Goals of Obesity Treatment
KELLY D. BROWNELL
ALBERT J. STUNKARD
Establishing the goals of treatment is the first, and in many ways, the most important aspect of the treatment of obesity. These goals consist of improvement of both health and well-being. However, the goals that obese individuals bring to treatment can range from the realistic improvement in health and risk factors to fantasies of marrying the ideal mate and living happily ever after.
Much of the treatment negotiation between the provider and the patient consists of agreeing on the goals of treatment. In some instances, the parties agree from the outset about the desirability of losing weight by modifying food intake and physical activity. The relatively simple task of treatment is then to implement a program that will produce weight loss, reduce risk factors, and improve well-being. At the other extreme are people whose goals are so unrealistic that much of treatment consists of redefining goals to render them potentially achievable. In this redefinition, provider and patient should attempt to achieve (1) shared goals; (2) clear understanding of the responsibility of each part; and (3) reasonable expectations of outcome. In the course of this collaboration, expectations may be lowered, often substantially, in terms of lesser amounts of weight loss. Expectations may also be raised in terms of increased self-esteem, improved body image, and more effective social functioning (see Chapters 70, 72, 90, and 108).
Losing weight is but one means by which individuals can improve health and well-being. Changes in diet and physical activity are beneficial in their own right and can improve an individual’s life independent of weight loss (see Chapters 7 and 89). Issues addressed in