Weight GoalsSaturday, January 15, 2011
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.
One of the first questions a patient will ask you as they embark on an intentional weight-loss effort is, “How much do you think I should weigh?” Unfortunately, there is no correct answer.
Patients often want to know their ideal weight or ideal BMI. While a variety of different classification schemes for obesity are available, their utility lies primarily in statistical analysis and research, not in the individual clinical encounter.
Telling a patient whose BMI is 50 that they need to lose virtually 50% of their present body weight to be healthy is an exceptionally unhelpful means of discussing weight. The patient may not have weighed that little in decades, and you will have only provided them with a goal that seems daunting if not wholly unattainable.
Waist circumference and waist-to-hip ratios are useful in ascertaining the medical risk a patient’s weight presents, but are no better than BMI in terms of goal-setting.
Even a 5% weight loss has been shown to produce medically measurable results, so any amount of weight loss is helpful. In some cases, rapid weight loss over the first few weeks of a weight-management program, as induced by a very low-calorie* diet, can increase motivation. However, this rapid rate of weight loss cannot be maintained and is likely to lead to frustration later in the program. As with any obesity treatment, the maintenance of lean body mass is crucial and rapid weight loss has been shown to disproportionately affect lean tissue. If a patient insists on rapid weight loss, you may need to reassess their underlying motivations and expectations.
© 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.
Sunday, January 16, 2011
Another intriguing post, and here are some follow-up thoughts:
I have never in my own experience or the story of anyone I have heard – family member, friend, client or more distant, heard of a doctor who when asked the question “How much should I weigh?”, led their response by saying that there is no absolute certainty in this area or that losses as small as five percent can result in health benefits. I know these things, but I have learned them on my own.
Imagine how heartening these statements might be to hear from the get-go for the discouraged person who has tried many approaches with a variety of results, rebounds, and so on! Part of what makes starting the doctor’s part of the conversation in this way difficult I believe, is that there is an innate tension for doctors in patients wanting you to be the one who knows, definitively, what “the answer” is. The area of obesity and weight management is an excellent example of how incredibly complex both the question and the answer, can be.
Another way to consider the question is this: what is your patient actually asking you? Could he or she be asking you something that is support-seeking, e.g. “how much hope can I expect you my doctor, to have for me in this process”, or something more in the moral realm, for example “how bad do you think I am?” I believe the question of how much you think the patient should weigh, though medical in content, also contains fears and expectations of the particular patient at the precise moment they are asking you. It’s also my belief and experience that those fears are not solely about the numbers issue but about how they expect the doctor-patient relationship to go.