ADOLESCENT MEDICINE: Edited by Sara F. Forman and Sarah PittsThe set point: weight destiny established before adulthood?Rose, Kelsey L.a; Evans, E. Whitneyb,c; Sonneville, Kendrin R.d; Richmond, Tracya,e Author Information aDivision of Adolescent and Young Adult Medicine, Boston Children's Hospital bDepartment of Psychiatry and Human Behavior, Alpert Medical School of Brown University and The Miriam Hospital cWeight Control and Diabetes Research Center, Providence, Rhode Island dDepartment of Nutritional Sciences, University of Michigan School of Public Health eDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA Correspondence to Kelsey L. Rose, MPH, RDN, LDN, Boston Children's Hosptial, Boston, MA, USA. Tel: +1 617 355 8385; e-mail: [email protected] Current Opinion in Pediatrics: August 2021 - Volume 33 - Issue 4 - p 368-372 doi: 10.1097/MOP.0000000000001024 Buy Metrics Abstract Purpose of review Although the set point is one of the best understood weight defense mechanisms, how and when a set point is established and what causes its disruption are not well understood. The purpose of this review is to address these gaps in the literature by exploring studies on the establishment of the set point theory and the underlying metabolic processes that support its existence. Recent findings Research suggests that weight loss achieved through restricted energy intake and increased energy expenditure is difficult to maintain and is often followed by greater weight gain over time. It is hypothesized that such weight gain is driven by an individual's set point, a weight range in which the body seeks to remain by adjusting metabolism (e.g. by moderating energy expenditure based on energy intake in times of diet or energy fluctuation). Similar to adults, weight loss in adolescence results in decreased resting metabolic rate (RMR), and that the RMR remains suppressed even with weight restoration. Summary Recommending weight loss in youth results in metabolic adaptations to restore weight and weight inclusive approaches may be more appropriate to protect their health and wellbeing. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.