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A Thoughtful Reminder About Using Weight As a (Primary) Measure of Health

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Family physician Yoni Freedhoff, MD (Associate Professor, Department of Family Medicine, University of Ottawa; Medical Director, Bariatric Medical Institute, Ottawa, Ontario, Canada) recently penned a worthy read over on MedScape – Scaling Back on Weight as a Measure of Patient Health. (Note – free account required to read the full article).

From the article –

…When I was a medical student in the 1990s, I wasn’t taught how to use a scale, and I’m betting that the same is true for most medical students today. Don’t get me wrong; it’s not that I think scales are complicated pieces of equipment, but after exclusively practicing obesity medicine for the past 15 years, I do think that their proper use is worth discussing.

Scales do measure the gravitational pull of Earth at a given moment in time. Scales don’t measure the presence or absence of health, nor do they measure lifestyle or effort. And for patients, it’s useful to note that scales don’t measure happiness, success, or self-worth, either…

He goes on to remind that while weight is without question a significant risk factor for a plethora of medical conditions, particularly at the extremes of the body weight curve, weight alone is not a guarantee that any or all of these conditions will occur. He also reminds that inferring health status from body weight alone is often a fool’s errand, and that scales don’t measure lifestyle.

My specific intent in mentioning the article is two-fold. One, to remind us all that the principle objective of improving our nutrition and fitness is to optimize our health and ability to function in life, not necessarily attaining some (often arbitrarily derived) number on a scale that conforms to our (real or not) body image.

And two, it’s always interesting to read responses to opinion articles that are targeted toward a physician audience and “peek behind the curtain” if you will at their responses. I for one think it’s a good thing conventional medicine is beginning to talk in earnest (at least part of the time) about lifestyle influences on health…

Question of the Day: How Often Should I Weigh?

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Interesting question from John about how often to check in on the scales…

I’ve just now been converting to a healthy diet (more or less classic paleo) over the past six weeks or so. I’m what most would consider a huge guy – I weigh over 420 pounds – and realize that it’s going to take me months (maybe years) to recover my body. I dropped 15 pounds in the first two week, and now progress is much slower. Weighing every day, and even every week is pretty discouraging given the big challenge facing me, what would you advise?

I’m on the road today, but wanted to share a few quick thoughts with John, given in particular that I personally faced a similar, and at one point, discouraging challenge. (As an aside, I happen to be a data nerd and love tracking all sorts of metrics, but I stopped doing weekly weight checks as I’ll share below.)

That said, several quick thoughts…

Attaboy John, You’ve Made the Right Choice to Get Started

First, an enthusiastic attaboy for making the decision to get started on your journey to recover your health, fitness, and function. Never doubt that it can be done; I weighed over 400 pounds myself a little over three years ago, and am a today few weeks away from having lost half my former body weight.

It’s not a glamorous process, but a very attainable one, and you’ve gotten off to a great start thus far. My first piece of heartfelt advice is this: recognize it’s going to take a months to reach your targets (whatever they might be at this point), focus on working your persistence and patience muscles daily.

Remember that Body Weight is Only One of Many Meaningful Metrics

For those of us facing the daunting challenge of dropping significant excess body weight, using the scale as our only measure of success, especially early on, can be discouraging given the rate of change we see, particularly if weighing daily (which I don’t advise for you), or at this stage in the game, even weekly.

Look for other tangible and valuable measures of success; clothes fit better and then you’ll find the need to drop a size or two. As you move more in daily life, walking becomes easier, your endurance will improve, and exercise for strength and endurance will become something you’ll look forward to. Sleep will improve, heartburn will resolve, and I’ll bet the barn your mood and attitude will begin to reshape too.

Numbers on a scale may not end up being the most valuable indicator of progress at all.

How Often to Weigh? Consider This Option With A Long Way to Go…

When it’s all said and done, how often to weigh eventually boils down to a matter of personal preference, and there’s clearly no right or wrong answer as long as the scale doesn’t become an instrument or focus of an obsession.

Let me share a quick story from my own experience; early on in my own recovery journey, I charted weekly weights, though found three or four months in that dropping anywhere from 1-2 pounds per week seemed discouraging, even with an occasional 3 pound week mixed in. Looking at where I was, and comparing to my end goals (>200 pound loss), on some days prompted that voice of self doubt to creep in, usually something along the lines of “who in the hell do you think you are to imagine you could drop this much weight; you’ll never get there, etc…”.

A friend, actually a former 800m Olympic runner back in the day, encouraged me one day to quit focusing so much on the scale, and focus more on my daily process – eating good food that’s been well-prepared in line with my goal macros and that day’s fitness pursuits (whether fun or a grind it out workout). She challenged me to move to monthly weigh-ins, which I did over two years ago and continue to this day. For those of us with goals of dropping a lot of pounds, I still advise considering a trial of at least a couple of months weighing only monthly.

And to be frank, in my own experience, changing my wardrobe has been a hell of lot more gratifying – and reinforcing – than dropping big numbers on the scale.

I’d certainly encourage you to eschew the daily weight checks, and weigh no more often than weekly. If monthly checks leave you feeling a data void, consider twice a month on the first and fifteenth.

More to come…