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How Will You Lose Weight?



Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.

HOW WILL YOU LOSE WEIGHT?

How does your patient plan to achieve weight loss? Most patients have some idea how they would like to achieve their goal. Some will have a positive plan, while others have thought more about what they are not willing to do, such as liquid diets, going to the gym or giving up soft drinks. Listen carefully to the patient’s intentions, as these will help provide proper guidance.

Plan vs. No Plan?

The more specific a patient’s plan, the greater the likelihood of success. A patient may state a plan to cut out soft drinks, snacks, or high-glycemic index (GI) foods. Patients with unrealistic plans involving approaches such as a cabbage-soup diet, a 10-day fast, or eating no food after 5 p.m., should be counselled on more appropriate strategies. The impact of what you say may be minimal, but it is better to try and discourage patients than do nothing. Patients who have no specific plan will need positive guidance. The question “What can you see yourself doing?” may be helpful.

Past Successes and Failures

Traditionally, the weight-loss component of obesity treatment has been relatively simple: all a patient had to do was suffer. Of course, if weight is lost through suffering, it will almost certainly be regained when your patient has decided that they have suffered enough and they revert to their original lifestyle.

Patients will often define success only in terms of the amount of weight lost. A more meaningful definition would be whether or not the weight loss was maintained.

We often advise patients to use the same approach that has worked for them in the past. However, it is important to explore why the patient abandoned that last effort. If a patient says, “It worked, but I hated it,” new approaches should be discussed. The vast majority of your patients will regain some, if not all, of the weight they lose. While a large part of this is likely due to a patient’s inability to sustain lifelong lifestyle changes, it is also partly due to the fact that our biology is designed to protect our weight and ensure that any lost weight is regained.

This is a good time to discuss the need for ongoing treatment once weight loss is achieved. To emphasize this point, we sometimes tell patients, “Maybe you should go and lose some weight and then come back for obesity treatment.” They should understand that the more weight they would like to permanently lose, the more of their lifestyles they will need to permanently change. And lifestyle changes alone may be insufficient — some patients will require the ongoing use of partial meal replacements and/or medication as adjunctive treatments. As with any other chronic medical condition, the cessation of treatment will result in the recurrence of the condition. If a patient ceases any aspect of their obesity treatment (lifestyle changes and/or partial meal replacements and/or medications), their excess weight will likely recur.

In some cases the only successful treatment may be surgical, but even surgical weight management approaches require sustained lifestyle changes and, sometimes, medications.

Unfortunately, there is currently no “cure” for obesity: whatever treatment is chosen, it will have to be continued forever — treatments that are not sustainable do not result in sustainable weight loss.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.
The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

If you have already read Best Weight, please take a few minutes to leave a review on the Amazon or Barnes & Nobles website.

6 Comments

  1. Once again, I am in awe as to how you guys look at things from such a realistic perspective. “Maybe you should go away amd lose some weight and then come back for obesity treatment”. I gain more common sense and true insights from this blog and, more recently, this fantastic book than any other resource. Thanks again Arya and Yoni!

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  2. This was beautifully written and honestly a positive reinforcement for many of us distinguishing between losing weight, and actually keeping it off.

    Only 6 percent of people who keep weight off lose it within six years, according to a ’00 study from the International Journal of Obesity. And for what little research has been focused solely on maintenance, there is no universally agreed upon scientific definition.

    The diet industry is able to market the desire to lose weight, but really haven’t figured out how to make maintenance marketable. Very few of the leading diet centers have any real maintenance program at all, save Nutrisystem.

    For all the support, attention, and media/marketing attention given to weight losers, once you hit goal and ask yourself “now what?” you’re largely left out in the cold. And you do get colder when you lose weight.

    That idea was abhorrent to me after losing 250 pounds, while visiting 6-8 restaurants a day as a food writer. I suppose that’s unique circumstances, but I made it work just like anyone else who loses weight does.

    It turns out that my life didn’t really change substantially dieting on its own. I just ate different things and moved more. The huge status quo shifts (not all pretty or positive) occurred when I hit goal and realized every facet of my life changed. And the whole world thought I was “cured.”

    I scoff at the notion of obesity-as-disease because to this day I can/could still be the 350-pound rock critic who worked in a newsroom all day and ate two pizzas a night.

    It’s an addiction, or at least a chronic illness. Being part of the six percent, in the current culture, is like living in the gray. You’re neither “fat” or “thin,” you’re not who you were and yet you’re never quite living like someone who never had a weight problem in the first place.

    What’s glossed over is the whole idea of “changing your lifestyle” isn’t limited to just the mechanics of weight loss (what you eat and how you move). There’s the significance also –your clothes, your relationships (both new, old and with yourself). In all the “Fat pants” celebration of attaining goal, the transition and all that’s required to actually keep your weight off gets overlooked.

