It might be easier to define what weight management isn’t. Weight management isn’t crashing one’s weight down through extreme efforts and approaches to reach some predetermined dream weight. Nor is it achieving a so-called normal or healthy weight. Weight management is the sum total of a person’s approach to their weight, and where their best weight is whatever weight they reach, living the healthiest life they can honestly enjoy.
There’s no question that weight confers increased risk of a wide range of medical problems and quality of life impacts especially at its extremes. Just as with any other risk factor, high blood pressure, high cholesterol, high blood sugar, while those conditions aren’t guarantees of medical consequences, we know that trying to reduce them, or keep them from rising, decreases risks to those who have them. The same is true with weight management.
Simply put there is not a country in the world that has seen a sustainable decrease in their rates of obesity in any age group. Suffice to say weight is rising around the globe which speaks to the fact that rises in weight are not the conscious choices of individuals but rather the natural outcome seen when genes forged through millions of years of extreme dietary insecurity meet our modern day food and lifestyle environments.
BMI is literally a measure of bigness. It expresses a person’s weight as a function of their height. It has utility when considering populations of people, but not individuals as with individuals BMI fails to account for age, race, gender, musculature and more. It also doesn’t speak at all to the impact a person’s weight might be having on their health or their quality of life.
BMR is the number of calories a person burns in a given day at rest (which is why it’s also called resting metabolic rate). It can be estimated by a whole host of different calculations or measured indirectly with an indirect calorimeter or directly through a direct calorimeter. Having measured thousands of people’s BMRs it’s clear that the vast majority of ours are well estimated by way of simple calculations with few people having markedly higher or lower than expected BMRs.
Dozens if not hundreds of factors affect our weights. Thousands of genes and dozens of hormones are known to be involved in our personal levels of hunger, cravings, and fullness as well as the emotional impact of food. Other medical conditions and medications can affect weight. How stressful life is and the impact that has on the use of food for comfort. Whether a person has a sweet tooth, how many calories they drink, how many meals they purchase, job and caregiving food related responsibilities and impacts, their quality of sleep. Truly this list could go on and on.
These of course will vary, but at the end of the day it’s important to remember that your goal shouldn’t be the healthiest eating habits that you can tolerate, but rather the healthiest eating habits you can enjoy. While those habits will vary dynamically depending on life circumstances they are likely to involve such things as frequencies of meals out, amount of liquid calories and indulgent foods, meal timing, macronutrient distribution, and of course, food choices and qualities. For a deeper dive, please take a look at our post on Changing Your Eating Habits for Weight Loss.
Portion control isn’t simply choosing to eat less every time you sit down to a meal or a snack, it’s about crafting your dietary patterns in a way so as to minimize hunger and cravings while maximizing fullness. Far easier to spend your willpower and energy on organizing your diet so as to minimize hunger rather than trying to stop eating when you are physiologically driven to continue. Experimenting with different meal and snack timings, distribution of calories, and macronutrient composition of meals and snacks can help you to discover what patterns work best for you.
Unless you have a medical condition impacting your ability to sense thirst, or you’re exercising vigorously for literal hours at a time, chances are if you simply drink water when you’re thirsty you’ll remain well hydrated. Unfortunately the notion that hydration plays an important role in weight management is more of a myth whereby perhaps the purposeful quantified consumption of water will help to affect at best a 2-4lb weight change over a year.
The most important thing to remember about exercise is that as far as weight goes, it doesn’t burn sufficient calories to have a major direct impact. That said, indirectly, by way of benefits to energy, sleep, mood, and attitude, exercise may be helpful in cultivating changes to behaviours as a whole - including dietary.
Worth mentioning too, there is no best or right exercise. Really the best exercise for you is the one you enjoy enough to sustain.
Similarly there’s no right amount with the aim being as much as you can enjoyably incorporate.
Finally, regardless of impact on weight, exercise is probably the best thing you can do to improve your health and preserve your functional independence.
Poor sleep and high stress can impact weight directly by way of slowing metabolism, increasing appetite, and indirectly by way of decreasing energy and mood which in turn will likely have a negative impact on healthy living behaviours as a whole. You can find some tips and tricks on how to get a better night's sleep in our post Mastering the Science of Sleep Hygiene.
Though unlikely to markedly affect weight on its own, mindful eating is certainly a good strategy for increasing enjoyment of your meals. This shouldn’t be confused with efforts to reduce distracted eating (in front of a TV, scrolling on your phone, etc.) - as studies have shown that distracted eaters eat more.
There are many different styles of intermittent fasting. Sometimes the term refers to time restricted eating whereby people restrict eating to particular windows in their day. Other times it may refer to alternate day fasting. And sometimes it refers to longer term fasts. Meta-analyses on the efficacy of intermittent fasting reveal it’s no better or worse a strategy than any other type of dieting, and like all diets, it works by way of caloric reduction. For many, the most challenging aspect of intermittent fasting is enjoying it enough to sustain it as often it will challenge people to face hunger and cravings and at times alter their social calendars and family eating plans. As with all diets, the key to success with fasting as a strategy is enjoying it enough to sustain it.
