Setting Goals

Discussing expectations for weight loss is important as the process begins. If a target goal is too difficult, the patient may quit in frustration. Studies show that a 5% to 10% body weight reduction is achievable through lifestyle approaches, and that this amount of weight loss will benefit health. If this goal is achieved and weight is still above the desired weight, a lower target can be set. Randomized trials demonstrate that weekly weight loss of 1 to 2 lb can be achieved with a daily calorie deficit of 500 to 1000 kcal (because 1 lb of fat contains 3500 kcal). Setting a target weight may not always be the most effective approach. For some patients, a process-oriented target (lifestyle) rather than an outcome-oriented target (weight) is more effective in the long run in terms of improving health. People who have made lifestyle changes by reducing caloric and saturated-fat intake and improving cardiovascular fitness have improved their health by reducing the risk of obesity-related complications, even if they have not reached a specific weight goal. Using the process-oriented target approach may be less frustrating to some patients, allowing them to sustain their lifestyle changes more effectively, which will have greater impact on their health.

Process and other goals should be specific, measurable, achievable, realistic, and trackable (SMART). For example, instead of setting a goal of just exercising more, a starting SMART goal is exercising by walking 20 minutes 3 days per week. Progress is logged and the goal gradually and regularly increased as fitness improves. A SMART dietary goal would be to eat 1 more piece of fruit and 1 more serving of vegetables daily, monitoring progress through diet records.

Patients should be counseled about the need to maintain indefinitely the lifestyle changes found to be effective. Because the specific type of lifestyle change may vary among patients, individual management is necessary. The NHLBI (2000) recommends that the initial goal of weight loss therapy should be 10% of baseline weight.

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