Helping Patients Set and Achieve Realistic Goals for Weight Loss Post COVID-19

Christopher D. Still, DO, FACN, FACP

Co-clinical Editor of Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute at Geisinger Medical Center in Danville, Pennsylvania.

Dear Colleagues:

As we begin to see patients returning from being quarantined for the last several months, many patients might have “lost some ground” on their weight loss journey. It is very important to remind them that this is a marathon and not a sprint and reinforce the importance of realistic expectations. It is important to tell them their struggles are not unique, and this applies to medical as well as surgical patients.

Realistic expectations are important because many patients 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 an unlikely for a medical management patient, we must balance known realistic expected weight loss, yet not have the patient feel that it is not worth the effort. Their ultimate goal can be 100 pounds, but small, attainable goals along the way might be preferable.

There have been multiple studies and publications regarding weight loss expectations both with medical and surgical treatments. Patients’ expectations for weight loss after bariatric surgery greatly exceed actual outcomes. Moreover, in a nice study by Foster et al, patients reported that they would be disappointed with a sustained weight loss that is close to the average expected outcome.^1–4

Initially, set an initial, attainable weight loss goal (e.g., 5 to 10 percent body weight loss). Once they achieve that first goal, then evaluate their situation and set a second modest goal. This approach is more realistic for patients, especially in patients with a greater amount of weight to lose. In the process, patients can see that even a modest weight loss significantly improves other medical problems, their quality of life, medication requirements, and mobility.

Proper communication of expectations needs to come from everybody working with a patient. Spouses, family members, friends, and even other physicians might 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 as well as lacking creditability.

Lastly, it’s important to review or re-review with patients ALL of their treatment options for which that the patient would qualify. For instance, initially, patients might not be interested in pharmacotherapy or bariatric surgery, but depending on how successful patients are on meeting their goals, discussions for escalating treatment should be discussed. Often patients can initially be apprehensive to try pharmacotherapy or consider bariatric surgery but more amenable if their weight loss wanes.

In closing, I hope you all are getting acclimated to your “new normal” and that you are enjoying your summer with friends and family.

Be well,

Christopher D. 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. 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.
3. 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.
4. 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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