Why doctors should stop setting numeric weight-loss goals for patients
Both on this blog, and in my own medical training, I’ve heard countless stories about doctors telling people a specific amount of weight they ought to lose to become “healthy.”
Sometimes this is based on the patient’s BMI, and sometimes it appears to pulled out of thin air, based on that particular doctor’s impression of what is appropriate when it comes to weight.
I think this is a terrible medical practice, and here’s why:
1. There’s no evidence behind these specific numerical targets.
Most of the best evidence from our medical studies of weight has examined the health benefits of losing a relatively small percentage of body weight (5-10%).
This modest weight loss has been associated with a myriad of health benefits including decreased risk of type 2 diabetes and cardiovascular disease. The evidence therefore doesn’t suggest a need for dramatic weight loss.
2. Setting an unrealistic goal makes people give up when they can’t achieve it!
For most patients with significant overweight or obesity, achieving a normal BMI is an unrealistic (and unnecessary) goal. Setting this goal is likely to result in guilt, disappointment, and abandonment of lifestyle change efforts.
3. This weight loss “goal” usually doesn’t come with any meaningful advice on how to achieve it.
Most patients receive very little in the way of specific, actionable advice from their doctor on how to make lifestyle changes to benefit their health.
Instead, they receive the condescending (and less-than-useful) advice to “eat less and move more.” If that simplistic phrase and the desire to lose weight were all it took to lose weight and improve health, we wouldn’t see so many people struggle with weight.
4. The focus is on the destination, rather than the journey.
Lifestyle changes like improving the quality of one’s diet or increasing the amount of physical activity in one’s routine have dramatic impacts on health. This is true even if weight loss doesn’t happen as a result of these changes.
So, physicians, let’s focus on supporting our patients to make lifestyle changes that benefit their overall health, rather than setting meaningless weight loss targets.
Because our real goal should be health improvement, not just weight loss.
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