Discussion Question 3
After reading this article, what would you as a
(future) practitioner recommend to your clients in regards to the frequency
that they should weigh themselves if trying to lose weight?
posted by Julie @ 7:20 PM
31 comments
31 Comments:
As a practitioner, I would still only recommend for individuals to weigh themselves weekly. When individuals begin to weigh themselves too often and focus solely on the number on the scale, they begin to lose sight of the big picture of just developing healthier lifestyle habits and decreasing their chances of developing a chronic disease. While weight is important, especially for BMI, it should not be the main focus of your clients. Clients should focus more on the changes they are making in their lives and feeling good, rather than how much weight they are losing and how quickly they are losing it. Again, if clients develop healthier lifestyle habits and make those changes that they need to, weight loss is something that naturally comes along with it.
This was just one study to show that weighing daily helps with weight loss. Other studies show improvement with weight loss when weighing just weekly, while other studies have showed no differences in weight loss amongst groups of those who weighed daily versus those who weighed weekly.
Weight can be a very personal issue as well, so again, more frequent weighing may be more of a turn-off and discouragement, rather than encouragement, especially if a client is in the plateau phase, It can cause stress and anxiety if a client gains weight one day, and some individuals can become obsessive. As a practicing dietitian who worked with overweight and obese children and teenagers in schools in District 150 in Peoria, I did weigh the students weekly when they came to see me because I had to track and document the outcomes of their weights, as the program I was apart of was based off grant money. Many of the students were very uncomfortable even with weekly weighing, and some even refused to be weighed. Some of the overweight or obese teenagers in high school would obsess over their numbers, especially if they were higher than the previous weeks. Weight fluctuate daily depending on hydration status, and scales, depending on the accuracy, also fluctuate as well. Therefore, from my personal experience as a practitioner, I would recommend less frequent weighing of once a week or even once every other week if a client does refuse and feels uncomfortable.
According to this article, I would not deter a client from weighing themselves every day if they desired to, as this study showed daily weighing was associated with greater weight loss. However, I believe further research needs to be done on this topic and with a more variable sample of participants in order to convince me to recommend daily weighing to all clients. I would stress to clients that the participants that weighed themselves every day also reported more changes in diet and exercise behaviors like reducing calorie intake, eating out less often, and exercising for 30 minutes or more. Therefore, I would recommend to my clients that diet and exercise behavior changes most likely impact weight loss more than how often they weigh themselves. I would recommend that clients weigh themselves a few times per week or even once per week, and I would ultimately advise that daily behavior modifications are more important than daily weighing in order for weight loss to occur.
While the study supports daily weighings as a means of promoting weight loss, as a general rule, I will not encourage my clients to weigh themselves daily. If I felt that a specific client understood that weight fluctuation day-to-day is normal and I felt they would benefit from seeing their weight often, I may recommend daily weigh-ins. However, I believe I will only recommend once-weekly weigh-ins for the majority of my clients seeking weight loss. This is because the focus should be on improving health through positive lifestyle choices, like diet and exercise, and not solely the number on the scale.
I vehemently agree with Janelle that weigh-ins can serve to discourage, and possible harm the weight loss process of, some individuals. Because of this, I may recommend that some clients avoid weighing themselves altogether, and simply judge based on the fit of their clothes. This would be especially appropriate for individuals that show obsessive tendencies toward food and weight.
I'm not a big fan of the idea of using a scale to do daily weights. Even weekly weights, in my opinion, can set up unhealthy habits in individuals. What does that number mean to the individual? People know when they've been eating well or have been "splurging," and most of the time people don't need a scale to tell them if they've lost or gained weight. Often, the biggest rewards for individuals are if their clothes are beginning to become loose, or if they have more energy to get and stay active. Also, just because someone is overweight doesn't mean that they are unhealthy. There are plenty of individuals who don't fit within their IBW but are healthy and active people. I would more likely stress getting regular physician check ups and encourage healthy lifestyle changes and habits. If I worked in a job that required me to weigh my clients, I'm not sure I would share the information with them, just because I think that sets up an unhealthy way of thinking about eating. What if a client went from eating 0 fruits and vegetables to eating 3 in a week, but had some weight gain because they were stressed and ate some larger servings at meals. Do we really want to discourage the healthy changes because the weight on the scale was not favorable? It might be more beneficial to focus on the habits of this client instead of their weight. If we really want to set up long-term lifestyle changes, I don't think results will be seen quickly, and it might do more harm to encourage individuals to weigh themselves frequently rather than focus on how their bodies feel.
