas food influences these circuits more indirectly. Signals from taste and smell, nutrient sensors in the digestive tract [31], and hormones released during digestion and nutrient absorption all communicate with the brain, thereby influencing the dopamine system [25].

Food intake is primarily regulated by three interacting neural systems: the homeostatic, reward-related, and inhibitory systems [15].

The inhibitory system—mainly involving the brain region responsible for self-control and decision-making—helps regulate eating behavior and inhibit excessive food intake [34].

Cognitive control of food reward

In humans, the urge to seek and consume palatable foods can be moderated by executive functions—the cognitive processes involved in self-control and decision-making.

One of the central dilemmas in daily life is balancing one's internal goals (e.g. cutting back on sweets to maintain health and weight control) against the immediate reward of eating tempting foods. This conflict is particularly challenging when highly desirable foods, such as donuts or pizza, are readily available [25].

Prospective studies in young individuals, as well as rodent experiments, suggest that severe caloric restriction, characterized by 24-hour fasting or fat-free diets, may increase the risk of developing binge eating and bulimia in the future [37,38].

Weight-loss dieting may reduce the size, but not the number, of fat cells [39]. It remains unclear whether hyperplasia (an increase in adipocyte number) contributes to weight rebound in weight-suppressed individuals [15]. However, in a study of obese rats, adipocyte hyperplasia was observed following refeeding after fasting [40].

In humans, a similar possibility has been suggested.

The mechanisms described in Sections (1)–(5) are generally thought to represent a series of anti-starvation (or anti-weight-loss) responses (Note 2) that occur in association with energy restriction and weight loss [15].

In contrast, my intestinal starvation hypothesis proposes that when all ingested food is completely digested and no undigested matter remains in the intestinal tract, the body may interpret this condition as a starvation signal.

Intestinal starvation may occur not only during strict dietary restriction for weight loss (e.g. skipping meals or eating extremely small amounts of food), but also during more moderate dieting or even everyday eating habits that are not intended for weight loss, such as skipping breakfast, eating a light lunch, having dinner late at night, or eating only two meals a day.

Furthermore, in my intestinal starvation hypothesis, adaptive responses to intestinal starvation may lead to weight gain suggestive of an upward shift in the body-weight set point. This weight gain may involve not only body fat but also lean body mass, including skeletal muscle. Therefore, this mechanism may differ from conventional models of obesity, in which weight gain is explained primarily by an increase in body fat.

【Related article】
How Intestinal Starvation Can Lead to Weight Gain

Note ２: Because these responses are activated despite adequate energy stores, some researchers prefer the term “anti-weight-loss” rather than anti-starvation mechanisms [15].

At present, the causal relationship between the biological responses described in Sections (1)–(5) and post-weight-loss weight rebound has not yet been fully established [15]. Nevertheless, many people who have experienced weight rebound after dieting may find that these mechanisms are consistent with their own experiences.

Some researchers have pointed out that the biological forces that resist weight loss and promote the recovery of lost weight are extremely powerful and difficult to overcome for most individuals attempting to lose weight through behavioral interventions. They have also suggested that achieving long-term weight loss will require the development of interventions that weaken these biological responses themselves [15].

　　　
I generally agree with this perspective, although my approach differs somewhat. 

In my opinion, achieving long-term weight loss depends not only on developing interventions that weaken these biological responses, but also on adopting dietary and lifestyle habits that minimize activation of the body's anti-starvation (or anti-weight-loss) mechanisms in the first place. 

Maintaining this type of dietary pattern may help prolong satiety and reduce feelings of hunger. Over the long term, I propose that it may also facilitate the transmission, via the gut-brain axis, of information to the brain indicating that food remains sufficiently available.

Note 2. I do not believe that foods high in fat should necessarily be avoided. Depending on the overall composition of the diet and how such foods are consumed, they can be incorporated appropriately.

　　　
【Related Article】
Weight Loss Without Rebounding Requires Two Steps

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【 Full text 】

I view the human body as possessing a homeostatic system that attempts to maintain body weight within a certain range, and from this perspective, I believe that the concept of a body-weight set point carries important implications.

In this article, I will discuss the background and challenges of set-point theory, which has received renewed attention in recent years. I believe that understanding the environmental and behavioral factors that may contribute to upward shifts in the body-weight set point is important for addressing the growing problem of obesity.

Obesity and weight loss attempts

♦An obese individual who insists that a lean friend has consistently eaten more than the fat person does, may well be telling the truth.（*snip*）

The group of obese patients who are greatly in need of our understanding are those who keep to a calorie intake of perhaps 1,000 kcal per day, yet lose less than one kg per week. There is no doubt whatsoever that such people exist, and can be studied in a metabolic ward under conditions where 'cheating' is virtually impossible without being detected.

Usually these are middle-aged women who have been perhaps 40 kg overweight, and who have already lost about 20 kg. They are often depressed, hypothermic, and have a low metabolic rate. The nature of this metabolic adaptation to a low-calorie diet is not known (as of 1973), but it is a phenomenon  that has been recognized since before the 1920s (J S Garrow, 1973)[1].　

     
♦For obese individuals, a certain amount of weight loss is possible through a range of treatments, but long-term maintenance of weight loss is much more challenging, and in most cases, the weight is regained [2]. In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years, more than 80% of lost weight was regained [3,4].

In addition, studies of those who are successful at sustained weight loss indicate that the maintenance of reduced body fat will probably require close attention to energy intake and expenditure, perhaps for life [5].

Contrary to popular belief, people with obesity generally have a higher absolute REE compared to leaner subjects. This is because obesity increases both body fat and metabolically active fat-free mass [7,8].

PAEE can be subdivided into "voluntary exercise" and “activities of daily living.” Despite typically engaging in less physical activity, obese individuals often have a daily energy cost for physical activity similar to that of non-obese individuals since PAEE is proportional to body weight [7,9]. Additionally, due to greater food intake, their DIT also tends to be higher [7].

