Shifting Your Perspective on Obesity Treatment Goals

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

Many people think about a healthy weight measured by body mass index (BMI). Body mass index is a measure of weight for a given height. Obesity is having a BMI over 30, and overweight is when your BMI is between 25 and 30. A BMI between 18 and 25 is 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. That is why many healthcare professionals refer to it as a healthy weight goal to achieve. However, it is important to think that through. Is expecting someone with obesity to keep a BMI below 25 a good goal? Is it a reasonable or necessary expectation?

The reality of obesity treatment

Consider another chronic condition that does not have the stigma that obesity does, for example, arthritis. If someone has arthritis, what are the goals of arthritis 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 it. Something about the weather may set it off, or certain exercises. So, the goals of treatment include reducing pain, minimizing joint damage, and improving or maintaining quality of life. Importantly, the goals of arthritis treatment are not to cure arthritis, but to manage it.

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 obesity and have a BMI less than 25 at any time. We now know that is not true, and obesity is a chronic health condition.

From this perspective then, what are good treatment goals for someone with obesity? Do they include having a BMI less than 25? In my experience, the reality of obesity treatment looks quite different from that. And an ideal BMI, and being "thin," have very little to do with it.

Focusing on weight loss as a percentage

Rather than a BMI goal, obesity treatment in my field is 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 of obesity prove that they produce 5-10 percent weight loss. This is enough weight loss to 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 quality of life.^3,4

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

Shifting your mindset about treatment goals

The improvements in health and quality of life from 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 health improvements to happen.

Many obesity treatments may not lead to a BMI that is in the "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 treatment goals. Instead of 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 and gets people to a much better place, and other times, more is needed. But the important thing to remember is you can achieve a lot by having a health-focused mindset, and a weight-focused mindset may not be practical or necessary.