I like the point Janelle brought up about the "plateau phase." I think this is probably one of our biggest challenges with clients looking to lose weight. How can we tell a client they're doing everything they are supposed to be doing and are still not losing weight? It definitely would be frustrating. Also, like Janelle mentioned, my biggest concern about weighing is it becoming an obsessive behavior, which can cause a lot of stress or anxiety. I'm a big proponent of people loving their bodies, and they should focus on being healthier, not skinnier.
I think you'd have to customize it to your client. You'd have to access their obsessive tendencies and see if a daily weight would be too much for them to handle. You can decide if a weekly weigh is sufficient to holding them accountable. It also depends on when you'd see them next. Their weight can fluctuate so much from day to day but maybe you weigh them yourself every month just to be more consistent. I would encourage them to focus on the big picture instead of the numbers on such a frequent basis.
Like Emma said, if the client understand that weight can fluctuate then I'd think they have a more healthy approach to their weight loss process. Susan brings up an interesting point that they have pick up healthier behaviors and gain a few pounds from that but we just have to pick and choose which behaviors we're going to applaud them for and which ones we really need to work with them more on.
I think there are bigger fish to fry when it comes to weight loss than how many times a person weighs per week. We saw this trend with nutrients, we got so specific trying to isolate single factors in foods that were responsible for health. We now have the wild west of the dietary supplement industry with a confused and captive audience of consumers while we try to battle saying “food first.” We are now taking a step back to look at overall food patterns as the contributor to health, high vegetable intake, lower added sugar intake, etc. It is wonderful for clinical and scientific purposes to have such precise isolation of contributing factors to weight loss for understanding, but I believe we should be looking at behavioral patterns like food patterns.
One specific behavior will not likely make or break an individual’s weight management success. It is the overall accumulation of behaviors both healthy and unhealthy that will determine outcomes. There does not seem to be anything more than an association between weighing more frequently and adoption of other weight management behaviors at this point. Weighing could just be another self-monitoring/weight management behavior. Instead of looking for a cause-->effect relationship, as practitioners in the field, we might be able to better visualize the connections of behaviors leading to weight loss as a web. The more strings of connected behaviors, the stronger the web, the more support for success. I stand by my response to question 1, we should explore the issue of weighing frequency with each client, make an accurate and unbiased presentation of the established relationships (and their strength), and then make recommendations based on their needs.
I agree with Janelle that weighing too frequently can cause a loss of attention to the big picture. So many things contribute to weight outcomes. Even if the number on the scale says a client is "healthy" they could still be participating in extremely detrimental health behaviors such as alcoholism or smoking. Weight is one indicator of many to assess a person's health status. With the obesity epidemic being so in our face as nutrition students, it is easy to get swept up in focusing on the number on the scale. We really need to remind ourselves to look at the whole picture of lifestyle for each client.
If I was approached by a client to recommended an ideal frequency for monitoring their weight, I think I would stick with 1-2 times per week and discuss with them the various fluctuations that our body weight makes on a daily basis. I would focus on keeping the time and pattern of the weighing consistent (ie: right after waking up with no clothes), but not push a high or low frequency of weighing. I think it is the preference of the client and what serves to motivate them. For certain individuals, weighing can be a fear. However for others, it can be an obsession. I do not think that there is one sound recommendation that we can stick to. It depends on the client and their overall attitude, psychological state, and goals.
I certainly agree with Janelle that weigh-ins can be intimidating and discouraging to many individuals on their weight loss progress. In a counseling video we watched in MNT, a client was given the option to participate in a blind weighing where only the dietitian would be able to see her weight. I think this may be an appropriate option for some clients - allowing for data collection and suggestions to be made, but not allowing the number on the scale to negatively interfere with the client's progress if it is not desired to be known.
As Dr. Brown would always say, "it depends." I don't think I can give a cookie-cutter answer to this question because it varies from client to client and what his/her goals are along with their mindset. If I meet with a client and all they want to talk about is weight but nothing else (e.g. physical activity, muscle mass, balanced diet etc.), I would definitely not recommend a daily weighing routine because they are giving me red flags that weight, and not health, is their primary concern. I am well aware that a healthy weight is associated with good health (duh!), but there is a lot more to health than a number on a scale. I think it becomes dangerous to focus on just the number because weights are highly variable and fluctuate on a daily (or even less than daily basis).
