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.“
Living ~400lbs 
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