Weight Loss is Not a Goal

One of the basic tenants of behaviour change is goal setting. A popular framework for this is S.M.A.R.T., which stands for Specific, Measureable, Attainable, Realistic and Timely.

But does goal setting in behaviour change actually work?

This question was addressed by CON-Bootcamper Erin Pearson from the University of Western Ontario (London, ON), in a paper just published in Patient Education and Counselling, in which she reports her findings from a systematic review of the literature.

Specifically, this paper describes goal setting components used for behavior change specific to diet and physical activity in community-based interventions targeting overweight and obese adults.

Eighteen studies were evaluated using the S.T.A.R.T. (Specificity, Timing, Acquisition, Rewards and feedback, and Tools) criteria which were developed for the purposes of this paper in order to elucidate which intervention features elicit optimal health behavior outcomes.

The analyses, however, ran into problems as, despite suggestions that developing specific goals that are in close proximity, involve the participant in acquisition, and incorporate regular feedback, are common features in these program, it was not possible to ascertain whether this goal setting element in itself was useful or not, as it was generally confounded by other intervention components such as education sessions or self-monitoring records.

Thus, Pearson concluded that while goal setting shows promise as a tool that can be incorporated into weight reduction programs by health care professionals and researchers, further studies are warranted to identify the specific mechanisms through which individuals with overweight or obesity can apply the S.T.A.R.T. criteria with respect to goal setting for the purposes of weight loss.

One aspect that is clear to me at least is that weight-loss itself should not be a goal as weight loss is not a behaviour. If the goal of the intervention is to change behaviour then the goals should probably be behavioural goals that meet the S.M.A.R.T. (or S.T.A.R.T.) criteria.

Whether or not these behaviour changes actually result in sustainable weight loss is likely irrelevant as long as they improve health.

Thus the goal to eat a proper breakfast on at least five mornings a week or to not eat out more than two times a week or to walk at least 5,000 steps on four days a week are specific, measurable, attainable, realistic and timely behavioural goals, whereas losing 10 lbs by the end of the month is not – why? Because “weight loss” is NOT a behaviour!

Indeed, I have warned before that there is an inherent danger of aiming for weight-loss goals:

1) patients tend to focus more on the numbers on the scale than on the actual health behaviours

2) if the weight goal is not achieved patients are generally disappointed, disheartened and likely to abandon the program altogether (along with the healthy behaviours)

3) Even if patients do achieve their first weight-goal, they tend to set new (even lower) weight-goals, which lead to the same problems described in 1 and 2 – ultimately they end up setting a weight goal that is either unachievable or unsustainable and the chances are that the lower the goal, the unhealthier the strategies used to achieve and/or sustain it.

Thus, while I fully support the notion of SMART (or START), the goal should be a behavioural goal and not weight loss.

Just remember that weight-loss is NOT a behaviour.

Edmonton, Alberta

Pearson ES (2011). Goal setting as a health behavior change strategy in overweight and obese adults: A systematic literature review examining intervention components. Patient education and counseling PMID: 21852063