For instance, what if a patient weighs every day and sees 155 one day, but then the next sees 158 the next morning (maybe they drank a whole bunch of water and are retaining stool volume), and they freak out and think they are doing nothing beneficial for their body? Now for any client that I meet with, I would tell them that weights will vary from day to day due to things other than fat loss/gain (e.g. fluid balance), but will they remember me telling them that or will the instinct of "I'm a complete failure, time to not eat all day until tonight when I get celery and a diet coke with lemon" mindset come into play? It may become an obsessive tendency, and I would hate to see people losing their sanity and causing themselves undue stress/anxiety because of a number.
On the other end, for those who truly believe that daily weighing will help them to stay accountable and also indicate that weight isn't their true focus but just something they can observe as a basic measure, I wouldn't have as much of an issue with it. I'm not saying I endorse it, but there are bigger issues I would probably focus on (like Gina said, "there are bigger fish to fry").
As this research indicated, daily weighing can help with weight loss efforts. For someone interested in daily weighing, I would try to ensure that they understand that weights will vary on a daily basis and also that our goal is health, and not weight per se. If I saw them again, and all they were focused on was the weight (and not "health"--healthy lifestyle behaviors such as balanced plates, physical activity, hydration etc.) I would probably ask them to take it easy on the scale for awhile. It's all about assessing the client and where they are at in their healthful lifestyle journey. We don't want our clients becoming obsessive about their weight--that sends the wrong message. As Janelle and Gina pointed out, it's the "big picture" here. We don't want daily weighing, or any other behavior, to take away from that view.
I think once a week is appropriate. However, I would ask my client how it makes them feel to weigh themselves. Do they get nervous on the day they weigh in? Do they restrict if they get bad numbers? What does it mean to them? If I got any indication that weighing could affect emotions, I would encourage my client to measure success by how their clothes feel and how they feel.
Janelle paints an accurate picture of what can happen when people focus too much on weight. I really don't feel like having a number as your goal is a good idea. I dislike how people ask 'what do I eat to lose weight?' or 'what should I weigh'? I want to encourage people to do things for the purpose of health. So instead of eating or exercising to lose weight, encouraging a life style for good health.
As a future practitioner, I still remain with my initial thought of it depends on the individual. Individuals who portray signs of a distorted body image would not be good clients to suggest this weight loss method of weighing themselves daily. This could potentially lead to obsessive habits and cause them to be overly concerned with weight loss on a daily basis. Since the general suggestion for weight loss is 2-3 pounds lost per day, there is no reason to weigh yourself everyday.
I agree with Janelle and Emma in saying that daily weighing could be discouraging, because progress results everyday is unrealistic. So if you were to weigh yourself weekly rather than daily, it would be more likely to see results and more encouraging to work hard and stay on track with your diet for the next week.
This article did not give enough science based evidence for me to promote daily weighing. However, every patient is unique and I think it should be determined by what they prefer and their individual goals. If they are making healthy lifestyle changes without becoming obsessive over the number on the scale, then I would be okay with it. Relating to Janelle's comment, using the daily weight technique with children, would be inappropriate. Certain populations have different risk issues for behavior consquences. Making sure the patient is fully educated about their weight loss plan and adequate nutrition should be the main focus. People doing daily weights and partaking in a new exercise regimen may need education on rehydration and the weight fluctuation they will see. Discussing the number on the scale may be very beneficial to people who find weighing themselves helpful to staying on track.
I'm still not ready to recommend that clients weight themselves every day. The main conclusion of this article is that the greater weight loss is likely due to the fact that those same people report grater adoption of diet and exercise behaviors associated with weight control. In other words, there is no reason to assume that daily weighing caused any changes, only that those same people happen to have healthier overall lifestyle habits. I just don't think there is anything to be gained from seeing a small gain/loss on the scale in a 24 hour period. So, I would stick to recommending once or twice a week, with the goal of weighing in on the same days each week for consistency. I think that allows us to keep clients focused on other important factors such as dietary changes, activity changes, and feelings of well-being.
I agree with Haley that every client is unique. We should take that into consideration with our recommendations. I definitely think some people can handle daily weighing, but I would just want to be certain of that before recommending it. And as Caroline mentions, I agree that we should be sure clients understand that diet and exercise are going to have the real impact, not the daily weighing.
This depends on the patient and their goals. Most people on weight loss regimens can adopt the weight watchers philosophy to weigh once a week. This keeps the client aware and on track but does not promote excessive body image obsession. Some people are perfectly ok with weighing daily. It depends on the intensity of the person, their reasons for the loss, their goals and how they plan to establish them, their perception of themselves, what their motivation is, etc.
I agree with Emma, it is very client specific and the focus should be on overall health, not just the number on the scale. Caroline is right, there needs to be more research on this area of study.
The type (or lack there of) of physical activity should also be addressed in the overall weight loss plan!
