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Setting weight loss goals

What we cover:

BMI and waist circumference are important measures for evaluating obesity-related health risks.1 There are several things that you as a healthcare provider can do in order to make this experience as comfortable for your patient as possible.

When weighing your patient:

  • Ensure weighing scales are in an area which offer privacy
  • Ensure weighing scales can measure greater than 200 kg
  • Refrain from announcing your patient’s weight in a non-private area

1. Assess BMI (Body Mass Index)

Diagnosing obesity begins with assessing your patient’s BMI – this is a simple measurement of your patient’s weight (kg) divided by the square of their height in metres.2

The World Health Organization propose a BMI-centric classification system to guide population level and clinical decision-making strategies.2

Classification

BMI

Obesity

≥30

Obesity class I

≥30 and <35

Obesity class II

≥35 and <40

Obesity class III

≥40

2. Measure waist circumference

Waist circumference is an important measure for evaluating health risks. Below is a guide on how you can make this a more comfortable experience for your patient:1

  1. Ask the person to stand facing you
  2. Hand them one end of the measuring tape and ask them to hold it at their belly button
  3. Request they make one turn so that the tape wraps around their waist
  4. Grasp both ends of the tape and adjust it to ensure the tape is at the level of the upper hip bones and record their waist circumference

Waist circumference cut-offs to identify increased relative risk for the development of obesity-related complications3

Men

> 102cm

Women

> 88cm

3. Start the conversation

Below are some examples of how your weight management conversation could start:

"If we can review your previous test results for a moment, I think it may be beneficial to discuss how improving your health and losing weight would benefit some of these results in the future."

"Carrying excess weight can be a cause of some of your health concerns. Can we discuss how losing weight can improve your health?"

Explain that obesity is not your patient’s fault. When discussing weight management with your patient, it is important you help them understand that body weight is influenced by many different factors, including genetics, environment and hormones, and that’s why losing weight and maintaining weight loss may be challenging for people living with obesity.4,5

4. Take weight history

During your weight management discussion, consider taking your patient’s weight history to understand any potential triggers for their weight gain, their weight loss attempts to date and to discuss any challenges they encountered.

Below are some examples of questions, which could help to initiate your weight history discussion with your patient:

"Do you feel as if your weight has been an issue in the past? For how long?"

"Tell me about your efforts with trying to lose weight in the past"

5. Set realistic and attainable goals

Once you have a good understanding of the patient’s weight journey so far, you can progress to discussing and setting goals together. Below are some examples of questions, which could support the conversation on goal setting with your patient:

"What are some reasonable goals you could set regarding your weight?"

"What kind of changes would you be willing to start with?"

Start by eliciting what your patient’s goals are. By doing this, you can help them to determine realistic and achievable targets. Consider the following:

  • Short-term goals
  • Long-term goals

Next, together with your patient, explore how they will be able to achieve these goals. The steps should be measurable and build on each other over time. The goals and the steps taken to achieve these goals should be mutually agreed with your patient.

Lastly, set realistic dates for when your patient will aim to achieve both their short- and long-term goals, and importantly, set expectations that weight management is a long-term process.6

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References

  1. NHLBI. The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Available at: https://www.ncbi.nlm.nih.gov/books/NBK2003/. Accessed November 2023
  2. WHO. Obesity: Preventing and managing the global epidemic. Available at: http://www.who.int/iris/handle/10665/42330. Accessed November 2023.
  3. Durrer Schutz D, Busetto L, Dicker D, et al. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts. 2019;12:40–66.
  4. Wright SM and Aronne LJ. Causes of obesity. Abdominal Imaging. 2012;37:730–732.
  5. National Institutes of Health. Clinical Guidelines On The Identification, Evaluation, And Treatment Of Overweight And Obesity In Adults. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf. Accessed November 2023.
  6. Vallis M, Piccinini-Vallis H, Sharma A, et al. Modified 5As. Can Fam Physician. 2013;59:27–31.
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