The biggest hurdle I face with new patients is to convince them to change their level of activity. Undoubtedly, getting people to acknowledge that, at the heart of their healthier lifestyle, is a regular program of physical activity is #1 on the problem list. Number two, and nearly as difficult, is setting realistic goals.
Many people who want to lose weight approach the process of weight loss as "an end unto itself." They want, as a goal unto itself, to merely lose weight. As I tell my patients, weight loss is not the goal. The goal is to live a healthier lifestyle. This new set of habits that will make up this lifestyle will lead to many health benefits. One of them may very well be loss of excess body fat. But that is but one possible benefit of adopting new, healthier habits. Others include, but are not limited to:
While our society focuses, sadly, on losing weight, I ask: are not each of these benefits not of equal importance? I sure think so.
Unfortunately, I can't recall anyone coming in to my clinic and saying "Doc, I want to live a healthier lifestyle so I can have more energy to accomplish more at work and play with my kids." Or, "Doc, can you you help me adopt a new eating and exercise plan that will give me more energy and live life to its fullest?" The public, by and large, are fixated on losing weight and, even more alarmingly, "being skinnier." Weight loss, in and of itself, is not a health goals; it is a cosmetic changes - like getting a nose job or a facelift.
Convincing people of this simple truth is difficult. People want to lose weight to lose weight for the summer, for a wedding, for a class reunion, to find a companion or, more distressingly, to keep a companion or spouse. These are not goals, they are deceptions. Deceptions for the individual's psyche and for those they are losing weight to deceive. None of these "reasons" are to improve one's health and that is what the one and only goal should be.
We are a society that expects immediate gratification. We want it - whatever "it" is - now. Better still, we want "it" yesterday. Fedex® and overnight delivery, drive through banking and fast food, one-hour photo development and digital cameras, lottery tickets and casinos are all growing testaments to our needs for instant reward. The same is true for the expectations for our health. We want "30 pounds in 30 days" weight loss. Whatever the diet, sacrifices, inconveniences, or cost. Why do abdominal crunches or workout on a stairmaster for 3 months when you can get liposuction?
A prime example of this is the deplorable and distressing reality show "Celebrity Fit Club." Whereas the show superficially professes to encourage "celebrity" participants to adopt a healthier lifestyle, the focus on the show is the individual weigh-in and the team weight loss measured on "the big scale." Despite all the talk about lifestyle and healthier habits, the big "hook" for the show is weight. I hear glimmers of reason from one of the "coaches," the reputable David Katz, M.D., but the others giving advice, apparently a hypnotherapist and a former drill instructor, are pretty predictable in their contributions. The show is simply perpetuating the illusion that weight loss is the measure of success for changing one's lifestyle. And it is a fool's gold.
When you come to the ABC, we are not going to talk about living a healthier lifestyle. We are going to talk about what nutritious eating is and what you can do to get the amount of activity you need to improve your endurance, energy, and stamina. We will focus on improving your body composition - increasing your lean body tissue (muscle) and decreasing your body fat. If necessary, we will discuss organizing your life so that you can find time for exercise and food preparation.
Yes, we will talk about setting goals. If you do want to lose weight. we will help you set a reasonable time table and weight loss pattern. But this will be only after we have established that everything begins with lifestyle for a lifetime. I think I should copyright that phrase. A lifestyle for a lifetime of health, energy and stamina, mental alertness and focus, and longevity. And, along the path, quite probably, a more fit body with a reasonable body fat content.
If you improve your eating habits and food choices and become more physically active, all these healthy goals are possible. Losing weight from 250 pounds to your prom night size 6 dress is not reasonable or healthy. Losing 45 pounds in 3 months so you can look like unchanged for your high school classmates is not a goal, it is a recipe for failure. Saving your marriage by weighing the same 175 pounds you weighed when you married your wife will not work - and, trust me, that is not necessarily a bad thing. Losing weight so you can impress your boss and get promoted at work is foolish and a waste of your effort. Finding a boyfriend or a girlfriend by losing weight is not a sign of healthy self-esteem.
After establishing the lifestyle changes that we want as your game plan, I will be happy to discuss your weight loss expectations.What I want to accept are reasonable, healthy step-wise changes in body composition. An initial expectation would be to lose 10 percent of your current body weight. If you weigh 250 pounds, you should reasonably expect to lose 25 pounds with improved dietary habits and increased activity.
You should lose weight no faster than 1-2 pounds per week. Physiologically, the body can only burn around 1000 calories of body tissue per day. That tissue, if you are more active and doing resistance to preserve your lean tissue muscle (i.e. muscle), will be 90% fat tissue. Therefore, creation of a 1000 calorie daily energy deficit - achieved with a significant (50-75%) fraction of this deficit created by exercise and increased activity, will bring a weekly deficit of 7000 calories. Now, one pound of fat tissue contains 3500 calories of energy. It follows that a healthy, exercising body that faces a 7000 calorie energy deficit will extract this energy from consumption and conversion to energy of 2 pounds of fat tissue. In healthy weight loss, 2 pounds of tissue loss per week should be the maximum goal. If you lose more than 2 pounds of actual body mass per week, you will start loosing muscle mass. And muscle tissue loss has extremely adverse effects on your body and your chances of weight maintenance. Every pound of lean tissue lost leads to a reduction in your resting metabolic rate (RMR) and makes weigh regain more and more difficult.
The bottom line is by setting realistic weight loss goals - specifically, 1-2 pounds per week - you will not only be more likely to achieve these goals but you set yourself up for long-term success and weight maintenance. If you have 100 pounds of excess body fat to loose, you will need a minimum of 50 weeks, almost a year, to achieve your goal. Unrealistic expectations at the start of your healthier lifestyle changes will not only bring inevitable disappointment,(1,2) they will cause you to fall into weight cycling - weight loss then regain. Do not be in a hurry. The lifestyle changes - including healthier eating and more activity - are not part of a 3 month or 6 month change. They are, as they should be, changes you will follow for the rest of your life. Going into the modifications of your habits of a "lifestyle for a lifetime," remember: every ounce counts. Every pound is a victory and, with persistence and the right dedication, you can achieve your healthy goals.
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Albright Bariatric Clinic