Dynamic changes in energy expenditure

♦Obesity prevention is often erroneously described as a simple bookkeeping matter of balancing caloric intake and expenditure [10].

In this model, energy intake and expenditure are considered independent parameters determined solely by behavior. It is assumed that an obese person can steadily lose weight by eating less and/or moving more at a rate of one pound for every 3,500 kcal (or one kg for every 7,200 kcal) of accumulated dietary caloric deficit [7,11]. This view has been referred to as a “static model” of weight loss, but it has been shown to be physiologically impossible [7,12]. 

Body weight set point theory

♦In recent years, the influence of homeostatic control has become increasingly recognized, and growing evidence suggests that the body employs physiological mechanisms to regulate energy balance and maintain body weight around a genetically and environmentally determined set point [12].

In 1953, Kennedy proposed that body fat storage is regulated [15]. In 1982, nutritional researchers William Bennett and Joel Gurin expanded on Kennedy's concept when they developed the set-point theory [16]. The model has been widely adopted, and strengthened particularly after the discovery of leptin in the 1990s [7,12].

When an individual loses weight, the body significantly reduces energy expenditure to a degree that is often greater than predicted based on changes in body composition or the thermic effect of food. This process also causes an increase in appetite through hormonal regulation and alters food preferences through behavioral changes, to drive body weight back toward its set-point range[7,16]. 

♦Maintenance of a 10% or greater reduction in body weight in lean or obese individuals is accompanied by about 20 to 25% decline in 24-hour energy expenditure.  This decrease in weight maintenance calories is 10–15% greater than predicted based solely on changes in fat and lean mass [17,18].

Since obese individuals also display these compensatory metabolic adjustments in response to dietary restriction, obesity may be considered a natural physiological state for some people. Experimental studies on obesity in animals similarly suggest a view of obesity as a condition of body energy regulation at an elevated set point [19]. 

♦A meta-analysis of cross-sectional studies investigating adaptive thermogenesis (AT) by comparing formerly obese subjects who had lost weight with BMI-matched subjects who were never obese, found a 3–5% lower resting energy expenditure (REE) in formerly obese subjects compared to never obese controls [20].

This effect means, for example, that if an obese woman reduced her weight from 100 kg to 70 kg, she would have to consume fewer calories to remain at 70 kg than a woman who had consistently weighed 70 kg [6]. Similar results have been confirmed in animal experiments involving obese and normal-weight rats.

This suggests that the frequent claim made by obese people that they eat the same or less than their lean friends but lose no weight, must be given more credence than it is ordinarily accorded [19].

♦In addition, hyperphagia (overeating) has been demonstrated following experimental semi-starvation and short-term underfeeding, which is probably the result of homeostatic signals resulting from the loss of both body fat and lean tissue [7,21].

　
♦This theory also suggests that a person's body-weight set point is established early in life and remains relatively stable unless altered by specific conditions. However, the set point may change throughout one’s life due to factors such as marriage, childbirth, menopause, aging, and disease [16]. 

On the other hand, the set-point theory remains hypothetical because the molecular mechanisms involved in set-point regulation have not yet been fully elucidated, and some researchers may consider the theory overly simplistic [16].

On the other hand, some researchers have pointed out important limitations of the body-weight set-point model. 

If a homeostatic system truly exists to maintain body weight within a certain range, a fundamental question arises: why do so many individuals in Western countries continue to gain weight gradually throughout majority of their adult lives? In particular, this model does not adequately explain the increasing prevalence of obesity observed in many societies worldwide since around the 1970s [22].

　　
In response, some researchers have suggested that while metabolic resistance to sustaining a reduced body weight is strong, metabolic resistance to sustained increased adiposity may not be physiologically long-lasting. Indeed, the steady increase in obesity prevalence supports the idea that the human body may be physiologically more permissive of weight gain than of weight loss [17,23]. 

These explanations that continuous consumption of high-calorie diet leads to an increase in the body-weight set point may sound plausible at first. However, in my opinion, if body weight changes in only one direction in response to a single external factor, it can no longer be considered a true “set point.”

Moreover, when this hypothesis is applied to humans, it fails to account for the fact that some individuals remain lean despite frequently consuming similarly high-calorie foods. In practice, several contradictions can be identified, including the following: 

I propose that upward shifts in the body-weight set point are associated with adaptive responses to intestinal starvation.
The next section provides a more detailed explanation of this mechanism. 

At present, many international organizations classify obesity as a chronic disease.

Some researchers interested in the body-weight set-point theory have argued that determining whether obesity, as a chronic condition, is treatable requires a clear understanding of how genetic and environmental factors interact to regulate the set point. At the same time, it is also true that many important environmental and social influences remain insufficiently explained [22].

In this article, I will introduce the concept of “intestinal starvation” as a complementary perspective to address these challenges. The key points are outlined below in four parts.

It is generally assumed that weight gain requires a positive energy balance, and the recent rise in obesity is often explained by increased consumption of high-calorie foods and reduced levels of physical activity. Paradoxically, however, the fact that obesity rates have increased in parallel with the growing prevalence of dieting aimed at weight loss [30] suggests that our current understanding of energy balance may warrant reconsideration [12].

What I want to emphasize is that while short-term weight gain due to overeating can be explained by excess energy intake, long-term and potentially irreversible weight gain may instead be triggered by energy deprivation or by the body’s perception that food is scarce. This pattern is also consistent with the phenomenon in which body weight increases beyond its previous level following experimental starvation or weight-loss dieting. 

【Related Articles】The Spread of Dieting May Be Fueling the Rise in Obesity

It is certainly true that high-calorie foods have become increasingly common since the 1970s. However, an even more important factor affecting the human body may be the rise of food processing—particularly ultra-processing. As food processing advanced, hard-to-digest components were gradually removed, while softer and more easily digestible components became increasingly dominant. 

Intestinal starvation is a physiological state that is more likely to occur when four factors overlap simultaneously. This concept provides a framework for understanding obesity as a chronic condition arising from interactions between genetic and environmental factors.

