The Notion of “Ideal” Weight Promotes Weight Bias

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.

Edmonton, Alberta