Obesity management metrics: Should weight loss be the goal?

The term “weight loss” is everywhere these days.

The tremendous amount of weight stigma, discrimination and bias contribute to the unhealthy stereotype that thin, slender figures are considered the most attractive — leading patients to quick fixes and unhealthy practices to lose weight.

As health care providers, we often hear patients say things like, “I want to lose 100 lbs to look the way I want,” or, “I want to be 150 lbs.” These unrealistic expectations don’t consider that we all come in different shapes and sizes, and that trying to be a particular size or weight will never prove successful. It is our role as providers to help patients determine a healthy, realistic amount of weight loss and suggest a personalized plan for creating a healthier lifestyle. We have the opportunity to redirect these unrealistic goals into healthy processes. When patients aim for the processes that lead to weight loss, they will lose weight eventually, but if they solely aim to lose weight, they may not succeed.

Amardeep Shrestha

Obesity management should not be confined to obesity experts. However, all health care providers ought to be obesity experts. As we continue to see obesity rates rise each year, our band of providers must grow as well. From lifestyle interventions to anti-obesity medications and surgery, all health care providers must feel comfortable and knowledgeable to navigate the range of resources and tools available to combat obesity.

Creating S.M.A.R.T goals

Instead of focusing on a specific number on the scale or outcome goals, we can help patients create achievable process goals. When patients focus on process goals, they develop healthy lifestyle habits that are long-lasting. These objectives should be S.M.A.R.T:

• Specific
• Measurable
• Achievable
• Relevant
• Time-bound

While every patient is different when it comes to a healthy weight-loss timeline, as a general rule, patients shouldn’t lose more than 1 to 2 lbs per week. Similarly, a goal of 5% to 10% weight loss of a patient’s overall body weight over the course of 6 months is generally realistic and healthy.

The negative implications of weight loss goals

Extreme weight loss goals can be dangerous. When patients take drastic measures to achieve their weight loss goals, their restrictive diets can cause many nutritional deficiencies and dehydration. Restricting calories also restricts essential vitamins and minerals, which can lead to hair loss and skin problems.

When patients don’t achieve their lofty weight goals, their mental health can take a toll. Feelings of failure and low self-esteem can result in anxiety, sleep issues and depression. This mental imbalance can impact their physical and occupational health tremendously. The stress of not achieving their goals can also lead to more weight gain and other health consequences.

Productive ways to help patients seeking weight loss guidance

As the first contact to learn about weight and its health implications, primary care physicians play a major role in the weight management of their patients. For some patients, primary care is the only regular health contact patients have, which is why we should always take the opportunity to advocate for healthy weight management practices.

Here are some helpful ways to communicate with patients about weight loss:

1. Discuss weight management in a supportive way. Receiving permission to talk about patients’ weight can help strike a nonjudgmental tone. Always connect weight to health and not to size.
2. Do not label obesity only using BMI. There are other tools and coexisting conditions that impact overall health.
3. Understand patients’ weight management stages. This will align their goals for their weight rather than your goals for their weight.
4. Aim for healthier lifestyles. Teach and educate patients to make smaller, S.M.A.R.T. goals.
5. Create one goal at a time. Encourage patients to achieve one goal before making another.
6. Discuss habit-changing behaviors. This will help patients understand that short-term changes in behavior don’t have a lasting effect.
7. Gain insight into patients’ culture and food habits to create healthy lifestyle plans. This will also help engage patients in designing their own healthy activity strategies.
8. Log medications. Sometimes a change in medications can help manage weight.
9. Share weight physiology knowledge. Weight is not just what we eat and how much we move. Once we start a restrictive diet, there are other compelling forces, such as hunger hormones and decreased metabolism, that cause our body to regain weight.
10. Always discuss the side effects and efficacy of weight loss medications. Rule out any contraindications.
11. Provide support through counseling and other appropriate strategies, such as empathy, listening and praise. Positive motivation goes a long way in behavior-changing attitudes.

By helping patients create process goals and understand that outcome goals are often unrealistic, we can better set them up for success on their health journeys. Our knowledge of obesity is always evolving. The Obesity Medicine Association also offers a variety of digital tools, webinars and educational resources for a spectrum of providers who care for patients with obesity. To learn more about OMA or to become a member, visit https://obesitymedicine.org/join.