【Related Article】Three (+1) Factors That Accelerate “Intestinal Starvation”

In cases of weight gain that may reflect an upward shift in the body-weight set point through intestinal starvation, the overall efficiency of nutrient absorption may increase. In other words, from the perspective of energy homeostasis, the balance point at which energy intake and expenditure are matched may itself shift to a higher level. This perspective may help explain why even obese individuals with substantial body fat often exhibit compensatory metabolic responses to caloric restriction.

【Related Article】How Intestinal Starvation Can Lead to Weight Gain
      

As mentioned in the section 2, an animal study in rats reported that 90 days of exposure to a “high-energy diet” resulted in irreversible weight gain suggestive of an upward shift in the body-weight set point (Rolls et al., 1980). However, the “fattening diet” used in this experiment consisted mainly of commercially available, highly palatable foods such as potato chips, cheese crackers, and cookies [25]. At the same time, these foods were also highly refined carbohydrates and (ultra-)processed foods.

In contrast, the solid chow provided to the control group consisted of cracked grains, soybean meal, fish meal, and similar ingredients, and may have contained larger amounts of less digestible matter, such as dietary fiber and the tough cell walls of plants. In this respect, the composition of the control diet may have resembled that of human diets commonly seen more than 50 years ago. 

         
Therefore, I believe that caution is needed before concluding that the long-term consumption of a high-energy diet directly caused weight gain suggestive of an upward shift in the body-weight set point.
            

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[30] Montani JP, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk? Obes Rev. 2015 Feb;16 Suppl 1:7-18.
      

According to George A. Bray (as of 2020, an emeritus professor at Pennington Biomedical Research Center), until the 1960’s, obesity was viewed as a "lack of will power," and many people thought, and some said "if only these patients would push themselves away from the table, they would not have this problem." 

With this view of obesity, he reflects that the turning point for obesity being accepted as a bona fide area of academic interest were the studies on overfeeding. Overfeeding studies began to provide valuable insights into the biology of obesity. For Doctor Bray, who was a postdoctoral fellow at the New England Medical Center Hospital in Boston at the time, the excitement that was generated when the Vermont overfeeding studies were first presented in 1968 was unforgettable[1].

This was the case with the overfeeding experiments conducted by Doctor Ethan Sims in the late 1960’s. Until then, it was commonly believed that, "overeating obviously leads to obesity," so few such experiments had been conducted.

According to Dr. Jason Fung, the author of “The Obesity Code,” Dr. Sims recruited lean students at the nearby University of Vermont and encouraged them to eat a lot to gain weight. However, despite what both he and the students had expected, the students did not become obese. 

Over two hundred days on this overfeeding regimen, twenty inmates gained an average of twenty to twenty-five pounds. (About 10 kg.) However, once the experiment ended and their caloric intake returned to normal, the men had difficulty maintaining the weight gain, and most shed all the weight they had gained relatively easily. The exceptions were two inmates who struggled to lose that weight[3].

At the time, Dr. Bray was allowed to participate as a co-researcher in Dr. Sims' experiment to examine the metabolic changes occurring in adipose tissue during the weight gain that followed overfeeding. 

Later, in 1972, he conducted his own overeating experiment, using himself as a guinea pig. Initially, he tried to double what he usually ate at each meal, but he couldn't finish, so he switched to energy-dense foods, such as ice cream.

Dr.Bray states that this rapid return to normal weight contrasts with the difficulties people with spontaneous obesity have in losing weight, and the even more difficult task of a maintaining a lower weight. Many who develop obesity over years suffer from a different kind of pain than those of us who acutely gain weight by overfeeding. For them, the obesity “slips up” on them and once present, is difficult to reverse.

The history of overfeeding and underfeeding trials and other lines of evidence clearly show that obesity prevention and treatment cannot simply rely on the advice to "eat less and exercise more." [1]

Alex Leaf (Western States University) and Jose Antonio (Nova Southeastern University) reviewed overfeeding studies conducted up to 2017 that evaluated various combinations of macronutrient overfeeding and its effects on body composition. 

They found twenty-five overfeeding studies that reported changes in fat mass (FM) and fat-free mass (FFM), in addition to changes in body weight. The study durations ranged from nine to one hundred days, and all but four were conducted in sedentary populations[4]. Notably, the objectives of each study varied, and not all mentioned weight loss following the end of the experiments.

To give a few examples, a study on identical twins was published in 1990.

■Bouchard (Laval University, Canada) et. al. recruited twelve pairs of young adult male identical twins (twenty-four individuals) with no exercise habits. Each participant's energy requirements were measured during a two-week base-line period, and after that, they were overfed by 1000 kcal per day (comprising 15% protein, 35% fat, and 50% carbohydrates), six days per week, for a total of eighty-four days during a one hundred-day period. The men were housed in a closed section of a university dormitory, and were under supervision by staff all day. 

■Conford (University of Michigan) et. al. conducted a study in 2012 involving nine healthy, non-obese adults (seven men and two women). The participants were admitted to the hospital for two weeks, during which time they ate 4000 kcals per day (comprising 15% protein, 35% fat, and 50% carbohydrates). Their energy requirements were determined during a one-week baseline period before the start of the experiment. In addition to three main meals, they had four snacks each day. The average weight gain was 2.1 kg, of which 67 % was fat mass (FM).[6]

The summary of this review indicates that overfeeding healthy, sedentary adults with a diet moderately high in both carbohydrates and fats (35-50% energy intake each) and low in protein (11-15%) primarily results in a gain in fat mass (FM), which accounts for 60-70 % of the weight gain. Additionally, the increase in fat-free mass (FFM) may be due to an increase in body water content rather than skeletal muscle tissue. In contrast, diets with significantly increased protein intake showed favorable changes in body composition, even with increased energy intake[4]. 

Why did the participant’s weight rapidly return to normal over the ensuing weeks when they stopped overeating?

According to Dr. Bray, one of the striking findings in this Vermont study was that to maintain the weight they gained after overfeeding, they required more energy per unit surface area than before weight gain. When Dr. Bray moved to the University of California in 1970, his new lab began operating to explore his hypothesis about why extra energy was required to maintain the increased weight[1].