I think it depends on the client. Daily weighing may be appropriate for some clients, and help them reach their desired goals by keeping them motivated and on track. Other clients may respond negatively to a lack of improvement. It would be best to gauge the emotional response of the client and monitor their progress carefully, so you can change the frequency of weighing if the initial method appears to be unsuccessful.
After reading this article, it seems like daily or more frequent weigh-ins can assist with weight loss. Based off this article alone (although I would suggest further studies on this topic), I would recommend my patients who need to lose weight for health reasons, to weigh themselves more frequently. If they're comfortable with weighing themselves once daily, it could be a starting point for them to encourage weight loss. If they are unsure about daily weigh-ins and think it will make them fall into unhealthy behaviors, I would recommend them starting at once a week or maybe even 3 days a week. If my client can achieve weight loss without daily weigh-ins and continue healthy behaviors such as regular exercise, balancing energy intake, and meal planning.
When my client reaches their goal weight, I would recommend them to reduce their frequency to weighing no more than once a week. I think if they continue to weigh themselves daily or frequently, it can lead to unhealthy behaviors and my client may lose too much weight.
If I were to base my recommendation on this article alone, I would not feel comfortable telling clients to weigh themselves daily. Especially considering the predominantly white, female population, the study does not prove to me that this is a method that is for everyone. Counseling a patient on weight loss is a very individualized approach. I would possibly consider this daily weighing approach after I had gotten to know the client through our sessions if I could gauge whether it would be beneficial for them. On the other hand, if a client would ask me if it is okay to weigh themselves every day, I would state what I do know. I would explain to them the pros and cons. For example, I might say that a study was published on a small sample showing that there may be weight loss benefits to daily weight monitoring, however I would also let them know that this might not always be a clear picture of their weight. I would also ask them if seeing their weight fluctuating from day-to-day would be bothersome or discouraging to them. If so, I might recommend that they do less frequent weighing.
I believe every client is different. Some clients can go weeks without checking their weight and are completely fine with it, while others have anxiety about not checking their weight daily. I think it is important to talk to your client about what they prefer. Based on your discussion with your client if you feel that they are checking their weight too much and it is becoming unhealthy (i.e. becoming an obsession, feeling depressed about their weight from constantly checking it, or becoming dependent on checking their weight) you should discuss with this client how weight may not be an accurate representation of their health status. Encouraging your client to weigh only weekly or monthly may help change your clients focus from the number on the scale to making healthy lifestyle modifications. Although the article showed positive results for checking your weight daily I still believe it depends on the individual person and although it may be helpful for some it can also be detrimental to others.
I agree with Tina that focusing on the big picture rather than the numbers is a more effective for long term weight loss in my opinion. I also think that weighing yourself once a month for consistency might be beneficial for certain clients.
Haley also brought up a good point that this article alone did not give enough science based evidence to conclude that frequent weighing can cause weight loss. More studies need to be done that isolate the variable of weighing in daily rather than adding other variables like education.
As a future practitioner, I do not think that I would recommend for individuals to weigh themselves daily. I feel that weighing once per week is sufficient enough for staying on track towards overall goals of weight loss. Even with weighing just once a week, we need to ensure that the client fully understands that many different factors contribute to overall body weight and that there are potential factors leading to possible errors in the weighing process (same time, same scale, same amount of clothing). However, as others have mentioned, I feel that this is absolutely dependent upon the individual client that you are working with as well as their overall health goals. We need to fully examine each person’s unique situation before recommending to everyone that they should be weighing daily.
Arthur mentioned a great point about being able to recognize some of those red flags and clear indicators (fixation on weight/numbers) that an individual should not be weighing daily. Through counseling with the client we should be actively listening and sensing to determine what is best. Each individual person will respond differently to the weight loss process and this is why I would proceed with extreme caution before ever directing someone towards weighing daily.
I certainly would not recommend that a client begin to weigh themselves daily based upon this research study alone. There needs to be more research studies performed in the future that address the limitations that we have discussed previously before we can say for sure. The individual’s overall weight loss plan should be specifically tailored to fit their individual needs with long-term goals in mind.
I think I would still suggest to the patient to weigh themselves weekly instead of daily. This article did not convince me that daily weighing was the major reason for weight loss. Weight loss is a difficult process, and successfully keeping the pounds off is a challenge. I agree with Carly that it has to be customized to the client. If someone refuses to weigh themselves daily, this method of daily weighing would not be successful for them. For some, daily weighing may even be discouraging and defer weight loss. Once I am a practicing RD, I will be able to discuss with my client what the ideal and realistic plan for them would be.
