Weight management is about addressing the complications of overweight
and obesity, many of which are primarily managed with sustained weight
loss. Although many discussions surround the fact that minimal weight
loss is beneficial for a number of medical conditions, it is clear to
me that for many complications, more than 5% weight loss is needed to
see a clinically relevant benefit.1,4 Prevention of
diabetes starts at 3% weight loss, yet this improves significantly
with losses greater than 5%.1,3 Diabetes remission requires
10 to 15% weight loss.1,3 Conditions such as obstructive
sleep apnea and osteoarthritis also require more weight loss than 5%.1
When we ask patients about their weight loss expectations, they
state that they expect 30% weight loss.5 Although that
much weight loss is often considered an unreasonable expectation for
strategies outside of bariatric surgery, we question patients for
considering such lofty goals. The medical field disagrees with such
high expectations primarily due to the fact that there have been no
interventions, outside of bariatric surgery, that can attain this
amount of weight loss over the long term. We blame the patient for
expecting too much. We should blame the lack of effective
non-surgical interventions for not getting us to that goal.
Patients should expect enough weight loss to correct their
weight-related complications and that is, in most cases, more than 5%,
as documented by the majority of studies looking at clinically
relevant improvements or even resolution of complications related to
obesity.1,4 Obesity medicine specialists should stop
pretending that 5% is enough, and when all the available interventions
are capable of achieving over 10% weight loss in patients, it is
likely that they will.
We championed 5% weight loss as the reasonable goal, likely due to
the fact that 5% was all that could be achieved in the long term with
the most commonly used non-surgical treatments such as lifestyle
intervention. We should no longer accept long term weight loss of 5%
as a minimum standard. The necessity of needing more weight loss - and
the need for more effective medication in weight management - is
evident. Current anti-obesity medications can enable weight loss
beyond 5%. We need to challenge current standards of clinically
relevant weight loss to achieve real improvements in weight-related
complications and our patients deserve that level of
intervention.
