Weight Loss Expectations: NIH vs Popular Thought

What expectations do people have when they start a weight loss program?  The Fantasy of Being Thin is very common, and usually isn’t about being less fat.  It’s about being THIN.

So this blurb from The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, from the US National Institutes of Health (NIH) guidelines on “obesity treatment” actually came as a bit of sanity to me:

“How much weight does the patient expect to lose? What other benefits does he or she anticipate?” Obese individuals typically want to lose 2 to 3 times the 8 to 15 percent often observed and are disappointed when they do not.  (p32)*

First, note that offhand reference to “the 8 to 15 percent [weight loss] often observed”.   That sounds like the authors have reviewed weight loss research and consider 8-15% pretty common.**

Second, this is also in line with the recommended initial weight-loss goal of 10% of “baseline weight”.  (p29)   For someone who weighs 250lbs, that’s 25lbs.  For me, it’s 40lbs.  The NIH recommended weight loss goal is NOT to diet into the “normal weight” range or “overweight” range.   Let’s highlight that, shall we?

NIH recommended weight loss goal: 10% of “baseline” weight.

This is a revelation to me.

I’ve lost 10% of my baseline weight many, many times in my life.  I’ve never had a parent, teacher, or medical professional congratulate me for it.   The closest I ever got was being told to “keep it up”.   Because 10% is not enough. Because I was still fat.  If losing 10% of your current weight would get you into the “normal weight” range, you’re not very fat.  (Of course, most people who are fat aren’t very fat.)

Let me set this off, too, because it’s important: If losing 10% of your current weight would get you into the “normal weight” range, you’re not  in the “obese weight”range.  You might already be in the “normal” range, or possibly the “overweight” range. 

News flash: The WW and Jenny Craig ads and TV shows extolling how someone went from 330lbs to “normal weight” and imply that anyone else can do the same?  The parents / doctors / nurses / trainers / therapists / weight loss counselors who casually tell people to  “drop the weight”?   Are not in line with NIH guidelines for the treatment of obesity.

The Practical Guide also includes this gem:

After a patient has achieved the targeted weight loss, the combined modalities of therapy (dietary therapy, physical activity, and behavior therapy) must be continued indefinitely; otherwise, excess weight will likely be regained. (p34)

Hear that?  It’s not “transition to a maintenance diet”.  It’s “continue indefinitely”.  Of course even that doesn’t usually work long-term, but at least they’re not pretending that you can end your diet. Unlike some doctors/teachers/parents/gym employees I could name….

I also noted that their section on “physical activity” has no suggestions for when the patient is already exercising the recommended amount — because apparently that’s impossible.

Oh, and the The Practical Guide actually doesn’t recommend weight loss for those in the “overweight” category unless one has an “obesity-related illness” (p35). (Oddly enough, many obese people don’t have “obesity-related” illnesses either.  But I digress….)

*For convenience, I’m using PDF page numbers, which can be entered into the PDF viewer to go directly to the page in question.  These do not map to the printed page numbering.

**As noted elsewhere: “Reviews of the scientific literature on dieting (e.g., Garner & Wooley, 1991; Jeffery et al., 2000; Perri&Fuller, 1995) generally draw two conclusions about diets.  First, diets do lead to short-term weight loss.  One summary of diet studies from the 1970s to the mid-1990s found that these weight loss programs consistently resulted in participants losing an average of 5%–10% of their weight (Perri&Fuller,1995).  Second, these losses are not maintained.”

Additional: Searching for “reasonable expectations of weight loss NIH” brings up lots of interesting results, such as “What is a reasonable weight loss? Patients’ expectations and evaluations of obesity treatment outcomes.







42 responses to “Weight Loss Expectations: NIH vs Popular Thought”

  1. Dominique Avatar

    SMASHING!! A marvelous post, which I will give to the next physician bugging me to lose weight!!

    1. Living 400lbs Avatar

      I think it’s most valuable as a way to set real expectations.

  2. vesta44 Avatar

    Too bad I’ve already told my doctor that my weight is off limits for discussion unless I tell her there’s been a big change in it up or down (I also refuse to be weighed every time I’m in there, I let them weigh me maybe once a year, just so I know where I’m at and so they have a record that I’m maintaining the same weight consistently). Otherwise I’d print that out and take it in to her,

    1. living400lbs Avatar

      The NIH does recommend weight loss for everyone who’s officially “obese”, and that if diet/exercise/etc fails then weight loss surgery should be considered. They are NOT advocating fat acceptance or HAES. But I was struck by how different their recommendations are from what I’ve experienced with medical professionals in the past (before I, too, decided to make it clear I’m not considering intentional weight loss). :)

  3. Regina T Avatar
    Regina T

    “After a patient has achieved the targeted weight loss, the combined modalities of therapy (dietary therapy, physical activity, and behavior therapy) must be continued indefinitely; otherwise, excess weight will likely be regained.”