From an over the counter supplement perspective simply put there aren’t any that are proven to be both safe and effective.
Medication wise, there are now multiple medications with proven safety and efficacy with great tolerability that may be options to discuss with your primary care provider. Though there are different drugs and classes, our most effective current class of medication are GLP-1 analogues which mimic a hormone produced by our intestines which in turn binds to a receptor in the appetite control centre of our brains and when bound decreases hunger, decreases cravings, and enhances fullness.
As with any strategy for weight loss, if you lose weight consequent to the benefits of medication, and then you stop that medication, the expectation would be weight regain - just as if you stopped your medication for high blood pressure and your high blood pressure returned.
Of all of our treatments for weight, none provides more total average weight loss or long term average weight loss than bariatric surgery. Bariatric surgery has been shown to both extend life and improve quality of life and leads to losses averaging between 20-40% of presurgical weight depending on which surgical procedure is chosen. If you're looking for more information on weight loss surgery in Canada, please check out our deep dive.
No diet has ever been shown to provide superior longer term weight loss, meaning low-carb diets and low-fat diets and everything in between all see their share of successes and challenges. At the end of the day, weight is about energy deficits - regardless of macronutrient. That’s not to say that all macronutrients provide the same impact to health or quality of life, but no doubt you can both lose weight and eat a healthful diet with and without the consumption of carbohydrates.
Some people might experience weight loss by skipping meals due to the consequent decrease in total energy intake. However, for others, skipping meals can stimulate the production of hunger hormones. These hormones can influence dietary choices and portions, often leading to an increased consumption of energy-dense foods during the next meal. This increased intake can sometimes be greater than what they might have consumed had they been eating more regularly, thus offsetting the initial intention of meal skipping.
Trans-fats are bad. Full stop. As far as unsaturated and saturated fats, the goal should be to when possible, replace saturated fats (meat, dairy) with unsaturated (avocado, nuts, seeds olive oil, fish) when you can as the former raise cholesterol levels in a manner causal for heart disease while the latter appear to be protective.
In fact exercising for hours might lead a person to struggle with hunger, cravings, or reward eating to the point where it impairs weight loss. But really, exercise burns fewer calories than would be fair and it would appear that beyond moderate amounts of exercise, our bodies actually compensate for the calories we burn exercising by burning fewer calories when not exercising.
exercise is for heath, and can indirectly help to bolster changes to dietary patterns, but exercise alone as a weight loss strategy is likely to lead to underwhelming results.
Aim to exercise as much and as often as you can enjoy. More than that and you’re liable to quit and in so doing, lose the many non-weight related health benefits of exercise.
If it were, weight would not be a challenge as little doubt people who struggle with theirs have not suffered a shortage of effort and willpower to manage things. Willpower also suggests that success requires perpetual suffering that a person must will themselves though. It’s just that as a species we’re not good at perpetual suffering, especially not around something as seminally pleasurable and important as food and where we have millions of years of evolution during times of severe dietary insecurity leading our bodies to betray our goals. Not because we lack willpower, but rather because the physiology of hunger is more powerful than our best intentions and goals.
Support systems are useful in all areas of our lives and weight management is no different. If you’re going to rely on others to help you along your way make sure to choose wisely. Disclosing your efforts to people who in turn might serve to undermine them and/or have views and attitudes around weight management that differ from yours may challenge your efforts.
The best goals are process goals. So not losing a certain number of pounds weekly or in total, or fitting into specific clothing sizes, or even goals like running a 10K. Instead set goals around the things that may get you there. Goals around food diary usage, regularity of fitness, cooking, reduction in liquid calories, etc. The goal is the road, not the destination.
Tracking progress can come in various forms. Certainly if goals set are behavioural, it’s easy to track how many days you’ve used a food diary, how many meals you’ve cooked this week, how many minutes of exercise you’ve accrued - etc. From an impact perspective, aside from tracking weight loss, tracking energy levels and sense of well-being can be valuable, as can tracking markers like blood pressure, blood sugar, pain levels, and more.
Much as people want to believe new habits can be formed in mere weeks, the truth is that they take far longer and generally require ongoing efforts to remind and encourage yourself to continue to live and choose differently. A system of continuous ongoing reminders is valuable and perhaps the easiest in this regard would be some form of food diary work. Whether tracking macronutrients, calories, or even just foods consumed, every time you use it you’ll be reminding yourself to continue working towards behaviour changes.
The more difficult or restrictive the interventions you use, the more challenging it’ll be to stay motivated. As noted, if your hope is not simply to lose weight but also to maintain your weight loss, it’s crucial that the efforts you undertake are ones that allow you to enjoy life and have a healthy relationship with food.
