I have been talking a lot about self-determination theory and the importance of having autonomous control. If you don’t have independent control over your weight loss, that will affect your motivation to continue. Relying on a scale to measure your progress can therefore lead to a feeling of failure despite doing everything that you can to lose weight, which is the main reason so many people give up their efforts to diet. On the other hand, if you don’t rely on a scale to measure how you’re progressing, how can you tell if you’re reaching your goals?

You start by clarifying the meaning of the word  “goal” and then determining what your goals will be. For the purposes of clarification, I recommend distinguishing between goals and outcomes. The challenges that I help people with normally involve goals that are related to behavioral change, as opposed to something like, say, a fundraising goal. Therefore, I define the idea of a behavior change goal as something that, in addition to being measurable and attainable, like any goal, is a behavior that you control exclusively and directly. The result of implementing that control is the outcome.

When this is applied to weight loss, your behavior – what you eat and how many calories you burn – is the only thing that fits that description of exclusive and direct control. Weight loss is merely the eventual outcome of the choices you make when you engage in those behaviors. Of course, if you make better choices consistently over a period of time, weight loss is pretty much guaranteed. How much you lose, and how quickly it happens, however, is unpredictable. That’s why diet ads have so many disclaimers like “individual results may vary.” So aiming for a specific weight and a deadline to achieve it may be more like setting up for failure than setting a goal.

The implication of shifting your focus from weight to behavior is that it involves a corresponding change in attitude. While your emphasis on your behavior becomes more active, your approach to weight loss becomes more passive. You become more of an observer of your weight change than a controller of it. Rather than anticipating the number on the scale with dread, you observe it with interest. Your behavior, however, has a new and elevated status. It becomes the focus of your attention and the measure of your success.

So how do you measure behavior? One idea that I recommend is to choose three new behaviors to focus on, one from each of three categories: reducing caloric intake, increasing physical activity, and making a lifestyle change that doesn’t directly involve either of the first two categories, but is associated with weight loss. For example, the first could be reducing portion sizes or looking for acceptable lower calorie alternatives to foods you currently enjoy. The second could be, say, walking more as part of your daily commute and errands, or routinely taking the stairs instead of the elevator. The third could be keeping track of what you eat or having at least two main meals sitting at a table.  These are just examples of the types of behaviors that you can choose.

Then you can use a wall calendar or some other month-at-a-glance format to take the place of the scale. At the end of each day, write a number in the box for that day that indicates how many of those behavioral goals you have accomplished that day. Each day’s score will range from 0 to 3, and t the end of each week you can add up those numbers and track your progress. This new “behavioral scale” will have a weekly total between 0 and 21 and you can track the results over time. You can even get fancy and put it on a spreadsheet so you can graph it, if that helps. If you’re hitting the maximum or close to it pretty regularly, than redefine the goal by increasing the behaviors required to reach it or replacing an old behavior that has become routine. You can also just add a new behavior; the limit doesn’t have to be 21.

Now you will have a meaningful goal and a way to track your progress as you would track your weight except that it truly represents your efforts at behavior change. With the behavioral scale you control every aspect of it, and you should never be surprised by the results. Using terms of autonomous control, you have exclusive authority over choosing the behaviors and reaching your goals, and the responsibility to achieve them is entirely yours.

Then, after a while, go ahead and pull out the scale from under your bed to check in on that outcome. Just out of curiosity, of course.

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Your Weight and Fortune

September 3, 2012

I used to have the annoying habit of answering a question with a question. Once, a friend wanted to share one of those light bulb-changing manpower jokes that involved therapists. “How many therapists does it take to screw in a light bulb?” he asked. The answer was supposed to be just one, but only if it really wants to change. Instead of playing along, I raised one eyebrow and with my best therapist expression responded with my first thought: “How many do you think?” Fortunately, he was a good sport and laughed.

I think I’ve gotten better about it, and when I occasionally do slip back into my old ways it’s usually for a good teaching opportunity. For example, when my patients ask me how often they should weigh themselves I usually respond with, “What’s it to you?” Okay, not in so many words, but I do ask them to tell me why they want to know their weight. I know it might sound like a dumb question, but my goal is to get them to think about what the number on the scale really means to them.