    This is the part that everyone doesn’t really let sink in…including myself. The phrase “lifestyle change” doesn’t even come close to explaining just exactly what this entails. I once heard Dr. Nancy Snyderman (whom I loathe because of how smug she comes off on TV) state, when talking about the recommended exercise guidelines that had been changed recently on the Today show, that people with a whole lot of weight to lose should in fact exercise 3 to 4 times MORE than those of a healthy weight. This amounts to 2 hrs. 15 mins-3 hrs. of exercise 5 days a week. She didn’t state that amount, but anyone can do the math since they were saying everyone needs to exercise at least 45 mins a day 5 times a week.

    Now, pair that with the above statement depicting the recommended therapies/activities adopted during active weight loss attempts, and it equals a full time job! Nevermind your REAL job, or caring for a family, or running a household, commuting, or any volunteering you do. And don’t even THINK about vacations, reading a book, playing board games, or maintaining your personal relationships (i.e. sitting down to talk over a cup of coffee with a friend or loved one). Sleep is for the lazy, dontcha know??!!

    In the medical establishment’s mind, a full and healthy life ONLY includes maintaining a healthy BMI. This is the saddest part of the entire thing. They don’t care if you are starving yourself, vomiting, neglecting sleep, having your guts rearranged and your stomach size reduced, alienating your family and friends, abusing laxatives, becoming irritable or depressed. They only care that your weight falls within the recommended guidelines. They fail to fully comprehend just what it takes to reach that BMI goal, yet expect…and even get irritated with, their patients for not achieving that goal.

    Even when you bring in your food and exercise diaries, take the medications they prescribed, or even achieved a 10% weight loss……for a super fatty like myself, it’s never good enough. Nevermind that there is more and more research concluding that obese people don’t have any more health problems than non-obese individuals. This flies in the face of the insurance companies saying that fat people cost the healthcare system more money than thin people. Could it be, that with all the hype about BMI that doctors are ASSuming we just HAVE to be sick because we’re so fat and order more tests and prescribe more pills? Nah…..it’s still our fault! They won’t be happy until everyone molds themselves into a body that conforms to their standard.

    It’s beyond ridiculous.

    1. Meowser Avatar

      No kidding, Regina T. Three hours a day of exercise, slamming it at your target heart rate the entire time, every single day without letup, no matter how tired, sick, wracked with pain, busy, or stressed out you are? And eating almost nothing at the same time, day in and day out? That’s not a “lifestyle change,” that’s house arrest.

      The sad part is, I could do all that and I’d probably still be fat. A little less fat, maybe, but that’s not worth life imprisonment. And any doctor who told me otherwise would be summarily shitcanned.

      1. Living 400lbs Avatar

        Yet most doctors wouldn’t believe that a fat person would NEED to eat that little. Fat people just need to stop overeating so they’ll be normal sized!


  4. CTJen Avatar

    “After a patient has achieved the targeted weight loss, the combined modalities of therapy (dietary therapy, physical activity, and behavior therapy) must be continued indefinitely; otherwise, excess weight will likely be regained.”

    Such a telling sentence. I left WW because “maintenance” for me would have been 2 hours of aerobic exercise *daily* and 900 calories (for the *whole* day).

    No. Just, no.

    1. Living 400lbs Avatar

      Maybe I’m not cool, but when I do 2 hours of aerobics it’s for fun. Like, dancing. ;)

  5. Lillian Avatar

    My current weight is on the border of overweight and obesity on the BMI. Anyway, if I was to lose 10 percent of my weight about 16 pounds. I would still be overweight, not normal weight and the recommendation is for people that are overweight not to lose weight. So the best anyone can hope for if they follow these recommendations is to be in the middle of the overweight range if they started out at the cut off for overweight/obese.

    I’m not currently deliberately trying to lose weight so I’m not going to try to lose those 16 pounds. Still, 16 even at my small size, it would hardly show. I would feel it in the way my clothes fit, but no one would notice that I lost weight. When I actively dieted it took a weight loss of 25 pounds or more for someone to notice my effort.

    By the way, as in most ‘in betweens” I wear a normal department store size, I’m a tiny size 8. I find it so amusing that I can be quote obese and wear a size 8. Even if a size 8 is what was a size 12 years ago, it still isn’t by any stretch of the imagination big.

  6. sleepydumpling Avatar

    Oh I’m bookmarking this puppy!

    Excellent post!

    1. Living 400lbs Avatar

      Thank you!

      It’s just … the disconnect is so huge.

  7. LexieDi Avatar

    Amazing! My heart right now is like “LOVE!” for you.