■Leibel (Rockefeller University) et. al. conducted a study in 1995 involving eighteen obese (BMI of 28 or higher) subjects (Group A) and twenty-three subjects who had never been obese (Group B).

They measured changes in energy expenditure under three conditions: at their usual body weight, after losing more than 10 percent of their body weight by underfeeding, and after gaining 10 percent of their body weight by overfeeding.

The study concluded that maintenance of a reduced weight or elevated body weight is associated with compensatory changes in energy expenditure, which resist maintaining the altered body weight and function to restore the original weight. This suggests that the long-term effectiveness of obesity treatment through caloric reduction may be limited[7]. 

As Dr. Bray mentioned, I also believe that weight gain from temporary excessive caloric intake is due to body mechanisms entirely different from those underlying fundamental obesity. If compensatory metabolic mechanisms resist changes in body weight, why do some people continue to gain weight?

As I have repeatedly mentioned through this blog, the difference between people who are overweight and lean can be explained by the difference in set-point for body weight. (One's set-point weight goes up through intestinal starvation.) 

For example, suppose a person who normally weighs a stable sixty kg  is temporarily overfed and reaches sixty-three kg. 

Today, we are sometimes said to be living in an "obesogenic environment" that promotes obesity, but that does not necessarily mean consuming high-calorie foods or living sedentary lifestyles. As some researchers have already mentioned, calorie counting is clearly of little significance. Changes in caloric intake only lead to temporary weight gain or loss. 

     
Rader, the "obesogenic environment" in my opinion is related to foods that are overly digestible foods (refined carbohydrates, fast food, processed foods, etc.) and an imbalanced diet (lack of vegetables, etc.). When these factors overlap with some other conditions such as skipping breakfast or eating late dinners, intestinal starvation is more likely to be induced.

Of course, researchers will say that in order to gain weight, more energy must be taken into the body than before. For more on why intestinal starvation leads to greater energy intake and weight gain, please refer to the article below.

[Related article]　 Gaining Weight by Intestinal Starvation; What Does It Mean?

<References>

[1]Bray GA. The pain of weight gain: self-experimentation with overfeeding. Am J Clin Nutr. 2020 Jan 1;111(1):17-20. 

[2] Fung J, The Obesity Code, Greystone books, 2016, P114-116.

[3] Jou C. The biology and genetics of obesity--a century of inquiries. N Engl J Med. 2014 May 15;370(20):1874-7.  

[4] Leaf A, Antonio J. The Effects of Overfeeding on Body Composition: The Role of Macronutrient Composition. Int J Exerc Sci. 2017 Dec 1;10(8):1275-1296. 

[5] Bouchard C et al. The response to long-term overfeeding in identical twins. N Engl J Med. 1990 May 24;322(21):1477-82. 

[6] Cornford AS et al. Rapid development of systemic insulin resistance with overeating is not accompanied by robust changes in skeletal muscle glucose and lipid metabolism. Appl Physiol Nutr Metab. 2013 May;38(5):512-9. 

[7] Leibel RL et al. Changes in energy expenditure resulting from altered body weight. N Engl J Med. 1995 Mar 9;332(10):621-8. 

In this article, I will discuss the central theme of this blog: why a state I call “intestinal starvation” can lead to weight gain. This idea is based on my own personal experience, which I have organized and interpreted from a physiological perspective and presented here as a hypothesis. 

When I entered university, my body weight had dropped into the 30-kilogram range. Even when I increased my food intake, my weight barely increased.

However, at one point, despite eating relatively little, my body weight suddenly increased by about five kilograms over the course of four to five days. This increase involved not only body fat but also muscle mass. Because I was underweight at the time, I strongly felt that this rapid weight gain was not a coincidence but rather the result of a distinct physiological change.

　　　
The idea presented in this article may seem counterintuitive to many readers. Nevertheless, for those who feel that weight gain cannot be fully explained by calorie balance alone, I hope this perspective offers a useful way of thinking. 

The idea that humans have evolved to store fat more efficiently in preparation for temporary food shortages or famine is one that most researchers studying obesity have likely considered at least once. However, this simple hypothesis has historically been treated with caution—or even skepticism—within the scientific community[1].

Underlying this skepticism is the common observation that people with obesity tend to have a higher energy intake, whereas individuals experiencing severe famine, such as refugees in parts of Africa, are markedly underweight due to malnutrition. From this perspective , some may raise the following counterargument: 

“If hunger leads to weight gain, then refugees in Africa should be overweight.”　

This condition can be regarded as a modern form of hunger that began to emerge primarily in developed countries around the 1970s and has since been spreading to many parts of the world.

In developed countries, diets have increasingly shifted toward the routine consumption of high-calorie, highly processed foods. In particular, when a diet is consistently dominated by rapidly digestible refined carbohydrates and (ultra-)processed foods, undigested matter does not remain in the intestinal tract for extended periods, which may create conditions that make intestinal starvation more likely to occur. 

　　　
In fact, obesity has become a serious problem even among some low-income populations worldwide[2]. What is commonly observed in these settings is not simply excessive caloric intake or high sugar consumption, but rather a poorly balanced diet heavily reliant on inexpensive refined carbohydrates and highly processed foods. 

I propose that one of the fundamental problems underlying obesity is that the body-weight set point is elevated. I further suggest that this upward shift in the set point may involve adaptive responses that are triggered when the body, in some form, perceives a state of starvation. 

In this section, I will explain the concept of intestinal starvation—one form of perceived starvation—and the process by which it may lead to weight gain, using an analogy from plant biology. (Note that the discussion here is limited to intestinal starvation and does not attempt to explain other known or unknown mechanisms involved in weight gain.)

Having said that, it should be emphasized that this does not imply that the protrusions on the intestinal folds—the villi—physically elongate. What I am proposing is not a change in the intestinal structure or function itself, but rather more superficial changes that influence absorptive efficiency.

