Why I don’t talk about weight loss
The health world is obsessed with weight. Medical providers talk about it. Health coaches talk about it A LOT. I don't. Here's why.
People come to me in my practice for lots of reasons, but one I hear very often is "I want to lose weight". My response is to ask why. This puzzles people-- why do I want to lose weight? What do you mean? As though it were self-evident that weight loss is a universal goal. This confusion is understandable: many people have been told all their lives either directly (like by a doctor or coach) or indirectly (by TV characters, magazines, or peers) that they should lose weight. We've become used to the idea that weight loss is a good thing and we should always be pursing it. But here's the thing: weight loss isn't good. Weight loss isn't bad. Neither is weight. It's a number, reflective of mass and gravity. Not of health. Not of value. Does this mean no one should ever lose weight? Of course not! But weight isn't inherently meaningful. Focusing on this number engenders frustration, confusion, hollow victories, and unnecessary feelings of failure. Here's how asking "why" helps:
Example 1:
Patient: I want to lose weight.
Me: OK! Tell me a little about why you want to lose weight.
Patient: I want to get my blood pressure under control and cut my risk of diabetes.
Me: That sounds like a great goal. Let's review your numbers and risk factors and look at practices that can help with blood pressure and blood sugar. Maybe we can set some goals based on these health markers, and look at some strategies that will help those things.
Patient: Will I lose weight?
Me: Maybe, but since you're really thinking about your health here, let's start with that. We can look at some strategies around nutrition, movement, and stress management that might help. What do you think?
Real issue: health
Example 2:
Patient: I want to lose weight.
Me: OK! Tell me a little about why you want to lose weight.
Patient: I want to get ready for summer. You know. Bathing suit season.
Me: What does "ready for summer" mean for you?
Patient: I need to lose about 10 pounds so my stomach is flatter.
Me: Hmm, OK. How do you hope you will you feel if your stomach is flatter?
Patient: More confident and comfortable in my skin. I guess I feel like if I look better, I'll feel better.
Me: Wow, OK, I want you to feel better. It doesn't feel great to feel uncomfortable with your body. Can we talk more about that and come up with a plan to help you feel better about your body?
Patient: Will it help me lose weight?
Me: Maybe, but it sounds like part of what you're after is feeling better, so let's start with that.
Real issue: body confidence
If the focus stayed on weight, person 1 might go on a crash diet, lose 20 pounds, and wind up less metabolically healthy than they started. Person 2 might restrict their food, lose those 10 pounds, then start fixating on another body part, and meanwhile, wind up falling "off the wagon" and cycling through diets for years. By shifting the focus away from weight, we're looking for more meaningful problems to address and more meaningful outcomes to assess. Everyone does better. Except maybe the diet-industrial complex.