  8. Lillian Avatar

    I made that post to show what the obesity epidemic looks like. They look me. Tiny. No one would look at me standard size clothes and think fat. I don’t look model thin, but most people would look at me and think I was on the thin side of average. Men look at me and not in disgust when I wear skimpy clothes. I’m the woman that men enjoy watching her eat. People don’t see me when they think fat. Yet, the majority of ‘fat’ people look more like me than they look like Living 400 lbs.

    There are many women that are 5’2″ and a hundred and sixty-five pounds. I just wanted to talk about the disconnect. The typical curvy healthy looking woman is the real face of the obesity epidemic. There are far more women that look like me out there. Okay, most women whose weight sit on the overweight/obese line are taller, but they are still the type of women that most men would find attractive and no one would think of telling her not to eat that ice cream cone or call her a disgusting pig.

    1. Living 400lbs Avatar

      Oh, I know. That’s why I linked this post to my statement that “most fat people aren’t very fat”, because it shows a typical American BMI distribution – roughly a bell-shaped curve with MOST people in the “overweight” category.

      This chart, http://seattletimes.nwsource.com/news/health/suddenlysick/sickdefinitions26.html, is also useful in showing how changing the “overweight” definition in 98 made 30.5 million MORE people overweight overnight.

  9. Patsy Nevins Avatar
    Patsy Nevins

    BTW, Lillian, there are plenty of men who give second & third looks at & feel desire & love for those of us who DO look ‘fat’ to the naked eye. I am a mid-size woman in my 60’s, after being an in-betweenie most of life, &, after having people tell me all my life that I was “NOT fat”, I am undeniably fat. And most who post here are my size or much larger, so we do face the judgment, ridicule, & discrimination (that I personally only have gotten flak from relatives over the years about my size, strangers reserve most of THEIR abuse for my disability), & most of us have no trouble finding lovers, mates, etc., either. I do understand that you mean that you look like the kind of woman who is considered attractive & acceptably thin by the establishment.

    As for exercise, the last I heard, it was considered that 20-30 minutes of activity daily or at least 150 minutes per week was considered ample for any real ‘health’
    benefits of exercise, not to mention the fact that I know & have known reasonably healthy & often very long-lived people of various sizes, including fat, who do not exercise at all. I am a lifelong exerciser, have probably walked at least 60,000 miles in my life, & I have also had four different periods in my life of 3-4 years when I exercised compulsively, about 4 hours daily EVERY day. The last period started over ten years ago & lasted about four years & the part of doing 1500 crunches every day I kept up for about 7 years, until I had to admit that, with my cerebral palsy & arthritis & general mobility issues, it is just too hard to get down on the floor every day. I now exercise between 45 minutes & 90 minutes daily, walking at least once daily & sometimes twice. In those four years of working out FOUR HOURS every day, I lost a TOTAL of 18 pounds. Since cutting back to regular exercise for me, more than ample exercise by any sane standards, & since also finishing menopause & aging, of course, I have regained about 40 pounds & become the heaviest I have been in my life.

    But they recommend living as I have at my most compulsive forever, eating almost nothing, suffering nutritional deficiences, in order to reach weights that THEY deem acceptable, despite overwhelming evidence that dieting is not only counterproductive but damaging to health, enough so that by the time you reach my age, losing weight increases your mortality risks by several hundred percent. They push this shit despite knowing that virtually NO ONE can maintain the weight loss, no matter how much exercise & food restriction is practiced. They push this even though more or more genuine, as opposed to junk science, shows that being fat is NOT a health risk, that almost ALL the so-called ‘increased risks’ come from the emotional/psychological stresses of being abused, discriminated against, barred from full access in society, & from the physical/emotional/psychological stress of dieting/WLS/excessive exercise itself, & further evidence that being heavier is not only not an increased risk factor, but is actually protective to most of us, that some slight weight gain with aging is normal & protective for most people, & whatever TINY ‘risks of obesity’ MAY exist at all virtually disappear as we age.

    No way in HELL is any of this about concern for our health. It is about appearances, about prejudice, about conforming, & about the desire of the ‘nannies’ to control everyone’s life down to the tiniest detail, & it is about society needing a scapegoat, & about the vultures needing a market for all the useless crap they have to sell. They know very well that body size/weight is at least 80% genetic & that dieting does NOT work, so, if they can keep us believing the lies & hating ourselves & our bodies, they have a reliable customer base. We all need to smarten up, develop self-esteem, & stand up for our rights to own our bodies & live in them as we please, & put these jerks ot of business.

  10. Lillian Avatar

    I might not currently be what most people call fat. First, there are many that call someone my size fat. I was called that from a person yelling from a car, not long ago. When I was thinner in my youth, I was tortured by family members, strangers, fellow students into believing my slightly overweight body was disgusting; I was normal weight by BMI at the time. I decided that dieting was useless and I was to live my life fat and disgusting.