Reading this article did not change my opinion of daily weighing and I would still recommend weekly weighing to clients or patients. Weekly weighing is more than sufficient to monitor weight loss progress, and the design of the study did not convince me that the actual daily weigh in is the reason behind the greater weight loss. I think it's very easy for people to become caught up or even obsessed with numbers and be too hard on themselves if they're not seeing the scale come down each and every day. I also feel that if you're working with a client or patient on a regular basis, you could probably get a feeling for what works for them and be able to make a recommendation that would be appropriate for that client.
Susan, you bring up a great point about not having a number be the goal. I love what you said about someone eating more fruits and vegetables, but focusing on the weight instead of the healthy changes that they're making. Focusing on a number on the scale takes the focus off of the bigger picture, which is incorporating healthier habits overall.
Amanda, I really like your point about how weight loss counseling is highly individualized. I don't necessarily think we should go into any counseling session with a 100% preconceived agenda. Some of my internship preceptors (especially those in outpatient counseling) took this approach, and it really worked. We've got to adjust our recommendations for the client and his/her needs, and we can really only determine their needs after meeting with them.
It's okay to go into a session with an outline of a plan, but I wouldn't enter a first time weight-loss counseling session telling myself "Okay, they are only allowed to weigh themselves once every seven days, no exceptions." If the client thinks that more frequent weighing will be a helpful approach and there aren't any negative ramifications from such a practice (as evidenced by their attitude during the first session and in future counseling sessions), it may not be the worst thing in the world. It's a person by person kind of thing, and this is a situation where everybody's best friend, the "clinical judgement" component of healthcare, comes into play.
Brady, I also like your point about weighing consistency. Good call. I also think that weights should be taken at consistent times and days. If a patient is weighing in twice a week, they should do so on the same two days each week whenever possible. Similarly, if it all possible, if a patient is weighing every day, I would probably recommend that it be at the same time each day (i.e. right upon waking, after their workout etc.).
I agreed with Arthur's approach to this question by basing my recommendation based on the individual person. Even though we generally recommend weighing 1-2 times per week, as Jenn mentions, I also think that it is okay to recommend if that is something the client believes might be beneficial.
Gina also makes a great point about this one factor not making or breaking the progress of the client. Likely more than one factor of the client will need to be considered for their weight loss success.
I agree with Jenn, that there isn't really one recommendation for weighing frequency that we can automatically advise to everyone. Every client is different, and frequency of weighing will depend on the client, their psychological state, and their goals. We need to get to know our clients and figure out what will work best for them.
As a future practitioner I would evaluate the needs of my client and decide from there what to recommend. As Amanda stated individualizing your weight loss plan to your client's situation is critical for success and creating an appropriate intervention. That being said, if I had an individual where weight loss was crucial I would consider having them weigh themselves daily, again I would examine the situation and analyze if this would be an appropriate intervention for that individual.
I appreciate Caroline and Jenn addressing the other side of daily weighing frequency and the wants and desires of the client. If this is something the client truly feels like he or she can handle without developing disordered/risky behaviors, I think it is ok to do. Things should be client focused and centered around the clients wants/needs, so if they believe this could benefit/help them with weight loss, I think it is important to support their decision and encourage them. It really should be about what makes the client most comfortable and what tools they believe will give them the best results and success with weight loss.
Susan, Sammy and others had a good point about focusing on healthy behaviors rather than a number. If clients are building muscle, their weight may be increasing, but their body fat may be decreasing. Water can also play a part in disguising healthy or unhealthy body changes. Since weight is not an accurate indicator of and improvement in health, I would not recommend my clients focus on it exclusively, but instead consider other indicators such as the behavior changes they have made and changes in how their clothes fit.
I like Amanda's point about individualizing the client's weigh-in frequency after some counseling sessions. And Arthur expanding brings up great points expanding that as well. Obviously not everyone fits into a cookie cutter idea of a weight loss plan including frequency of weigh-ins. It may be effective for weight loss for many females, but this study does not address the long term effects it may have and how the subjects may feel in response to having to weigh themselves daily such as anxiety, stress, or disappointment. I specifically like Arthur's point about having an outline when going into a counseling session rather than a concrete agenda. Then we can adjust the outline according to the client's response. And sometimes it may take several counseling sessions before we can move into how many times the client should weigh themselves. I think it is more important to encourage the client to have healthy habits and healthy feelings rather than having them start daily weigh-ins and find out that it makes them uncomfortable and they may already be in a stressed and obsessed mindset by the time you tell them to reduce their weigh-in frequencies.
Ultimately, we have to get to know our clients first!
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