Redefine Your Obesity Treatment Goals to Look Beyond the Scale

When it comes to obesity, the focus of treatment in most people’s minds is solely on weight loss. We set goals that we think are healthy, and we work toward them. But, what exactly is a healthy weight when you are living with obesity?

Many people evaluate their weight loss progress based on body mass index (BMI). Body mass index is a measure of weight relative to a person's height. Clinically, obesity is defined as having a BMI over 30, while overweight is when the BMI is between 25 and 30. A BMI between 18 and 25 is traditionally considered "healthy."¹

But, where does this definition of a healthy BMI come from? And should it apply to everyone? Having a BMI between 18 and 25 is associated with the best health in scientific studies, which is why many healthcare professionals refer to it as a target weight. However, it is important to think critically about this. Is expecting someone with obesity to maintain a BMI below 25 a realistic goal? Is it a reasonable or necessary expectatio for long-term success?

The reality of managing a chronic condition

Consider another chronic condition that does not have the societal stigma that obesity does, for example, arthritis. If someone has arthritis, what are the goals of their treatment?

Arthritis drugs and other therapies can reduce pain and stiffness. But there may still be days or weeks when symptoms flare up, despite best efforts to medically manage the condition. Something about the weather may set it off, or certain exercises. In this case, the goals of treatment include reducing pain, minimizing joint damage, and improving or maintaining quality of life. Importantly, the primary objectives of arthritis treatment are not to "cure" the disease, but to manage it effectively.

Moving away from the misconception that obesity is a choice

We tend to think about obesity differently. Most of us have been taught—incorrectly—that obesity is a choice, and that someone could choose to reverse it and achieve a BMI less than 25 at any time. We now know that is not true; obesity is a complex, chronic health condition.

From this perspective, then, what are meaningful obesity treatment goals? Do they necessarily include having a BMI less than 25? In my experience, the reality of clinical success looks quite different from that. And an ideal BMI, and being "thin," have very little to do with actual wellness. This understanding is a crucial part of advocacy for better, more compassionate care.

Why clinicians focus on weight loss as a percentage

Rather than a strict BMI goal, medical obesity treatment in my field is often measured by the change in weight as a percentage. As an example, if you start at 200 pounds and lose 20 pounds, that would mean you lost 10 percent of your body weight.

Studies about lifestyle treatment strategies prove that they consistently produce 5-10 percent weight loss. This is enough to significantly reduce the risk of many health conditions caused by obesity. It reduces blood pressure, diabetes risk, and triglycerides. It also improves joint pain, cholesterol, and improves overall quality of life.^3,4

Other more intensive interventions medical treatments include weight loss medications and bariatric surgery. Those options can produce closer to 15-20 percent weight loss. This degree of weight reduction can have an even bigger impact on overall health.⁴

Shifting your mindset toward holistic wellness

The improvements in health and quality of life from these obesity treatments are meaningful. Health improvements happen even with modest weight loss. And contrary to what most people think, you do not have to achieve an "ideal" BMI for significant health improvements to happen.

Many effective obesity treatments may not lead to a BMI that is in the so-called "healthy weight" range. For example, consider someone with a weight of 230 pounds, a height of 5 feet 5 inches, and a BMI of 38. If this person loses 20 percent of their weight, that is an excellent outcome. But, they still have a BMI of 31 by the end of treatment.

I usually suggest that people shift their mindset about their personal obesity treatment goals. Instead of chasing an "ideal weight" goal, be open-minded. Aim for a weight where you feel healthier and more comfortable. Sometimes, 5-10 percent weight loss is enough to get people to a much better place, and other times, more is needed. But the important thing to remember is that you can achieve a lot by having a health-focused mindset, whereas a weight-focused mindset may not be practical or necessary.