At best, people regard their weight as a quick and simple indicator of whether their eating habits have gotten off-track by comparing their current weight with what has always been normal for them. That’s not a bad way to use the scale. They know what they usually weigh, and if they see an increase of a few pounds, it serves as an early warning sign to start paying more attention to their eating.

For many people, though, especially those who struggle with their eating, the number on the scale takes on a far more important and frankly worrisome meaning: it represents their Score of Personal Worth. It’s often taken as a sign of whether they’re literally measuring up. It’s a score of how successful they are at being in control of their weight, and by extension, their lives. Here’s how one blogger on the Weight Watchers website describes the feeling:

“I’m always on edge Friday nights before Saturday morning weigh-ins. I guess until I’ve had more losing weeks, I’ll feel that way. It’s always a surprise, for sure. Sometimes when I’ve been very, very good, I’ll gain. Sometimes when I’ve been very naughty, I’ll lose. It’s a little surreal…like the Zoltar wish machine from Big with Tom Hanks. Please, Zoltar, I wish to weigh less!”

Relying exclusively on weight to measure progress with behavior change can have a very real negative impact on your motivation because expectations are often unrealistic, and the results are therefore likely a surprise. What’s worse is that the surprise can have a negative effect regardless of whether the results are worse or better than expected. If it’s worse, the reaction may be to give up the belief that things will ever improve. If it’s better than expected, it can create the unwarranted confidence that you can eat as much as you want and still lose weight!

When I worked at a hospital-based weight management program, we would normally weigh clients before the therapy session. For the staff, it was just part of keeping good medical records and noting any changes. But when I saw how patients reacted I became increasingly concerned about how they really felt about that part of the routine and how it impacted them.

Often, they would appear apprehensive before stepping on the scale. In addition to taking off their shoes, they would typically remove light sweaters, silk scarves, jewelry, just about anything that might add an ounce or two to that dreaded number. Sometimes, they would ask me not to tell them the result while they either covered their eyes or stood facing away from the digital display.

My concern bordered on alarm when a patient, anxious but optimistic about the results, reacted with mute shock and then outright despair when it was not what she had expected. I spent most of the session helping her out of that emotional state before we even had an opportunity to discuss the outsized personal meaning her weight held for her. At that point I realized that people not only overvalue the information on the scale, but it may actually be undermining their efforts at behavior change.

Most misleading is the normal daily fluctuation in weight due to the body’s retention of water. This can cause a variation in weight of as much as three to five pounds in either direction that is irrelevant as a meaningful indicator of anything. This can be due to water that you recently drank, salt intake, menstrual cycles and numerous other causes.

Even when weight is calculated together with height, as in the Body Mass Index (or BMI) that is widely used in medicine, the information is at best incomplete and at worst misleading. The BMI score is used to determine weight classifications, such as underweight, normal, overweight, and obese. However, these numbers were based on population norms used in actuarial tables to underwrite life insurance policies, where it would serve as a red flag. If the BMI indicated that an individual’s BMI is higher than the norm, it may trigger a need to more closely evaluate the person’s health. The index was not intended to assess health risk for an individual, as it is commonly used today. It also does not account for bone density, body frame, or muscle mass, all of which can overstate the meaning of a higher than average BMI.

Simple weight reflects only behavior that was undertaken prior to stepping on the scale. It may be useful if it changed in direct response and proportion to the recent effort someone puts forward in changing their eating behavior, but that is not at all the case. As I discussed in the previous section about the weight-loss plateau, dietary changes can take a long time to be reflected in weight, and the correlation between cause and effect is not a straight line.

Most importantly, even a truly meaningful measure of the percentage of body fat is not under our direct control. On the other hand, our behavior is under our direct and exclusive control. Not only that, but the outcome of that control, lifestyle change, is immediate, and eventually does indeed have a profound impact on weight, health, and well-being.

The bottom line is that your weight alone does not carry the meaning usually ascribed to it – in what it says about our health, well-being, or appearance – and it’s certainly not a measure of our self-worth! So if you’re still wondering whether or not you should weigh yourself on a regular basis, I would say, what do you think?