At the Obesity Canada Summit in Montreal last Thursday, a diverse group of patients, clinicians, and advocates delivered a simple but powerful message: obesity care needs to aim for goals beyond weight loss – for better health. They presented a compelling case for setting goals and targets in obesity care through a co-design process with patients and professionals as equal partners.

A recent paper by Carel le Roux and many of the presenters in this session provides an analysis of such an approach in Diabetes, Obesity, and Metabolism. They found potential for better clinical outcomes and concluded:

“A preferred framework would integrate improvements in cardiometabolic risk, physical function, other measures of quality of life, and patient preferences.”

Stuck on Weight Loss

For decades, a percentage of weight loss – often 5% – has served as the default benchmark for success. But as the presenters made clear, body weight is a biologically regulated outcome. It does not reliably capture what matters most to people living with obesity: better health, improved function, and a higher quality of life. So these presenters propose a framework that reflects a growing body of research. Evidence from that research shows meaningful improvements in diabetes, sleep, mobility, mental health, and daily living can occur even when weight loss is modest or variable.

Shared Decision-Making Beyond Weight

The alternative they propose is both practical and humane: shared decision-making.

Rather than imposing a single numeric target, clinicians and patients begin by exploring what matters most to the individual. Is it reducing fatigue? Improving blood glucose? Being able to play with grandchildren? These priorities become the foundation for care. From there, patients and providers agree on a small set of meaningful goals and select measures that reflect them – clinical markers, patient-reported outcomes, and quality-of-life indicators.

This approach transforms obesity care into something more aligned with how we manage other chronic diseases. It becomes a process of “treating to target,” where targets are personalized, monitored over time, and adjusted as needed. Importantly, it also builds trust – especially for patients who have experienced stigma or dismissal in healthcare settings.

Better Care

The real value here is not just better metrics. It is better care. When patients have a voice in defining success, care becomes more relevant, more sustainable, and more effective.

Moving beyond weight is not about ignoring it. It’s about putting it in its proper place – one measure among many, not the measure that defines everything.

Click here for the paper by le Roux et al, here and here for more on shared decision-making in obesity care.

Canadian Obesity Summit Presenters, photograph by Megan Racey / Obesity Canada