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