As a result, the surface area available for contact with nutrients increases, and the effective absorptive efficiency may rise in a way that is not merely transient  but can persist thereafter.

If such a change in absorptive efficiency occurs, regardless of whether the weight gain is 0.3 kg or 3 kg, the body may transition to a state of energy homeostasis at a higher body weight within a relatively short period of time. Unlike weight gain caused by overeating, this would imply an upward shift in the body-weight set point itself.

This hypothesis may help explain, at least in part, why individuals with obesity—despite having substantial energy stores in the form of body fat—can exhibit metabolic resistance to caloric restriction[3].

【Related articles】The Increasingly Important "Set-Point" Theory of Body Weight

     
    
Taken together, I propose that one fundamental difference between obese and lean individuals may lie in how efficiently ingested food is digested and absorbed.

In Japan, people with obesity sometimes describe themselves as “having a body that gains weight even from drinking water.” Of course, drinking water alone does not lead to weight gain. However, this expression may intuitively reflect a state in which nutrient absorption efficiency is elevated in individuals with obesity.

Weight gain reflecting an elevation of the body-weight set point means, from the perspective of energy homeostasis, that the balance point at which energy intake and expenditure are matched has shifted to a higher level. In other words, a more positive energy balance becomes easier to maintain, making weight loss increasingly difficult.

Even if body weight temporarily decreases through caloric restriction, it is highly likely to rebound once the original diet is resumed.

Moreover, repeated cycles of dietary restriction may raise concerns about a gradual increase in body weight over the long term. With extreme dietary restriction, prolonged periods of hunger are common, which may make intestinal starvation more likely to occur during this process and, in turn, further elevate the set point for body weight.
       

However, these findings are primarily observational and do not demonstrate that the increase in body fat itself—or the associated increase in body weight load—directly stimulates muscle growth. 

In this hypothesis, increases in muscle mass are not attributed to mechanical loading from higher body weight. Rather, they are considered to occur alongside increases in body fat to some extent as a secondary change associated with alterations in nutritional status and the metabolic environment.
          

An increase in overall nutrient uptake shifts the body toward a more positive energy balance, while simultaneously allowing the following phenomena to occur. Since digestive enzymes and many hormones are composed of proteins (amino acids), improvements in nutritional status may lead to changes in digestive function and appetite regulation mechanisms.

In contrast, in an excessively lean state, reduced absorptive efficiency may limit the body’s ability to effectively utilize ingested nutrients, such as protein. As a result, decreases in the muscle mass that supports internal organs, together with reduced secretion of digestive enzymes, can further impair the capacity to digest and absorb food efficiently.

This creates a vicious cycle in which a negative energy balance is more easily maintained. Consequently, even when caloric intake is increased, body weight may not increase easily.

【Related articles】
After Gaining Weight, We Eat Too Much and Do Less Exercise

References

[1]Speakman JR, Elmquist JK. Obesity: an evolutionary context. Life Metab. 2022 Apr 29;1(1):10-24. 

[2]Gary Taubes. Why We Get Fat. New York: Anchor Books. 2011. Pages 15-32.

[3]Richard E. Keesey, Matt D. Hirvonen, Body Weight Set-Points: Determination and Adjustment, The Journal of Nutrition, Volume 127, Issue 9, 1997, Pages 1875S-1883S, ISSN 0022-3166.

[4]Kyle UG et al. Fat-free and fat mass percentiles in 5225 healthy subjects aged 15 to 98 years. Nutrition. 2001 Jul-Aug;17(7-8):534-41. 

[5]Heymsfield SB et al. Human body composition: advances in models and methods. Annu Rev Nutr. 1997;17:527-58. 

[6] Janssen I et al. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol (1985). 2000 Jul;89(1):81-8. 

[7]Fornari R et al. Lean mass in obese adult subjects correlates with higher levels of vitamin D, insulin sensitivity and lower inflammation. J Endocrinol Invest. 2015 Mar;38(3):367-72. 
        

First, some people think in terms like "overeating always leads to weight gain" or "exercise causes weight loss," as shown in Figure-1. 

Exercise certainly consumes more energy, but a counter-regulatory function－that the body tries to regain energy that it has expended－should work.

In other words, exercise is essentially a force that pushes the body in the direction of gaining strength and ultimately, storing energy (weight gain) as it tries to stimulate energy circulation and re-energize the body. (In particular, it works more strongly in resistant exercises that target muscles.) 

As Dr. Briffa, the author of “Escape the Diet Trap,” says in his book, it is better to think that, "originally lean people start running marathons or playing soccer, and eventually become athletes[1].” It may be a cynical view, but I think it’s probably correct. 

They know they never gain weight even though they eat a lot, and most athletes eat three well-balanced meals, plus other nutritional supplements and snacks. 

On the other hand, there might be people who have gained 3–4 kg over the past few years because their work involves desk tasks or light physical activity, and they haven’t exercised recently. 

However, the real issue, I believe, is not the lack of exercise, but rather skipping meals, eating light meals, having an unbalanced diet relying too much on carbohydrates, or irregular eating habits.

Additionally, when athletes retire, their caloric expenditure decreases and opportunities to eat often increase, which can lead to a few kilograms of weight gain. I see this as the same mechanism that causes weight to rebound after dieting, where the body returns to its set-point weight. 

However, if there is a weight gain of more than ten kilograms over a few years, this is likely due more to changes in eating habits, as explained above, and can be attributed to weight gain caused by intestinal starvation.
            

Fighters and sumo wrestlers exercise, of course, but due to the nature of their sports, they sometimes need to increase their muscle mass or body weight. However, we often hear that it’s not easy for some fighters to gain muscle mass and weight even if they eat protein supplements in addition to their three meals. 

On the other hand, those who don’t want to gain weight sometimes put on weight quite effortlessly. This is because, as I have mentioned so many times, gaining weight (meaning an increase in one’s set-point weight) requires the induction of intestinal starvation.

During high-intensity strength exercises, like barbell exercises, the body’s regulatory mechanism to restore lost energy is even more powerful than with aerobic exercise.