    I always exercised because I enjoyed it, not because I thought it would help me lose weight since weight lose was always temporary.

    I didn’t start wearing skimpy clothes until after I was over thirty. I figured that I needed to live for the day. I learned that I was attractive. Workmen looked at me when I was in my bikini sunbathing while watching my babies. I realize that men find women of all sizes attractive: slender, in-betweens like myself, and visibly fat women. It’s great that they do because we all need love and companionship.

    A lot of in-betweens like myself think that they are too fat to be loved. I’m glad that I saw beyond that. I hope that sites like this can help all fat women- ones like myself that are only called fat by so-called friends and family and the ones that are larger.

  11. longweight Avatar

    Honestly, if I lose 31 pounds from 310 pounds, it may be right according to some guideline but it won’t be worth the trouble. 310 pounds and 279 pounds are not much different. The idea is too feel good about yourself and for that one needs to come down a lot more…

    1. Living 400lbs Avatar

      This is a big part of why I don’t diet anymore. I did Atkins some years back, lost a little over 30lbs, and then started regaining while still on the diet. I didn’t abandon the diet until I’d regained half the weight I’d lost, and yeah, I don’t consider 15lbs all that worth it!

      The government guidelines I was quoting suggested that medical practitioners should try to get dieters to focus on things like blood pressure and cholesterol and blood sugars so that THOSE will (hopefully) improve even if the weight loss isn’t as much as what the dieter would really want. Meanwhile, I’m a bit frustrated that they don’t point out those things can improve with exercise alone.

      (If you haven’t read much of the blog, I am very jaded on diets, am not afraid of research on how diets don’t work, but do exercise regularly.)

  12. […] I also note they did find one group where weight loss reduced risk of cardiovascular disease:  obese men who lost between 5% and 15% of their max weight.  I also note that reducing risk of cardiovascular disease can be done by increasing exercise and other such changes, without focusing on weight loss. *Posted about here. […]

  13. Aggie Avatar

    Great post and comments. Thanks to the person who gave the link to the “suddenly sick” chart. I am amazed at the number of people who are taking multiple medications for this, that, or the other condition just to achieve “normal” numbers. http://abcnews.go.com/Health/Story?id=3232247&page=1

    I also recommend Dr. Hadler’s books, Worried Sick and The Last Well Person.

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  15. […] Belt Extenders: Not just for airplanesFat Birth Control Jeans and big bellies"But you're thin!"Weight Loss ExpectationsWhy This Blog is Anonymous, or On Not Coming […]

  16. […] that the National Institutes of Health states that a “8-15% weight loss is often observed” from dieting.  So losing an average of 8.9% doesn’t seem all that to me. It is enough […]

  17. […] written before that the US National Institutes of Health (NIH) guidelines for treating obesity recommends a 10% weight loss ….  Not to diet down to “normal weight”, or even to just “overweight”.   […]

  18. […] if Gov Christie attempted weight loss, he would not necessarily have immediate or noticeable results, so guess what?  Other people might not notice … and again, it’s not any of their […]

  19. […] not trying to manipulate my weight up or […]

  20. […] not trying to manipulate my weight up or […]

  21. […] you are considering weight loss I suggest you check out the recommendations from the NIH discussed here. Share this:TwitterFacebookRedditLike this:LikeOne blogger likes this […]

  22. […] the American NIH, which is not exactly a fat-accepting organization, notes that weight loss is often limited: “How much weight does the patient expect to lose? What other benefits does he or she […]

  23. […] there is persistent societal pressure to change body weight. Still, body weight is not easy to change and changes are often not long-lasting.  Fatness, like height, can be a measure of overall […]

  24. […] not trying to manipulate my weight up or […]

  25. […] I do not think those risks make weight loss any easier or any more likely to last.  There’s no proof that maintaining weight loss improves health […]

  26. […] the “must hold out hope of weight loss!” bias.  Especially when the article notes that losing 10% of their weight is typical, and very few lose […]

  27. […] not trying to manipulate my weight up or […]

  28. […] Contrary to popular belief, weight loss usually results in being less fat, not thinness. […]

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    […] Contrary to popular belief, weight loss usually results in being less fat, not thinness. […]

  30. […] can and should reach normal weight according to BMI, however, the CDC does not consider this a reasonable expectation in their guide for physicians.” — Criticism of the work. […]

  31. […] of “successful weight loss” for diet drugs needs to be better known.  Like the NIH expectations of weight loss, the FDA’s expectations are for a much more modest weight loss than is commonly expected or […]

  32. […] I disagree with the guidelines insisting that everyone “overweight” (BMI < 25) should lose weight – especially considering “overweight” has a lower mortality risk than “normal weight” and the NIH doesn’t recommend weight loss for people with a BMI under 30 unless there’s comorbid…. […]

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