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How Can I Support My Clients in Setting Realistic Weight Loss Goals?

Published:December 14, 2013DOI:https://doi.org/10.1016/j.jand.2013.11.006
      January 1st is the perennial start date for many clients/patients to resolve to improve their diets, most notably, in order to lose weight. Unrealistic and overly aggressive weight-loss goals may undermine the efforts of the success of weight-loss attempts, according to a 2009 study published in the Journal.
      • Wamsteker E.W.
      • Geenen R.
      • Zelissen P.M.
      • van Furth E.F.
      • Iestra J.
      Unrealistic weight-loss goals among obese patients are associated with age and causal attributions.
      This Dutch study investigated the frequency of unrealistic personal goals at the start of a dietary treatment and the association with other patient characteristics at the start of a weight-loss program. An unrealistic goal was arbitrarily defined as exceeding the medically advised goals by more than 50%. Unrealistic goals were observed in 49% of the patients. Significantly more younger patients than older patients had unrealistic personal weight loss goals. The frequency of unrealistic goals did not vary by body mass index subgroups or by sex in this study. A realistic initial weight loss goal according to the 1998 National Institutes of Health Guidelines is to reduce body weight by approximately 10% from baseline for the first 6 months of treatment.

      National Institutes of Health/National Heart Lung and Blood Institute. Clinical Guidelines on the identification, evaluation and treatment of overweight and obesity in adults: The Evidence Report. http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf. Accessed October 25, 2013.

      Goal setting was one of the strategies the Nutrition Counseling Evidence Analysis Team included in a systematic review of peer-reviewed literature related to behavior change theories and strategies used in nutrition counseling. Good evidence supports the use of goal setting as a strategy, but additional research is needed to assess effectiveness in a broader range of populations over a broader range of nutrition goals.
      • Spahn J.M.
      • Reeves R.S.
      • Keim K.S.
      • et al.
      State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.
      Every client has his or her own weight gain story to tell. Careful listening and the use of effective open-ended questions facilitates client participation and can assist in moving clients toward the behavior changes needed to successfully implement an individualized reduced-calorie diet, the basis of the dietary component of weight loss interventions.
      • Abusabha R.
      Interviewing clients and patients: Improving the skill of asking open-ended questions.
      A model for setting very specific goals self-determined by the patient is the WHAT System recommended by the authors of the Academy publication, Inspiring and Supporting Behavior Change: A Food and Nutrition Professional's Counseling Guide.
      • Constance A.
      • Sauter C.
      Inspiring and Supporting Behavior Change: A Food and Nutrition Professional's Counseling Guide.
      • W stands for what the patient will do, when he or she will do it, and where he or she will do it.
      • H is for how much or how many, and how often.
      • A stands for achievable (and believable).
      • T represents the time frame for accomplishing the goal.
      Behavior change is a process that, for the most part, is measured through self-monitoring. SuperTracker, the US Department of Agriculture’s online diet and activity tool, available at www.SuperTracker.usda.gov, is a free resource that assists clients in tracking diet (Food Tracker) and physical activity (Physical Activity Tracker). In addition, the My Weight Manager feature is a visual reminder of personal weight management goals and progress. The My Top 5 Goals feature allows consumers to choose and track up to five personal goals. There are currently 19 different goals that can be set related to weight management, physical activity, calories, food groups, and nutrients. Consumers can easily measure progress toward their goals on the My Top 5 Goals page with both daily graphs and weekly trend analyses.
      • Post R.C.
      • Herrup M.
      • Chang S.
      • Leone A.
      Getting plates in shape using SuperTracker.
      Articles related to MyPlate and associated tools like SuperTracker are housed on the Journal website under the collections tab as “The MyPlate Message Chronicles,” available at http://www.adajournal.org/content/myplate.
      Realistic goal setting is just one component of effective nutrition counseling and should be preceded by an assessment of the client’s readiness to change, both of which are addressed in the resources cited earlier.
      • Spahn J.M.
      • Reeves R.S.
      • Keim K.S.
      • et al.
      State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.
      • Constance A.
      • Sauter C.
      Inspiring and Supporting Behavior Change: A Food and Nutrition Professional's Counseling Guide.
      Routine use and documentation of evidence-based interventions will enable registered dietitian nutritionists to better understand the intricacies of nutrition-related behavior change and strategies that are effective in aiding clients in achieving behavior change goals.

      References

        • Wamsteker E.W.
        • Geenen R.
        • Zelissen P.M.
        • van Furth E.F.
        • Iestra J.
        Unrealistic weight-loss goals among obese patients are associated with age and causal attributions.
        J Am Diet Assoc. 2009; 109 (1903–1903)
      1. National Institutes of Health/National Heart Lung and Blood Institute. Clinical Guidelines on the identification, evaluation and treatment of overweight and obesity in adults: The Evidence Report. http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf. Accessed October 25, 2013.

        • Spahn J.M.
        • Reeves R.S.
        • Keim K.S.
        • et al.
        State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.
        J Am Diet Assoc. 2010; 110: 879-891
        • Abusabha R.
        Interviewing clients and patients: Improving the skill of asking open-ended questions.
        J Acad Nutr Diet. 2013; 113: 624-633
        • Constance A.
        • Sauter C.
        Inspiring and Supporting Behavior Change: A Food and Nutrition Professional's Counseling Guide.
        American Dietetic Association, Chicago, IL2011
        • Post R.C.
        • Herrup M.
        • Chang S.
        • Leone A.
        Getting plates in shape using SuperTracker.
        J Acad Nutr Diet. 2012; 112: 354-358