What is the goal of weight loss? Among weight loss Physicians, the goal of reducing excess weight is to improve the complications created by excess weight. We know that just a modest amount of weight loss will lead to significant health improvements. Normalizing body weight to a “normal” BMI is not required.
While our current diet culture promotes an ideal body size, many variations in body size are also considered healthy. When there is interval development of complications from Obesity, varying amounts of weight loss will also produce varying amounts of improvement depending on the complication.
Ultimately, when we prescribe weight loss, we are trying to reduce both the mechanical weight burden of fat and the excess visceral fat “metabolic syndrome fat” that is driving disease. The good news is that as soon as we start losing weight, the excess visceral fat is the first to go.
Did you know that losing weight causes a disproportional reduction in visceral fat? Whenever we lose 5% of our body weight, visceral fat is reduced by 9%. When we achieve 16% body weight loss, visceral fat is reduced by 30%. Has anyone told you that you have underlying fatty liver? Well, with 16% body weight loss, 65% of liver fat is cleared. Whoa.
Let’s look at diabetes. Among patients with impaired glucose tolerance (risk for future diabetes), 10% body weight loss can eliminate the progression to Type 2 Diabetes all together. Among patients with Type 2 Diabetes, 15% body weight loss can produce diabetes remission without the need for medications.
When it comes to cardiovascular risk factors, it takes just 5% body weight loss to see improvements in cholesterol as well as blood pressure. Bringing down inflammatory markers such as C-reactive protein does require weight loss of 10 to 15% body weight.
Among patients with obstructive sleep apnea, 10% body weight loss will lead to a reduction in the number of times someone has low oxygen overnight.
Among patients with knee osteoarthritis, did you know that each pound of weight lost can result in a four-fold reduction in the load of weight exerted on the knee with each step?
Is all this talk about precents making things confusing to evaluate your health goals? It shouldn’t, but we need to reframe what is realistic and unrealistic in terms of weight loss goals.
Diet culture has us duped believing that what’s important is the number of pounds we can lose in a week or a month. For example, “lose 2 pounds each week”, or “lose 30 lbs in 6 months”. Depending on someone starting weight, genetics, and biological factors, this can either be realistic or very unrealistic.
Rather, it’s best to think in percent body weight loss and set goals that are achievable at 3, 6 and 12 months. A good goal for example is 5% body weight loss at 3 months. At six months, 10% body weight loss is realistic gaol. At 12 months, 15% body weight loss is realistic. For someone who weighs 200 lb, this looks like 10 lb at 3 months, 20 lb at 6 months and 30 lb at 12 months.