However, if one tries to consume more calories and nutrients every 4 to 5 hours through meals or protein supplements, some undigested food tends to remain in the intestines throughout the day, which could ultimately hinder an increase in set-point weight. 

<A sumo wrestler's diet: a practical approach to increasing body weight>
        

■For details on how weight is increased when intestinal starvation is induced, please refer to the article below. 

[Related article]
 Gaining Weight by Intestinal Starvation; What Does It Mean?

(1)The relationship between diet and exercise is not simply an energy "in/out" relationship.
Exercise is essentially a force that works toward gaining strength and weight because the opposite reaction－that the body tries to regain energy that it has expended－should work (especially in the case of high-intensity exercise).

      
(2) However, the priority is in how we control our diet. Eating three well-balanced meals every day will help undigested food to remain in the intestines, and the set-point weight is less likely to increase. 

People who are originally lean start athletics, soccer, etc., and if they eat three well-balanced meals every day, they are less likely to gain weight and maintain the same body shape over the years.

      
(3) People tend to skip meals or eat less when they aren’t exercising or are only doing light physical work. In such cases, the body's regulatory function to absorb nutrients and store fat are weaker than during exercise, but in contrast, people end up feeling hungrier and intestinal starvation is more likely to be caused, resulting in an increase in one's set-point weight. 

      
(4)The way sumo wrestlers eat and exercise is a logical approach to increasing muscle strength and body weight. By eating digestible meals including a good amount of rice twice a day, they are more likely to induce intestinal starvation. Intense training further accelerates this effect.
         

"The experts who say that we get fat because we overeat or we get fat as a  result of overeating - the vast majority  - are making the kind of mistake that would (or at least should) earn a failing grade in a high-school science class.

They're taking a law of nature that says absolutely nothing about why we get fat and a phenomenon that has to happen if we do get fat - overeating - and assuming these say all that needs to be said."
(Gary Taubes. 2011. Why we get fat. New York: Anchor Books,  Page 76.)

The way Wade explained it to me, the animal doesn't get fat because it overeats, it overeats because it's getting fat. The cause and effect are reversed.

(*snip*)

The evidence that fat tissue is carefully regulated, not just a garbage can where we dump whatever calories we don't burn, is incontrovertible.(*snip*)

Those who get fat do so because of the way their fat happens to be regulated and that a conspicuous consequence of this regulation is to cause the eating behavior (gluttony) and the physical inactivity (sloth) that we so readily assume are the actual causes."
(Taubes.  Why we get fat. Page 89-90, 93-4.)

"Just prior to the Second World War, European medical researchers argued that it is absurd to think about obesity as caused by overeating, because anything that makes people growーwhether in height or in weight, in muscle or in fatーwill make them overeat.

Children, for example, don't grow taller because they eat voraciously and consume more calories than they expend. They eat so muchーovereatーbecause they're growing."
(Taubes. Why we get fat. Page 9.)

This time, I would like to discuss three key factors－plus one additional factor－that may contribute to the occurrence of what I call “intestinal starvation."

【Related article】

In addition to these, many other factors may also be indirectly involved in the recent increase in obesity. However, it is not always clear how multiple factors combine to drive weight gain across the population as a whole.

I propose that one possible explanation involves a mechanism I refer to as “intestinal starvation.”

This condition is unlikely to occur due to a single factor alone, but is more likely to arise when the three factors (+1) described below overlap at the same time. For this reason, it may help explain how everyday eating habits and lifestyle patterns—when considered together—can lead to weight gain.

This idea is consistent with the view that consuming low-GI (glycemic index) foods and minimally processed foods help prevent obesity.

It doesn’t depend on the amount of calories you eat, but the quality and balance of food you eat. For example, eating a variety of foods and having a good balance vs a bad balance may lead to gaining weight, even if you eat small amounts.

Eating speed, how well you chew, and how much fluid you drink during meals may also influence this factor.

【Related article】
The Dilution Effect/ Pushing Out Effect of Carbohydrates

Eating Fat/Oil Can be a Deterrent to Gaining Weight (3 Perspectives Regarding Fat)

Many people report gaining weight due to lifestyle changes such as skipping breakfast or eating dinner late at night. Behind this type of weight gain caused by irregular daily routines lies the issue of long gaps between meals—in other words, enduring hunger for extended periods of time.

Eating late at night does not always lead to weight gain by itself. If dinner has to be late, having a small snack in the early evening—such as nuts, milk, or a sandwich—can help prevent intestinal starvation by avoiding prolonged hunger.

Even when eating the same meals, people with strong stomachs and high digestive capacity may be more likely to experience intestinal starvation than those whose digestion is slower. In today’s society, where energy-dense foods are common, the ability to digest protein and fat may have a particularly strong influence on whether intestinal starvation occurs.

On the other hand, people with sensitive stomachs or conditions such as gastroptosis may find it difficult to fully digest all ingested food in the first place.

If genetic factors contribute to obesity, then the secretion of enzymes and hormones that affect digestive capacity and appetite, as well as the sensitivity of their receptors, is likely to play a major role. Of course, these factors can also change due to environmental and lifestyle influences.
      

In addition to the three factors, I added one more important element as “+1,” which can be explained by “continuity.”

What this means is that not only the meal you have just finished, but also your previous meal and the meals before that can influence whether intestinal starvation occurs or not. 

The reason is that the intestines are very long—about 7 to 8 meters in total (with the small intestine alone being about 6 meters)—and it takes, on average, more than ten hours for food to pass through the entire intestinal tract. Because intestinal starvation is judged across the whole intestine (or possibly only the small intestine), it is influenced not only by a single meal, but also by your previous meal and the meals before that.

This is also the flip side of why eating well-balanced meals three times a day is thought to help prevent obesity: it helps ensure that the intestines are continuously exposed to food of adequate quality, reducing the chance that the body interprets the situation as “starvation.” 

