Communication is Key in Helping Patients Set and Achieve Realistic Goals for Weight Loss with Any Treatment Modality

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania.

Dear Colleagues,
This month we feature an article on a topic that is very near and dear to me—talking to patients about realistic expectations for weight loss. Authors Gretchen E. Ames, PhD, ABPP; Matthew M. Clark, PhD, ABPP; Karen B. Grothe, PhD, ABPP; Maria L. Collazo-Clavell, MD; and Enrique F. Elli, MD, address patient expectations for weight loss and also quality of life, body image, and relationships. Although they mainly discuss expectations after bariatric surgery, I feel the same communication can and should be applied for individuals undergoing any weight loss intervention, including diet, exercise, behavior modification, and pharmacotherapy.

Realistic expectations are important because patients often present with unattainable goals, at least in the short term. For instance, a patient might express wanting to lose 100 pounds and achieving type 2 diabetes mellitus (T2DM) remission six months after beginning an intervention. While this is unlikely, we have to balance known realistic expected weight loss, while preventing the the patient from feeling that it is not worth the effort. Their ultimate goal can be 100 pounds, but small, attainable goals along the way may be preferable.

Through thorough literature review, Ames et al conclude the following: 1) patients’ expectations for weight loss after bariatric surgery greatly exceed actual outcome, and 2) patients report that they would be disappointed with a sustained weight loss that is close to the average expected outcome.[1–6] They discuss the challenge for providers to strike a balance between “guiding patients toward an accurate understanding of treatment outcome without diminishing enthusiasm for the possibility of living a different life after weight loss.” I attempt to achieve that balance by taking a step-wise approach with my patients.

First, I help the patient set an initial, attainable weight loss goal (e.g., 5 to 10 percent body weight loss). Once they achieve that first goal, then I evaluate their situation and set a second modest goal. I think this approach is more realistic for patients. In the process, they can see that even a modest weight loss significantly improves other medical problems, their quality of life, medication requirements, mobility, etc. It is definitely a balancing act that is crucial in working with patients who are trying to achieve weight loss.

Proper communication of expectations needs to come from everybody working with a patient. Spouses, family members, friends, and even other physicians may be reinforcing a patient’s unrealistic expectations. The entire care team should be working to present unified communication. If one provider tells a patient they can expect to lose 50 pounds three months after gastric bypass and another provider relays a different amount of expected weight loss, the patient is left wondering who is correct. These mixed messages create a potential treatment nightmare.

We need to work together to ensure a patient is receiving the same message. The multidisciplinary care environment is ideal for achieving this, as all providers are under one roof, communicating frequently. At Geisinger, we spend a lot of time and effort to get all providers on the same page. We have regular multidisciplinary meetings to ensure that everyone is educated and up to date on the newest guidelines and recommendations.

The same lesson can be applied to other disciplines. Just as I hope that providers are relaying a unified message in terms of weight loss expectations, I want to make sure that I’m educated and can reiterate treatment messages that are coming from the nutritionists, exercise physiologist, and other team members. Communication is essential not only in managing patient expectations, but across all aspects of care.

Sincerely,

Christopher Still, DO, FACN, FACP

References
1.    Wee CC, Hamel MB, Apovian CM, et al. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg. 2013;148(3):264–271.
2.    Heinberg LJ, Keating K, Simonelli L. Discrepancy between ideal and realistic goal weights in three bariatric procedures: who is likely to be unrealistic? Obes Surg. 2010;20(2):148–153.
3.    White MA, Masheb RM, Rothschild BS, Burke-Martindale CH, Grilo CM. Do patients’ unrealistic weight goals have prognostic significance for bariatric surgery? Obes Surg. 2007;17(1):74–81.
4.    Karmali S, Kadikoy H, Brandt ML, Sherman V. What is my goal? Expected weight loss and comorbidity outcomes among bariatric surgery patients. Obes Surg. 2011;21(5):595–603.
5.    Price HI, Gregory DM, Twells LK. Weight loss expectations of laparoscopic sleeve gastrectomy candidates compared to clinically expected weight loss outcomes 1-year post-surgery. Obes Surg. 2013;23(12):1987–1993.
6.    Foster GD, Wadden TA, Vogt RA, Brewer G. What is a reasonable weight loss? Patients’ expectations and evaluations of obesity treatment outcomes. J Consult Clin Psychol. 1997;65(1):79–85.

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