Realistic goals help keep pounds off
By John Casey
WebMD Weight Loss Clinic - Feature
Reviewed By Kathleen Zelman, MPH, RD, LD
Yo-yo dieting. Creeping weight gain. It goes by many names, some of which are unprintable here, but we all have it -- that tendency to put back on weight we have worked hard to get off.
In many ways, it makes no difference how you accomplish the weight loss -- whether it's by working with your doctor or nutritionist to develop a plan of diet changes; with diet medications and increased exercise; or whether you simply cut out Krispy Kremes, Ding Dongs, and Cheetos in favor of low-fat foods. What does matter, say many weight-management experts, is having realistic goals about where your weight is now and where you want it to be a long way down the road. Realistic expectations, experts say, can be a big help in keeping the pounds from coming back.
"When a person who has dieted extensively to lose weight keeps the reality of the situation in mind, that person knows that weight management is long-term," says Ali H. Mokdad, PhD, a senior epidemiologist at the Centers for Disease Control and Prevention (CDC) who is an expert in obesity and one of its many related conditions: namely, diabetes.
"It's nothing special to drop a few pounds, but for an obese or chronically overweight patient to lose 10% of their weight and keep it off for a long time, that is the kind of weight control that will add greatly to a patient's quality of life later in life as they avoid or minimize [related] conditions of obesity, such as type 2 diabetes, osteoarthritis, even some types of cancers."
The message behind weight management is simple, says Mokdad.
"Weight loss is best achieved through long-term, consistent lifestyle changes, as simple as eating more fruits and vegetables, getting at least 30 minutes of physical activity a day and avoiding high-calorie foods that have no nutritional value, such as all the sugar sodas and super-sized portions of French fries and snack items that the American [diet] is so full of."
But somehow, this message is not getting through, he says. He and his colleagues at the CDC, along with other obesity researchers, are working to try to find out why even people who are in weight-management programs under their doctors' supervision have trouble with the idea that you have to eat fewer calories and get more exercise to avoid the kinds of diseases that can affect your quality of life in later years.
"It's really a mystery," he says. "We have proven, effective treatments that are simple. We need to find out why patients -- even self-motivated patients -- resist this."
Leslie J. Bonci, MPH, RD, a spokesperson for the American Dietetic Association and director of the Sports Medicine Nutrition program at the University of Pittsburgh in Pennsylvania, says part of the problem is that we focus too much on weight loss and not on long-term management.
"A lot of weight-loss programs out there direct people at the action phase of weight-loss only," she says. "These programs take an all-or-nothing approach that is not conducive to long-term weight management -- setting realistic goals and developing the kind of working knowledge of good nutrition to enable them to make smart food choices over a lifetime."
So just what is a realistic weight-loss goal?
"A good rule of thumb in weight loss is no more than a pound per week," says Leslie Womble, PhD, an assistant professor in the Psychiatry Department at the University of Pennsylvania School of Medicine in Philadelphia. "That may seem very slow when you get on the scale and want to see some progress there, but anything faster puts the weight-loss plan at risk of later weight regain."
Womble and her colleagues did a study to find out whether patients' attitudes change when they have a clear understanding of how much weight they can expect to lose in one year of lifestyle modification, in combination with a weight-loss medication.
The researchers gave 53 female subjects a questionnaire to find out how much weight the women expected to lose over 52 weeks of treatment. The researchers met with each woman and explained that each could expect to lose between 5% and 15% of their starting weight. In the consent form that the subjects signed, the 5% to 15% "expectation" estimate was repeated twice more. Once all the women had signed the consent form, they were given a second questionnaire to gauge how their expectations might have changed after this in-person counseling and the printed reminders.
Before getting the in-person counseling, most of the women had predicted they would lose 25% of their starting weight after one year of treatment. After the counseling, the researchers found, the women's expectations had come into line with the more realistic weight-loss estimates.
"What we found was important because it tells us two things," says Womble. "First, it says that many patients under treatment for obesity have unrealistic ideas about weight loss, even those patients under medical supervision. Second, it says that we in the medical community, the healthcare providers, need to address our patients' lack of understanding about what they can expect from treatment."
Originally published Jan. 16, 2003.
Medically updated Sept. 1, 2004.
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