From an evolutionary biology perspective, humans and many other animals are thought to have developed mechanisms to cope with intermittent food shortages over long periods of evolution. Because periods of abundant food were limited, the ability to store energy in the liver, skeletal muscles, and adipose tissue was likely favored by natural selection.

From this perspective, obesity can be understood not merely as a consequence of overeating, but as a state that arises as a result of adaptive physiological responses, in which the body attempts to store energy when it perceives a risk of starvation.

　
The concept of “intestinal starvation” adds a new perspective to the discussion of how our bodies perceive a lack of food, moving beyond the traditional focus on energy intake alone.

【Related articles】
Why Does the Body Perceive That It Is More Starved than in the Past?

Note 1: It is unclear whether intestinal starvation is sensed throughout the entire gut or only in the small intestine, which is sometimes referred to as the "second brain."

Note 2: Because dietary fats generally require more time for digestion and gastric emptying, they may, in some individuals, help prevent the onset of intestinal starvation. However, there is substantial individual variability in the capacity to digest fats, and when fats are consumed together with refined carbohydrates, this suppressive effect may not be sufficiently achieved.

【Related articles】Eating Fat/Oil Can be a Deterrent to Gaining Weight

Even if you consume a large amount of food, a diet composed mostly of refined carbohydrates and other easily digestible items (including certain protein sources and small amounts of fat)—combined with long gaps between meals, such as eating only twice a day—can induce an intestinal starvation state or a condition very close to it.

Even when overall food intake is small, a diet composed mainly of easily digestible foods such as refined carbohydrates and certain protein sources (e.g., ultra-processed foods such as simple burgers or sandwiches, or instant noodles) may still trigger intestinal starvation. 

Due to recent dieting trends, many people try to keep breakfast or lunch light in an effort to lose weight, but this approach may end up being counterproductive in the long run.

In contrast, when you eat a balanced diet including fiber-rich vegetables, and minimally processed foods three times a day, some fraction of undigested matter remains in the intestinal tract continuously throughout the day, making it less likely for intestinal starvation to be induced.

Since human genes are unlikely to change dramatically over just a few decades, changes in lifestyle and food environments since the 1970s are likely to have had a substantial impact on the recent global rise in obesity[3].

Strictly speaking, four factors (see Note 3) need to overlap for intestinal starvation to be triggered, which may explain why obesity is more likely to occur at the intersection of multiple factors, including genetic, environmental, and physiological factors.

Note3: The four factors are “what you eat,” duration of hunger, digestive ability, and continuity.

Genetic traits related to intestinal starvation include the secretion capacity and receptor sensitivity of enzymes and hormones that regulate digestion and appetite. In particular, differences in genetic background—reflecting both population-level and individual variability—that enable more rapid digestion of proteins and fats may influence the occurrence of intestinal starvation.

Of course, these biological traits may also change as a result of acquired conditions, such as obesity or gastric reduction surgery performed for weight loss.

Since the 1970s, one of the most notable environmental changes, I believe, has not merely been the increase in energy-dense foods, but rather the rise in easily digestible foods resulting from industrialized food production. Examples include refined carbohydrates, certain protein sources, and ultra-processed foods.

In vegetables and grains, the less digestible parts have been removed (e.g. refined grains), and some are now mashed or strained (e.g. mashed potatoes and potage soups). Meat and fish are often minced or ground, making them easier to digest.

<Lifestyle>

Intestinal starvation is related not only to what people eat but also to "how they eat."

Since the 1970s, changes in lifestyle have been accompanied by dramatic shifts in eating habits. In Japan, for example, the traditional rice-based breakfast has gradually been replaced by a Western-style breakfast consisting of toast, coffee, and fried (or boiled) eggs, etc.

    
In addition, many people now tend to eat light breakfasts and lunches, while consuming the majority of their daily calories at dinner. Such eating patterns may promote intestinal starvation, because our intestines are about seven to eight meters long, and all ingested food may be completely digested while traveling through the intestinal tract. 

Intestinal starvation represents an adaptive physiological response related to intestinal processing and hormonal secretion, and may prove that people who eat a balanced diet every day are likely to be less prone to weight gain. 

Although intestinal starvation may not be directly associated with the gut microbiota, the types of foods consumed have a significant impact on the intestinal environment.

Individuals who eat a wide variety of foods in a well-balanced manner are less likely to induce intestinal starvation, which may indirectly suggest a relationship that those with a healthier gut microbiota are less susceptible to obesity.

<References>

[1]Flores-Dorantes MT, Díaz-López YE, Gutiérrez-Aguilar R. Environment and Gene Association With Obesity and Their Impact on Neurodegenerative and Neurodevelopmental Diseases. Front Neurosci. 2020 Aug 28;14:863. 

[2]Khan MJ et al. Role of Gut Microbiota in the Aetiology of Obesity: Proposed Mechanisms and Review of the Literature. J Obes. 2016;2016:7353642. 

[3] Jason Fung. The Obesity Code. Greystone Books, 2016, Page 21-2.

In everyday conversation, weight gain is often understood simply as “an increase in body weight (usually body fat)” compared with the past. However, this expression may lump together multiple processes that are physiologically distinct.

To make the discussion easier to follow, the complex phenomena involved in weight gain are deliberately divided here into two processes as a hypothetical framework.

     
For example, the idea that eating high-calorie foods leads to weight gain is widely shared. In contrast, understanding phenomena such as weight rebound after dieting—sometimes resulting in greater weight gain than before—requires a more explicitly physiological perspective.

I believe that because these qualitatively different processes of weight gain have often been discussed without clear distinction, misleading information about weight loss may have spread, leading many people to engage in dieting practices that are not necessarily appropriate or effective. 

【Related article】

The Increasingly Important "Set-Point" Theory of Body Weight

The first type of “weight gain” reflects, and arises as part of, the body’s homeostatic drive to return to its set point (Fig. 1A).

Many people who are overweight, or tend to gain weight easily, deliberately try to keep their body weight lower by reducing their daily caloric intake and/or increasing physical activity.

