Stop Setting Weight Goals in Obesity?

“Stop setting weight goals. Behaviors are something you do, weight loss is something that happens.” That was the bottom line from Arya Sharma in his keynote address to the YWM2014 national convention of the Obesity Action Coalition.

Is this really a radical proposition? So much is written in the obesity literature about losing 5 to 10% of body weight that people become preoccupied with arbitrary goals and numbers for weight loss. But anyone who has dealt seriously with obesity knows that weight loss — in the short term — is easy. Maintaining a healthy weight is where the real challenge lies.

And then we have the absurdity of excess weight loss (EWL), which is how surgical treatment results are reported. The numbers are based on assumptions about ideal body weight, which Sharma explained is an inherently flawed concept. But EWL translates into bigger provides bigger percentages, so bariatric surgery studies keep on reporting this number.

Sharma’s proposition requires two adjustments to the way that many people look at obesity. First is a shift away from relying on BMI to an approach like the Edmonton Obesity Staging System. The EOSS focuses on the health and life impact of obesity for diagnosing its severity. Some people will push back hard at the idea of good health at a high BMI, but a very few people with a BMI above 40 (class III obesity) enjoy relatively good health. The health-centered approach of the EOSS takes this into account.

The second adjustment is to completely discard notions of ideal body weight that are so deeply embedded in BMI charts. Instead, clinicians and patients need to focus on finding their own best weight, defined as: “Whatever weight someone can achieve and maintain while living the healthiest lifestyle they can truly enjoy.”

And that means focusing on healthy behavior goals, not arbitrary weight goals.

Best Weight: A Practical Guide to Office-Based Obesity Management is available here for free with registration on the Canadian Obesity Network. For the latest updates on YWM2014, you can tune in to the OAC YouTube channel here, including live streams on Friday at 11:15am and Saturday at 9:15am EDT. You can follow the meeting on Twitter with the hashtag #YWM2014 and on Facebook here.

Foggy Goals, photograph © MTSOfan / flickr

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