January 2017 Question 1.
1.The study’s results
support a new group of thought on goal setting for weight loss. The debate is
described in the study’s introduction. “The controversy associated with this
issue was emphasized in a recent review that included the importance of setting
realistic goals for weight loss as one of the seven myths about obesity
treatment, because empirical data show no consistent negative association
between ambitious goals and treatment completion.” (Calugi, Marchesini, Ghoch, Gavasso, and Grave, 2017).
Review the following supplementary resource and consider the question below.
http://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20048224 (Link Describing the Conventional Advice for Goal Setting for Weight Loss)
What level of importance
would you place on setting a realistic goal for weight loss? What would you
recommend to your client to determine weight loss goals? Did this study’s
results cause you to reconsider your recommendations?
posted by Unknown @ 7:49 PM
15 comments
15 Comments:
My initial inclination in terms of recommending how ambitious of a weight loss goal for a client to make, is to emphasize making a realistic goal. Logically, setting a realistic goal seems desirable because the client could feasibly achieve it in a specified time and then create a new realistic goal. By making and reaching several smaller realistic goals, I would expect a sense of achievement and motivation from the client. It seems like setting and achieving several small goals would be the most effective way to help clients lose the most weight. I would expect setting larger, possibly unrealistic goals to lead to discouragement if the goal is not met by the client. After reading the study though, my impression of setting weight loss goals has changed. The findings that indicate that higher weight loss goals are associated with greater weight loss suggest that goals do not necessarily need to be realistic. Combining my prior knowledge of weight loss goals and the study results has led me to put less emphasis on making realistic weight loss goals. If I were counseling a client who wanted to set a realistic weight loss goal (in terms of feasibility for that individual), I would not push them to make a bigger weight loss goal simply because of the study results. However, if I were counseling a client who wanted to set a very high (and possibly not realistic) weight loss goal, I would not discourage them from setting such an ambitious goal instead of a more realistic goal. Instead, I would acknowledge that their goal weight loss was a big goal and I would share the study results as a form of encouragement. No matter the scale of the weight loss goal, I would strive to provide equally encouraging feedback, advice, and guidance to the client so that they are best equipped to reach whatever goal they have set for themselves.
Based on the article and supplemental resource, I believe setting those realistic goals is crucial to positive outcomes. Often times people set outcome goals at the beginning of the new year, such as losing 30 pounds for bikini season in the summer. While that may be a good goal to set, setting up process goals for oneself helps make the outcome goal more feasible in their mind. Applying process goals to achieve a main goal may increase participant adherence because although they cannot achieve the outcome goal right away, they can slowly accomplish many goals which can increase positivity and feelings of accomplishment throughout their weight loss journey.
After reviewing the article and the supplemental resource about weight loss goals, I feel it would be best to encourage clients to set long-term and short-term weight loss goals. Short-term goals might include process goals as discussed by Nikki and and the Mayo Clinic Staff such as changing eating and exercise habits. Long-term goals might consist of attaining an ideal body weight or feeling comfortable in summer cloths. I think combining the focus and process goals creates a fuller picture for the client in working towards weight loss. While the article supports setting higher weight loss goals in order to achieve weight loss, I an skeptical whether this would work outside of a weight loss study. In an environment without food diaries, weight-ins, and regular monitoring, I expect clients would lose sight of the unrealistic weight loss goals and fall off track. Therefore, I feel that this article supports setting high expectation in the long-term, but we should still encourage clients to set process goals for day-to-day lifestyle modification management. In the end, it is these process goals involving diet and exercise improvements that will impact client health the most.
Since this study confirmed an association between higher weight-loss targets, greater weight loss, and weight loss satisfaction, as well as weight maintenance, setting overall weight-loss targets over 5 to 10 percent body weight may be in the clients best interest. So, I would be open to clients setting higher weight-loss targets, but I would work with them on creating SMART goals to aide in their reaching of their overall goal(s). I feel that the combination of the two types of goals will help clients maintain their motivation with the long and hard struggle of weight loss and weight maintenance.
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Discussion has split evenly for incorporating the articles results into weight loss counseling. Two contributors shared a willingness to allow clients to select higher weight-loss targets beyond traditionally realistic goal setting. Also, two contributors doubted the potential benefits of setting higher weight-loss targets as described in the study. Concerns were raised as the ability to reproduce weight-loss outcomes in a typical out-patient environment in absence of controlled inpatient interventions described in the weight loss study methodology. These contributors shared a preference in utilizing adjustable process and long-term goals in weight-loss counseling. A consensus has established all practitioners would utilize encouragement and motivation techniques to support progression towards weight loss goals.
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In the scenario presented by Nikki:
Client with a New Year’s resolution arrives at their appointment with a goal to lose 30# by bikini season (beginning of June in the Midwest).
Assuming the client is an average American female over the age of 20 years: The client is 166#, 5' 4". How would you address this weight loss goal with the client? Does the article results influence your response?