Your measures of success will also influence motivation. If your focus is on numbers, whether they’re pounds lost, inches lost, body fat percentage changes, etc. you risk frustration. Ideally your measure of how you’re doing are the things you’re actually doing, not their outcomes and consequently you can take pride and in turn see that pride fuel motivation in considering your actual efforts rather than where they take you. This is especially important in that life is complicated and there are absolutely times where our best efforts may not be all that fulsome but when considered in the context of whether you’re doing the best you can given the circumstances, can still be a source of pride.
The best way to avoid weight loss plateaus is to let go of the erroneous notions that all weeks must involve losing and that weight is directly within your control. If the scale isn’t moving but you’re living the healthiest life you can enjoy, that's not a plateau, that’s your best weight. That said, if the scale isn’t moving and you feel there are ways that you could enjoy and sustain that will lead to decreasing energy consumption or increasing your energy expenditure and you deploy them, you may see further weight loss as a result.
Setbacks are part of every aspect of all of our lives. A simple thought exercise when facing yours is to ask yourself how you’d counsel your best friend or loved one if they were recounting your situation back to you. You need to treat yourself with the same love, respect, and empathy you would treat them.
Another simple exercise when facing a setback is instead of asking yourself what’s wrong with you, what’s your problem, why can’t you do this, ask yourself what you can do today that will help even a little and then follow through on that to notch a small victory.
When it comes to younger children, we would caution against any discussion of weight. The worry is that regardless of how well intentioned and gentle the discussion, you may have a negative impact on your child’s self-esteem, body image, or relationship with food and potentially increase their risk of disordered eating. Worth noting too, the primary lever of weight in kids, just as in adults, is food, and young children simply aren’t in charge of food in their lives. And even if they were, we know that dietary change and restraint isn’t simply a choice and depends on genes, hormones, and dozens if not hundreds of other factors beyond our individual control.
With adolescents, who may have more involvement in dietary choice and meal preparation, discussions should focus on avoiding extremes of effort and cultivating a healthy relationship with food and could also include cooking skills.
Ideally children and adolescents should be seen by health professionals with specialized training to work with them, both to assess for other related medical concerns, to consider what types of treatment or approaches would be best, and to try to ensure safety.
Sometimes forgotten in the discussion of weight is that as we get older, weight may protect us by serving as a reserve tank of energy that may help us to weather medical storms. While people are not statistics, and BMI as a measure isn’t suited to individual assessment, research would suggest that over the age of 65 having a BMI between 27-30 sees the lowest associated mortality while BMIs between 30-35 should the same associated mortality as between 23-27.
Actively losing weight is not generally advised for pregnant women. Depending on a woman’s weight at the start of pregnancy, organizing diet in a way to minimize gain during the first and second trimester may be advisable with the goal of a total pregnancy related weight gain of between 12-20lbs. Pregnant women or those considering pregnancy should speak with their primary care providers or obstetric teams for advice pertinent to them.
The mechanism of weight loss is the same for everyone, regardless of ability, but different disabilities will have an impact on different aspects of weight management. Some may affect organization. Some may affect cooking abilities, skills, or access. Some may affect activity. What’s most important when considering weight management for people with disabilities is ensuring that realistic goals and expectations are met which in turn reflect the impact that person’s disability might have on food and fitness behaviours.
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At the end of the day weight management, while simply describable as an energy balance equation, is anything but simple. Influenced by dozens if not hundreds of factors beyond our control and forged by dysfunctional societal views around weight, our best efforts will vary. The key to long term success is finding dietary patterns that not only help to reduce dietary energy intake, but are also enjoyable enough to be sustained - because if a person’s food and lifestyle interventions are only tolerable, they’re not likely to last.
Sticking to the need to enjoy their lifestyle it’s important to recognize one person’s best diet is another person’s worst. So when it comes to weight management, thoughtful experimentation with different strategies that in turn take into account an individual’s likes, dislikes, and social determinants of health is key in finding the approach best suited to them.
There has never been a time where success was more certain. Whether by way of behavioural changes alone, or with the addition of safe effective medications, or by way of bariatric surgery, long term successful weight management is available to everyone.
Generally speaking, unless by way of surgery or with the benefit of medications, losing more than 2-3lbs per week suggests the adoption of a lifestyle that’s too strict to be sustainable. But as always the most important measure is whether or not you’re enjoying your lifestyle.
Weight losses greater than 5% of your weight have been shown to have benefits to blood pressure and blood sugar where benefits rise with increasing losses. At times, weight loss can push a person’s existing weight responsive medical conditions fully into remission and sustained weight loss reduces the risk of developing them in the first place for those who hadn’t yet.
As far as over the counter weight loss supplements go, unfortunately none have been shown to provide meaningful losses or benefits, nor have most seen their safety carefully studied or monitored.
Bariatric surgery provides the greatest and most durable average weight losses of any weight management options. Its safety profile has improved so dramatically that most centres of excellence’s bariatric surgical risk profiles are no greater than that of the risks seen with a standard gallbladder removal.
Whatever you do to lose your weight, you’ll need to keep doing to keep it off. This is why it’s so important that you choose an approach that you honestly enjoy as otherwise the likelihood of you sustaining it and your losses drops significantly.
