Takeaway
When supporting patients with weight management, focus on improving quality of life through sustainable habits instead of just the number on the scale.
Lifelong learning in clinical excellence | March 17, 2026 | 2 min read
By Summer Kessel, RD, CSOWM, LDN
Many patients think that a successful weight loss journey is celebrating pounds lost. But if the scale were all that mattered, the most extreme, health-destroying methods would win. Numbers on the scale—for better or worse—provide data with which we can make assessments. It’s fine to place some value on them and keep track, but it’s not the most important thing.
How to help patients choose a goal weight
Helping patients choose a goal weight is tricky. Of course, we can start with some basic math using the BMI scale to consider a normal range with which the chart might say they are “healthy.” But once we have this general range of numbers in mind, let’s ask ourselves some questions to see whether this number really works. Here are some questions to ask yourself about the weight you decide on with the patient:
1. What weight is actually sustainable to maintain long-term lifestyle habits without having to use an extreme diet or restriction? Can they see themselves eating and moving in the same way forever?
2. What weight do they feel the best at?Are they sleeping well? Is their digestion normal? Do they have good energy? Are they in a good mood most of the time? Are they able to continue to build strength and fitness? Losing too much weight and chronically under-eating can feel awful, and isn’t healthy.
3. At what weight do their previously out-of-bound metabolic labs normalize and chronic health conditions improve?
4. How much weight loss from starting weight is realistic based on the medication they’re on? Remember, patients on Wegovy typically lose about 15% from their starting weight and on Zepbound 20%, on average. Of course, it’s possible to lose more, but plateauing here is extremely common.
Far too often I see patients falling into the trap of chasing “the last 10 pounds.” Fighting their bodies, their lifestyle, their medicine—going to extremes—to shed more and more weight in search of a “perfect” number on the scale. This can make long-term maintenance much more challenging. The risk of rebound weight gain is real. The harder they “fight” to lose weight, the harder it will be to maintain it.
What if, instead of looking for a number, we looked for other measures of success? Can we help patients work toward finding a balance between the effort to maintain their health and all the other important aspects of life that have nothing to do with weight?
Remember, improving the quality of a patient’s day-to-day life is the ultimate goal. In maintenance, focusing on non-scale measures of progress and success is key.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.