by Barbara Berkeley, MD
Those who set out to lose weight view the process as a project and want a goal. Thus, it is rare that a new patient does not conclude our first visit by asking: "What should I weigh?"
Unfortunately (or perhaps fortunately) there is no simple answer to this question. You are a work in progress with no specific ending point. How does an artist know when a painting is done? The understanding of when to put the brush down is intuitive and is based on an internal sense of completeness. It is not determined by a pre-conceived number of brush strokes.
As my previous post discussed, charts that dictate perfect weights (BMI charts) are tyrannical and, to a large degree, useless. In my view, they are the first thing to ignore when thinking about goal weight. You do not have to fit into someone else's range of weights in order to vastly improve--or even maximize-- your health. You do not have to be "normal" weight to be normal. You don't have to be ultra skinny to look really great or be supremely successful. In fact, in a world where over 60% of us are overweight, those "normal" weights are the distinct outlier. Since most overweight and obese people can't achieve weights in this "normal" BMI range, why do we doctors continue to insist on it? Let's look at some goals that make sense and wind up making just about everyone happy.
Here is the way I advise patients on goal setting:
1. If you are 30 pounds overweight or more, consider a goal of 15% weight loss. This means that a 280 pound person should shoot for a loss of 44 pounds or greater. For larger people, 20% weight loss, if you can achieve it, is superb.
2. If you are less than 30 pounds overweight, consider a goal that puts you at about 10 pounds over your lowest adult weight. Lowest adult weight would be the lowest stable weight that you maintained for a period of time after the age of 30. Weights that people maintained in their twenties (especially very low weights) are often too low or unachievable for most dieters. There also may be no particular benefit to getting to these low weights.
3. If you have weight-related medical problems such as diabetes, cholesterol or high blood pressure, consider your weight loss successful when your medical issues have improved significantly. This might mean a decrease or discontinuation of medication or simply better blood test values. Your main focus with weight loss should always be to optimize health. Fitting into jeans comes second.
4. Consider using clothing size rather than scale numbers to set goals. If you are happy in a size 12 and you've gotten there, don't worry about what the scale says.
5. Always balance weight loss with the ability to maintain. Remember that weight loss occurs through starvation and is utterly meaningless in and of itself. It is only maintenance that counts. Accept a higher weight as your goal if that weight allows you to avoid regaining. Most goal weights that uber- dieters set and achieve feel good for a week but are impossible to hold onto for a year. True and heroic success goes not to those who become a size 4, but to those who maintain significant pounds of loss over years. In my experience, most of these people wind up falling into the overweight or even mildly obese categories on the BMI chart. But they are maintaining large, significant weight losses, look great, and are healthy.
6. Don't fall prey to what you read in magazines and see on TV. Our conception of weight loss is skewed, unrealistic and idiotic. Do this reality test: how many people do you know personally who have lost weight, become "normal weight" and remain there 2 years later? By the same token, how many public figures do you know---people who have incredible resources and are under intense scrutiny---who have done the same? Oprah? Kirstie Alley? Mike Huckabee? Chris Christie? Don't set yourself up for failure. Instead, prepare yourself for true success. Get leaner, get healthier, and figure out--intuitively and reasonably--- when your self-portrait is done.
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