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Typically in practice, we are educated on how to make "SMART" goals for our patients. SMART goals stands for goals that are: specific, measurable, attainable, realistic, and timely or tangible. I agree, the use of SMART goals is important in making sure you are specific while setting goals; however, I do believe the attainable and realistic component could be reconsidered. I have heard from other resources that it is okay if weight loss goals seem a bit high for a client because some people are motivated in different ways. Some people succeed in setting challenging goals that seem almost unattainable because it motivates them to push harder; whereas, others lose motivation when they are not getting close enough to the goal they set for themselves. I feel it is important to understand how your client is motivated/discouraged and set goals accordingly. Definitely after reading this article, I would be more compelled to encourage slightly higher weight loss goals due to the success in greater weight loss.
Rachel, with the scenario you posed, I would encourage the client's weight loss goal. Her goal seems realistic if she is motivated and disciplined. The rate at which she would need to lose the 30# would be a healthy rate since it would be over 4.5 months. In this case, the article's finding that higher weight loss goals are associated with higher weight loss would not influence my response. Her goal seems fitting for her and I would provide her with the necessary resources and support the achieve it.
Noel, I like what you said about understanding how each client is motivated when guiding weight loss goal setting. The type of goal setting that works for one person may not work for another.
Additionally, what Justine said about the unique circumstances of the study supporting weight loss rings true. Without the resources and the level of accountability required in the study, participants may not have been able to lose as much weight.
Noel, I also agree with your comment about respecting how different people may be motivated differently. Some clients may benefit from setting high weight loss goals, where others would only be discouraged. I think discussing how individuals have achieved goals in the past would shed insight into what types of goals would set up the client for the highest level of success.
I agree with many of my classmate's views on this topic. We have learned SMART goals through our schooling, the last two standing for realistic and timely. I believe that it is important to have a conversation about goal setting with the client about how they prefer to set goals. I can imagine that for some, setting an unrealistic goal can be counterproductive. Rather than it being a motivator, it could make the client feel overwhelmed and lead to a “why even try” attitude. The results of the study did surprise me. I don’t think I will encourage my clients to set unrealistic goals but I may me more open to supporting a client’s ambitious goal if my they are passionate and committed to it.
I feel that it is important to set realistic goals, especially for weight loss. Like our peers, I have been taught through all of my higher education to set SMART goals. This is a practice that can be used in many scenarios, not just weight loss. Personally, I feel that setting realistic goals prevents any potential "disappointments" or negative thoughts that can arise if clients do not meet their goals. However, on the opposite side, I would be inclined to encourage a client who had a high level of motivation to pursue more extreme goals.
I feel that Krista and I have a similar mindset. We should use our tools and motivational interviewing to help set up clients for success. Justine, however, brings up a valid point. I would be interested to see how this study played out in a "real world" situation (as 3 weeks of the controlled weight loss phase in the article was at an in-patient facility). Rachel, I feel that the scenario presented would not change my viewpoint. Allowing for 5-6 months of consistent weight loss to reach the 30 lb goal would still provide opportunity to set realistic goals. While the scale is a motivating factor, I would try to focus on consistent exercise, mindful eating, and positive body image.
As everyone has touched on, we have all been educated on the use of SMART goals. Although I believe the SMART goal system is applicable to almost everyone, I feel that it is a starting point for most individuals. Something often forgotten when it comes to goal setting is the rewards system. From what I have learned in my previous psychology courses, goals are associated with behavior change. Behavior change almost always requires some type of reward system. I think rewards are often ignored when it comes to weight loss, because one of common rewards individuals use for themselves is food. Weight loss then becomes a never ending cycle for some. I think making small attainable goals, paired with a small reward system unrelated to food leads to successful goal achievement.
Justine, I like how you pointed out that this study may not be applicable to the population outside of the study, because not everyone will have access to the food logs, weigh-ins, and monitoring the participants in this study had. It's important to assess the logistics of the study and to thoroughly understand the results, so they can be used in real world application effectively.
We have always learned in school the importance of individualizing goals to each client/pt and with that means making SMART, realistic goals that the pt can obtain. However, it can be ok at times to push client/pt past their goal for themselves. However, I still believe it has to be a goal that they want to accomplish and it can't be too unrealistic. Therefore, I again this stresses the importance of individualizing goals. As Noel mentioned, everyone is motivated differently. Therefore, if you have someone that will work past their goals you should help push them, but not everyone is motivated the same. I also agree with what Justine and Tessa said about the access individuals have. There are many different aspects to consider before developing weight loss goals with client/pt. But I think the most important thing is to individualize the goal to your client/pt on what will work for them.
Justine, I think you made a great point about encouraging clients to set long and short-term goals. I think that the combination of the goals will help maintain client motivation by allowing them to find success in meeting small goals while striving to meet their more ambitious long term goal(s).
Noel, I think you also brought up a great point about motivation. Not everyone is motivated by the same things, so as RDs we need to be able to help each client find the goals that will aide them towards the outcome(s) they desire.
Tessa, I enjoyed reading your comment about the reward systems role in goal setting/achieving. I agree, while attempting to loose weight, rewards are often left behind. Yes, individuals should treat themselves when they reach stepping points in there goal-- These rewards could be something such as a nice massage, or buying a new pair of shoes etc.
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