    Not if I have anything to say about it.

    So thank you, Dr. Sharma. The more people who distinguish between losing weight and living the life you want, post-weight, the more likely that 6 percent will rise. And people will be prepared for weight loss success long term.

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  3. So, the failure rate of long-range weight-loss maintenance accepted, why is the question “How will you lose weight?” The question should always be, “What are you doing and what can you do additionally to improve your own health?” If weight loss happens as a side effect, that’s a social bonus and may make your joints feel better too.

    I disagree with the doctors above (and the manual) that patients should be encouraged to go lose weight on their own and then return for “obesity treatment.” That’s ridiculous. There are so many patently dangerous ways to lose weight, and those methods will only mislead the patient with regard to health management. Hey, the doctor says to limit refined carbs, but you lose weight (and garner all the social rewards) by portion controling your Twinkies, so who’re ya’ gonna believe?

    I am in the 3% club, according to my research — maintaining 60 lbs. of loss, more than seven years. (The writer above says the latest study puts long-term maintenance at at 6%. I’ll take that. Probably a difference in definitions or that study’s methodology, not an actual change in the failure rate.) Weight loss is down-hill skiing. Maintenance is cross-country. But it’s all skiing. And Maintenance is harder. And lonlier. No one cheers for you. And NOT everyone can do it. I have certain blessings that make it possible for me. We all have redundant systems that push us to regain weight. I have, at least for a time, figured out mine and bypassed them. Some of us work really hard and benefit from luck. It takes both.

    EVERYONE, however, can contribute to improving their own health. How? That’s what the question should be. Grrrrrrrrr.

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  4. Hi DebraSY —

    Nice and grats on beating the odds! What study did you get your statistic from?

    I don’t buy that everyone can’t do maintenance — maybe not in this current landscape, but it’s not impossible. No one actually teaches you what’s all involved (it’s a combination of what I call the mechanics and the significance). And so you largely go it alone.

    That’s why those of us who have pulled maintenance off are so vital in the obesity discussions (beyond being a “success story” marketing tool) — there are many ways the diet, medical and fitness industries could include maintenance-related material, they just don’t think about it.

    Financially, it makes no sense to support maintenance (given the statistics). And otherwise people just don’t think about what’s actually entailed in keeping it off. They don’t get it.

    While I appreciate and get your metaphor — weight loss and post-weight being two variants of the same thing — I haven’t been convinced thinking of it in that manner is helpful. The same with the “healthy at any size” ideology. It’s not a question of “truth” (I don’t think you’re wrong — you’re absolutely right), but of approach.

    If “improving health” can/does actually motivate people, about time! Me Personally? I’ll be honest — my health never crossed my mind. I wanted to see who Russ was under 200 pounds.

    Here’s the thing, though: has thinking of it in that manner actually helped increase the 3-6 percent? Has that actually enabled people to sustain something they worked blood sweat and tears for? Has that enabled the industries who have a responsibility to us to empower people just starting out?

    It’s not necessarily a question of maintenance vs. Healthy at any size (they’re addressing different concerns, weight and health. Also like skiing). I just don’t think the latter’s particularly useful in weight loss.

    If you distinguish, illuminate and define the nuances of maintenance, they’re easier to understand and act upon. Otherwise you’re feeling your way through the dark.

    How this became my mission was I was looking at all the people who should be leading the charge weren’t. So I figured, just like my life, post-weight, I’d just have to do it myself.

    Thanks so much! Definitely want to continue this! I love talking and thinking critically about this stuff!

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  5. Hey, Russ, I hereby invite you to join me at my blog. I have answered all your concerns from my vantage point at some time or another (though it’s not a long-lived blog. I started the last week of September 2010). With regard to the studies on obesity success, that would be in my post entitled, “Hey, MDs, Listen to the PhDs, Please” (Dr. Sharma, by the way, is both.) I list three studies that come out at 3% or less, and I talk about the survey research at the NWCR, and how watered down that definition of success is.

    You might enjoy the discussions we have over there, on a variety of subjects, too. My readers are very sharp. We are lay people, mostly, discussing the science of weight-loss maintenance. I attract both maintainers and size acceptance proponents. Surprisingly, most of the time, we’re on the same page. Read my “about” page and you’ll know whether you want to go any further. I’m not a big cheerleader for weight loss/maintenance. There are plenty of those on the internet, so I don’t feel the need to go there, and it just doesn’t ring as genuine for me, and never will. I’m stoic more than ill-spirited, but some people don’t see it that way, and don’t like it. I say, more power to them, and I wish them well in finding the zippy “lifestyle” proponents who resonate with them.

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