In an article published in the latest issue of Surgery for Obesity and Related Diseases (SOARD), Shahzeer Karmali, Daniel Birch and I suggest that it is time to abandon the concept of “excess weight loss” (EWL), a paradigm generally used in reporting the outcomes in bariatric surgery.
In this article, we strongly argue that the notion of EWL deserves to be discarded because of the following:
1) The scientific fallacy of “ideal” weight
2) EWL is misleading and often a barrier to counseling patients
3) EWL and the notion of “ideal” weight potentially promotes weight bias
Without wanting to repeat all of the arguments and extensive rationale discussed in the article, perhaps just one brief excerpt that addresses the potential of EWL to promote weight bias:
By using the term “ideal weight” health professionals can be easily interpreted as conveying a value judgment about weight, that in someone who’s weight is far from “ideal” can further enhance distress. Indeed, it is not unlikely that many obese patients look at the term “ideal weight” only to fully realize how far away from this “ideal” they actually are with virtually no hope of ever getting there. This improper messaging continues during each visit when providers refer back to the ideal body weight to determine the EWL. Despite counseling about realistic weight-loss expectations, many patients will inherently continue to see “ideal weight” as the ultimate goal and regard inability to reach this weight as failure.
…health providers should be aware of the negative emotional reactions that can be elicited by improper use of language and terminology in communicating with patients and its impact on medical decision making. Given, as stated above, that “ideal weight” is a scientifically questionable concept, health professionals can easily avoid any negative judgmental connotations conjured up by the term “ideal” by simply striking this term from their vocabulary.
We conclude our article by recommending that the irrelevant and misleading concept of EWL be abandoned and replaced by presentation of outcomes as simple percentage of initial weight in all trials of obesity interventions, including bariatric surgery.
We look forward to comments.
AMS
Edmonton, Alberta
In The News
August 21st, 2009 at 1:08 pm
But I need some word to use when I’m talking with clients even if I am not the one to bring up the topic.
BTW, I always learn from reading your blog. Thanks.
August 21st, 2009 at 1:33 pm
In response to Gillian:
One option could be to talk about a “healthy” weight or even better to focus on the actual health improvements that the patient can expect even from moderate weight loss. The idea is simply not to reinforce false and unrealistic expectations that really have no science to back them up.
AMS
August 21st, 2009 at 1:37 pm
I personally prefer Excess Weight Loss or % EWL.
For example :
Me: female, 5′4″, 56 yrs old, 200 lbs
My son: male, 6′2″, 23 yrs old, 200 lbs
Suppose we both loose 10 lbs, to 190 lbs.
As % of Initial Weight, we each lost 5 %.
As % of Excess Weight lost, he lost 100% of his excess weight,
whereas I lost about 13 % of my excess weight.
(200-125 = 75. 10 is about 13% of 75.)
To me, that is a more accurate reflection of the state of weight for each of us, even though one could quibble over our exact “ideal” weights.
I think of % EWL as a range.
Over the past two years, I have actually gone from 250 lbs to 200 lbs, a 50 lb loss.
50 lbs lost is 45%-40%-36% of my range of excess weight.
Lost 45% of weight in excess of the top of normal weight range, 140
(250 - 140 = 110, 50 is 45%)
Lost 40% of weight in excess of “ideal” weight of 125
(250 - 125 = 125, 50 is 40%)
Lost 36% of weight in excess of the bottom of normal weight range, 110
(250 - 110 = 140, 50 is 36%)
Of course, weight charts vary, but that’s close enough.
Being a “normal” weight is a reasonable goal. A 30 lb window gives lots of wiggle room, so I’m not fixated on one “ideal” weight.
I find it is helpful to use “% EWL range” as a measure of how far along the road I’ve come towards my destination.
Besides, when I’m calculating, I’m not snacking!
September 15th, 2009 at 4:00 pm
I don’t know what else you would call it besides “excess.” Let’s face it, of course it’s “excess.” I had weight loss surgery in November. I did it for health reasons. I was able to have knee replacement surgery in July. I can walk without a cane for the first time in nearly 3 years. No doctor would operate on me when I was as heavy as I was then.