I very much enjoyed the article "Obese Patients' Perceptions of Treatment Outcomes and the Factors That Influence Them" by Foster et al,1 and would like to contribute a few comments. It is clear that there is a mismatch between obese patients' and their physicians' weight loss goals (for the patients!). Patients are driven by body image concerns, which require large weight losses. Although physicians would also like to help patients achieve their goals, we are also influenced by the knowledge that a relatively small weight loss is not only realistic, but also worthwhile, for health enhancement. It is clear that until we are able to consistently facilitate large weight losses, one of our main tasks is to convince patients that health enhancement with moderate weight loss should be an alternate goal, that weight loss short of body image ideal should be viewed as health success rather than (or at least in addition to) body image failure. For our part, we should not view our efforts as total failures if our patients do not accomplish immediate weight loss. If patients' attitude changes are necessary before they can commit themselves to working on lifestyle changes for modest but long-term weight loss, physicians' contributions should be viewed as incremental, helping patients move forward along the "stages of change" continuum. In my own practice, I have found it useful to focus on exercise recommendations, and to consistently praise any diet or exercise successes (patients tend to dismiss their small steps in the right direction).
Reinharth D. Weight Loss: Goals, Realities, and Strategies. Arch Intern Med. 2002;162(9):1069-1070. doi: