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Unrealistic Weight-Loss Expectations Guarantee Disappointment

Over the next little while, I will be taking a few days off and so I will be reposting some of my favourite past posts. The following article was first posted on Aug 27, 2008:

One of my all time favourite quotes is “No one is admired for failing to achieve the impossible.”

I have previously blogged about the issue around unrealistic expectations when it comes to weight management.

In fact, one of the principal reasons that we have successfully introduced the Orientation Sessions in the Weight Wise program, is to temper patients’ often ridiculously optimistic expectations about how much weight they can lose and keep off.

While a large proportion of patients are hoping to lose about 50% of their initial weight, the sad truth is that even with surgical treatment, the average patient can hope to lose only 25% – and that is when all goes well!

Why is managing expectations so important?

Because unrealistic expectations guarantee disappointment. (for my mathematical readers S=O/E where S=Satisfaction, O=actual Outcome, E=Expectations; if S<1 the patient is unsatisfied or disappointed).

The issue of ridiculous expectations is not limited to weight loss. In fact, Janet Polivy (University of Toronto), in a wonderful article published in the International Journal of Obesity (2001 – free PDF for download), termed this the “False Hope Syndrome”.

In the context of weight management, this syndrome is characterized by often completely unrealistic expectations as to:

1. the amount of weight loss that can be achieved (and maintained!)

2. the speed with which the weight can be lost

3. the ease with which lifestyle changes can be made

4. the effects that these changes (weight loss) will have on other (mostly non-health related) aspects of one’s life (e.g. finding a better job, attracting a partner, etc.)

When any of these unrealistic expectation are not met, the result is simply disappointment, discouragement and a sense of failure.

It is therefore a moral and ethical obligation for health professionals to actually talk patients out of thinking they can all become happy Ken and Barbie dolls if only they tried hard enough.

Unfortunately, it is very easy for health professionals to be caught up in the ridiculous expectations of their patients or even feed these expectations by demanding and expecting the impossible. Thus, for e.g. the orthopedic surgeon who expects his obese patients to lose 30% of their body weight before hip-replacement surgery is a “mental abuse” lawsuit waiting to happen (especially given that the evidence that obese patients benefit less from joint replacement surgery compared to non-obese patients is rather iffy).

There is little doubt that one of the major factors that drives these ridiculous expectations are the many commercial weight-loss programs, products, books and other scams that play on peoples’ fantasies, despite the reality that few (if any) users of these services or products actually achieve any of their long-term goals. Amazingly, these scams get away with it because the individuals strangely tend to blame themselves rather than the useless product or service for their failure, while in the rare cases of success, the programs take the credit.

Clearly, not a bad business to be in!

As for ethical programs, I would expect first and foremost that all possible effort is made to diagnose and manage the “False-Hope Syndrome” BEFORE embarking on any treatment – not doing so is simply guaranteeing failure, disappointment and relapse.

Edmonton, Alberta


  1. Hi, Absolutely you are right! When we think in a positive way we may expect positive results. In your psychological exercise, it can work well along with the treatment.Not only dieters but also doctors can gain a lot from your exercise.

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  2. weight loss — I’m not sure what you are trying to say here. How did you get from “False-Hope” syndrome to “positive thinking = positive results!” For too long we’ve made people feel as if they are failures if they don’t achieve and maintain significant weight loss, no matter where they start from. Any amount of positive thinking is not going to override the basic biological systems that make this an unrealistic goal for most. I can get very positive results from improving my health behaviors, and I do think positively about those. But if I think that if I just get my mind right I can get thin, I am setting myself up for failure.

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  3. If I had a client whose surgeon expected a 30% wt loss toward the goal of joint surgery I would guide them for a second opinion and enlist the family physician promptly!

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  4. I’ve always been under the impression that when surgeons ask for weight loss before an operation, it’s for their convenience. They have to know that people will starve themselves before the surgery and regain the weight afterwards, right? That’s the only thing that makes sense. Or, maybe they’re trying to pretend that the regain won’t happen.

    It’s absolutely not a reasonable thing to ask for – agreed – partly because it will leave many their patients heavier than they started out.

    As for reasonable goals (or a HAES side effect weight loss – let’s be honest), a lot of people aren’t going to be happy with that. It’s not just because of delusions of what being thin could improve in their lives. With the amount of prejudice out there, being thin probably does improve a lot of things, especially job and relationship prospects.

    It’s because doctors don’t distinguish between someone whose BMI is 35 who is at their heaviest and has poor eating habits and is sedentary, and someone whose BMI is 35, but who has great habits and is 20% below their top weight.

    In fact, in all of my 40+ years, I’ve never had a doctor ask me about my maximum weight and whether I’m below it. They calculate your BMI category and then they start making assumptions. If you’re thin and your medical numbers are good, I’d imagine that doctors give you credit for it. If you’re fat and they’re good, then they act like you’re a freak of nature. I had a doctor throw my blood test results at me once because she was angry that there wasn’t anything wrong with them.

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  5. “…..doctors don’t distinguish between someone whose BMI is 35 who is at their heaviest and has poor eating habits and is sedentary, and someone whose BMI is 35, but who has great habits and is 20% below their top weight.”

    Great one DeeLeigh! Am going to use this one if you don’t mind!


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  6. Hi, Dr. Sharma. You’re welcome to use anything I post to your blog. Thanks for listening. That, in particular is something that doctors need to talk about, because it can have a huge impact on people.

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  7. My experience is similar to DeeLeigh’s. My BMI at age 18 was 51. After decades of weight “battles,” (even a Ph.D. in psychology trying to make sense of it all) I have moved toward a HAES orientation, with a “healthy” BMI of 34. Just try explaining that to a physician who has little training in the science of obesity, and doesn’t believe that you can be healthy unless thin. Here in California, we are thinness obsessed, perhaps more so than in Canada? The hostility toward obese people is pervasive. I am subject to verbal abuse at times. Given the unceasing weight loss messages expelled by medical organizations, diet industry, and mainstream media, as well as the social acceptability of fat prejudice, is there really any way to educate the health care providers or general population about this complex issue? I really appreciate your voice of reason, Dr. Sharma! We need you here in the U.S. Have you spoken at some of the International conferences? Thanks for the fantastic work you are doing.

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