A new dieter, Alan, consulted me this week. He weighs 265 pounds and is 5'6". He would like to weigh 100 pounds less. "It's a mistake," I told him, "to set a big goal like that. First, we really don't know whether 165 pounds is a reasonable weight for you to get down to and maintain. Second, it's too far away." Alan immediately became discouraged and we had the following discussion (see pages 113-114 of the Beck Diet Solution).
Alan: But that was my weight 18 years ago. Why can't I try for it again?"
Dr. Beck: Can I give you an analogy? You have a ten year old daughter, right? What if your daughter came to you and said, ‘Dad, I want to become a nationally ranked gymnast.' Would you say, "Hey, that's a great goal!"
Dr. Beck: Why not?
Alan: Because I don't think she has the genetics for it. She's a big girl.
Dr. Beck: Any other reasons?
Alan: I wouldn't want her to set her sights on something unreasonable and then feel badly when she couldn't do it.
Dr. Beck: But what if she likes gymnastics? Do you think she shouldn't pursue it at all?
Alan: No, but.....I guess I'd want her to just have fun doing it-and not try for something too hard.
Dr. Beck: Well, it's the same with weight loss. I have no doubt that you can lose weight if you learn the skills you need, but I don't know now how much weight you can lose. It's not entirely under your control. I don't know how big your natural appetite is, how fast your metabolism is, what your lifestyle is like, how much exercise you do consistently, what your favorite foods are, how much access you have to selecting your food, how much stress you're under, how much time and energy you have for dieting, and so forth.
Dr. Beck: You know, most people think, "I should just be able to set a weight loss goal and achieve it." But like gymnastics, certain factors aren't completely under people's control. Now it's possible that you can lose 100 pounds. It's also possible that you could maintain your 100 pound weight loss. But to be honest with you, it's not likely.....For one thing, you don't have the same metabolism as you did 18 years ago....Now does that mean you shouldn't try at all?
Alan: I guess not.
Dr. Beck: So are you willing to set a goal just to lose five pounds? When you do, you'll celebrate and then you can see whether it's reasonable to set a goal to lose another five pounds, and so on. How does that sound?
Alan: Okay, I guess.
Dr. Beck: I know, I know, it's disappointing. I think the media usually makes it sound as if people can lose as much as they want, that they can override their biology. I can help people overcome their psychology, help them stick to an eating plan that's reasonable for them, but biology is another matter. And I'd rather have you set your sights lower now, even if it's disappointing, than have an unreasonable goal that you can't achieve and get so disappointed later that you gain back whatever weight you lose.
Alan: Fair enough.
I hope this dose of realism doesn't dissuade Alan from trying the cognitive behavioral approach. If it does, he may try another approach and end up back in my office within a year or two. Sometimes people just have to give other things a try before they're ready to settle down and be realistic.