In many countries, people often talk about “holiday weight gain” or say that high-calorie foods inevitably make them gain weight. Some also claim, “I gain weight as soon as I eat a little more.”

But in most cases, these experiences can be explained by the homeostatic mechanism that pulls body weight back toward its set point—meaning that the person is simply repeating small cycles of “mini-diets” followed by “mini-rebounds.”

In contrast, the second type of “weight gain” refers to cases in which the body-weight set point itself gradually increases (Fig. 1B).

I propose that an upward shift in the body-weight set point is associated with the body’s adaptive responses to perceived starvation. Broadly speaking, the body is thought to perceive starvation through two major pathways: one is a severe energy deficit caused by excessive caloric restriction, and the other is what I describe in this blog as “intestinal starvation.”

【Related article】
Biological Responses Driving Weight Rebound After Weight Loss

    
Here, I will focus on the latter—cases in which an increase in the body-weight set point is thought to be primarily associated with intestinal starvation.

This pattern can be observed in people who are mindful of their caloric intake and keep breakfast or lunch light—such as opting for a simple burger or sandwich, or instant noodles—yet still find themselves saying, “I’ve gained three kilos over the past year,” or “I’m ten kilos heavier than I was three years ago.”

This phenomenon cannot be adequately explained by simple calorie balance alone. Rather, it suggests the possible involvement of intestinal starvation—which may be induced during prolonged periods of hunger—as well as other regulatory mechanisms in elevating the body-weight set point.

Such a shift may contribute to more fundamental differences between individuals who tend to gain weight easily and those who remain lean.

Indeed, research on set-point theory suggests that, for some individuals, obesity may represent a “natural physiological state” in which energy balance is stably maintained at a relatively high set point for body weight[1].

In real-world weight gain and post-diet rebound, the mechanism for maintaining body weight (A) and the mechanism by which the set point itself increases (B) often operate simultaneously or in an overlapping manner.

For example, the common observation that most people return to their original weight after dieting can be understood as the result of a homeostatic, weight-preserving mechanism (A) described above.

In contrast, when body weight not only returns to baseline but also exceeds the previous level, a mechanism (B) that raises the set point itself may be involved. This is because, during the process of caloric restriction, conditions may arise under which the body comes to perceive itself as being in a state of starvation.

■Sumo wrestlers in Japan are well known for eating large meals and becoming very heavy. In reality, however, their weight gain can be understood as involving a combination of mechanisms (A) and (B) described above.

<References>

[1] Richard E. Keesey, Matt D. Hirvonen, Body Weight Set-Points: Determination and Adjustment, The Journal of Nutrition, Volume 127, Issue 9, 1997, Pages 1875S-1883S, ISSN 0022-3166.

All through the year, we get thinner when we are busy, and we gain a little fat when we aren’t active and eat a lot. Although everyone repeats the same pattern, even if we don't calculate calories strictly, the body shape of person won't change so easily. Fat people are fat and thin people are thin. 

In other words, I believe that each person has a stable weight based on their body's homeostatic functions, which I initially defined as their "base weight."
     

[Base weight] = The stable weight one returns to after spending 3-5 days relaxing without excessive exercise or work, while consuming calories based on their daily energy needs.
      

Most of us do not consciously adjust our daily energy intake and expenditure. Nevertheless, an individual's body weight remains relatively stable.

Individual body weight variance is typically only 0.5% over periods of 6 to 10 weeks[1,2] (Khosha and Billewicz 1964). According to cross-sectional data, weight changes over longer periods of time are still modest, and even diabetic individuals display coefficients of body weight variation of only 3.7– 4.6% over a period of five years[1,3] (Goodner and Oglive 1974). 

With the global increase in obesity since the 1970’s, these coefficients of body weight variation may no longer be as accurate. However, many people still stay lean (especially in Asia), and, in fact, even those who are overweight or obese manage to maintain their weight, heavy as they may be, for many years[4]. 

In other words, despite some fluctuations in weight in daily life, there must be an internal regulatory mechanism that works to keep weight and fat within a certain range over the long haul.

■In recent years, the role of homeostatic regulation has been acknowledged, and there is growing evidence that the body employs physiological mechanisms to control energy balance and maintain body weight at a genetically and environmentally determined "set-point."[5]

When I started writing this blog, I had no knowledge of the theory about the body's "set-point," but it almost aligned with what I had always believed. I now believe that understanding the set-point theory is crucial in preventing the spread of obesity and proposing effective weight loss methods.

In particular, to explain the global rise in obesity since the 1970’s, I believe it is essential to understand how (I) genetic and biological factors, and (II) environmental and behavioral factors combine to increase the body’s set-point for weight. I believe my intestinal starvation theory can contribute to this understanding.

For more details, please refer to the articles below.

[Related article] 
 The Increasingly Important "Set-Point" Theory of Body Weight
      

References：
[1]Richard E. Keesey, Matt D. Hirvonen. Body Weight Set-Points: Determination and Adjustment. The Journal of Nutrition, Volume 127, Issue 9, 1997, Pages 1875S-1883S, ISSN 0022-3166.

[2]KHOSLA T, BILLEWICZ WZ. MEASUREMENT OF CHANGE IN BODY-WEIGHT. Br J Nutr. 1964;18:227-39. 

[3]Goodner CJ, Ogilvie JT. Homeostasis of body weight in a diabetes clinic population. Diabetes 1974 Apr;23(4):318-26. 

[4] Gary Taubes. 2011. Why we get fat. New York: Anchor books, Page 59.

[5]Egan AM, Collins AL. Dynamic changes in energy expenditure in response to underfeeding: a review. Proc Nutr Soc. 2022 May;81(2):199-212. doi: 10.1017/S0029665121003669. Epub 2021 Oct 4. PMID: 35103583.

[6]Ganipisetti VM, Bollimunta P. Obesity and Set-Point Theory. 2023 Apr 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 37276312.

[7]Bray GA.The pain of weight gain: self-experimentation with overfeeding. Am J Clin Nutr. 2020 Jan 1;111(1):17-20.