Beagle Obesity How to Incorporate Weight Loss into Daily Life

How to Get Beagle to Lose Weight: Effective Tips and Strategies

Are you worried about your adorable Beagles expanding waistline? If those extra pounds are making you howl with concern, fear not! Lets embark on this journey to a healthier and happier Beagle together: How to Get Beagle to Lose Weight.

We understand the importance of helping your Beagle shed those unwanted pounds and achieve their ideal weight. In this comprehensive guide, we will reveal effective strategies and tips to facilitate successful weight loss for Beagles. With our paw-some game plan, your furry friend will become the lean, energetic Beagle they were meant to be, bounding back to optimal health in no time.

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So, grab a treat for yourself and embark on an exciting journey to help your beloved Begal become the slim and trim superstar they were born to be!

Why is it Important to Help Your Beagle Lose Weight?

It is important to help your Beagle lose weight for several reasons:

• Health Concerns: Obesity in Beagles can lead to various health problems, including diabetes, heart disease, joint issues, and respiratory problems. Helping your Beagle maintain a healthy weight can reduce the risk of these conditions & promote overall well-being.

• Increased Lifespan: Beagles that are overweight tend to have shorter lifespans than those who maintain a healthy weight. By helping your Beagle shed excess pounds, you can extend its lifespan and enjoy more quality time together.

• Improved Mobility: Carrying excess weight strains your Beagles joints, making it difficult for them to move comfortably. By helping them lose weight, you can alleviate this strain and improve their mobility, allowing them to engage in physical activities more easily.

• Enhanced energy Levels: Being overweight can lead to lethargy and reduced energy levels in Beagles. Helping your Beagle achieve a healthy weight can increase their energy levels and promote a more active lifestyle, which is essential for their happiness and mental stimulation.

9 Top Ways: How to Help a Beagle Lose Weight

Top Ways to Help a Beagle Lose Weight

(I) Exercise

Engage your Beagle in physical activities such as brisk walks, jogging, or playing fetch. Gradually increase the duration & intensity of exercise to help burn calories and improve fitness.

(II) Start Measuring Calories

One of the first steps to help your Beagle lose weight is to measure their daily caloric intake. Consult your veterinarian to determine the appropriate calorie range for your dogs size, age, and activity level. Moreover, use a measuring kitchen scale to portion their food accurately.

(III) Make Changes in Diet

Evaluate your Beagles diet and make necessary adjustments to promote weight loss. Opt for a high-quality, balanced dog food specifically formulated for weight management. Avoid free-feeding and instead establish set meal times to control portion sizes.

(IV) Help Your Dog Move More

Regular exercise is crucial for weight loss. Increase your Beagles daily physical activity gradually. Start with shorter walks & gradually increase the duration and intensity. Moreover, consider activities like playing fetch or agility training, which can mentally and physically engage your Beagle.

(V) Provide Extra Play Time

Beagles are active and playful dogs. Encourage more playtime to burn additional calories. Engage them in interactive games, such as hiding treats or toys for them to search, stimulating their mind and keeping them physically active.

(VI) Use Vegetables as Treats

Instead of calorie-dense treats, offer your beagle low-calorie alternatives. Vegetables like carrots, green beans, or cucumber slices make excellent treats that are low in calories and fiber. They can be used as rewards during training sessions or as occasional snacks.

(VII) Cut Down Carbohydrates

Reducing the amount of carbohydrates in your Beagles diet can aid in weight loss. Choose dog foods with lower carbohydrate content and focus on providing more protein and healthy fats. Therefore, consult your veterinarian for appropriate diet recommendations.

(VIII) Prefer High Protein Diet Food

Feeding your Beagle a diet rich in lean proteins can help support weight loss. Protein keeps them feeling fuller for longer, reducing the urge to overeat. Look for dog food formulas with high-quality protein sources, such as chicken, turkey, or fish.

(IX) Feed Many Small Meals

Instead of feeding your Beagle one or two large meals, consider dividing their daily food allowance into multiple smaller meals. This approach can help prevent overeating and keep their metabolism active throughout the day.

Curious: Beagle Overweight Causes

Beagles are small to medium-sized breeds known for their friendly and outgoing nature. However, like any dog, they can become overweight if not properly managed. Several factors can contribute to a beagle becoming overweight:

• Overfeeding: One of the primary causes of Beagle overweight is overfeeding. Beagles tend to eat more than they need, especially if given unlimited access to food. They have a keen sense of smell and a strong food drive, which can lead to overeating if not controlled.

• Lack of portion control: In addition to overfeeding, inadequate portion control can also contribute to beagle obesity. Beagles should be fed according to their age, size, and activity level. Moreover, providing too much food at each meal or not measuring portions accurately can result in excessive calorie intake.

• Lack of exercise: Beagles are an active breed that requires regular exercise to maintain a healthy weight. An inactive lifestyle or lack of physical activity can lead to weight gain. Beagles should be given opportunities for daily walks, playtime, and mentally stimulating activities to help burn off calories.

• Treats and table scraps: Beagles are fond of food; excessive treats or table scraps can quickly contribute to weight gain. Many commercial treats are high in calories and can add up if given too frequently. Choosing low-calorie treats or using small pieces of healthy food as rewards during training is important.

• Neutering/spaying: Neutering or spaying your Beagle can alter its metabolism, leading to a decreased energy requirement. If the caloric intake is not adjusted accordingly, it can result in weight gain. Its important to consult your veterinarian to determine the appropriate diet and feeding plan for a spayed or neutered beagle.

Risks of Canine Obesity

Canine obesity, or excessive weight gain in dogs, is a growing concern among pet owners and veterinarians. While spoiling our furry friends with extra treats and indulgent meals may be tempting, its important to recognize the risks associated with canine obesity. Here are some of the key risks:

• Reduced Life Expectancy: Obese dogs are prone to a shorter lifespan than their healthy-weight counterparts. Studies have shown that obese dogs are likely to develop chronic health conditions that can significantly impact their quality of life and longevity.

• Joint and Mobility Issues: The additional weight strains a dogs joints, leading to arthritis and hip dysplasia. These conditions can cause pain, discomfort, and reduced mobility, making it difficult for dogs to enjoy physical activities and exercise.

• Increased Risk of Chronic Diseases: Obesity in dogs is related to a rising risk of developing multiple chronic health conditions, including diabetes, high blood pressure, heart disease, respiratory problems, and certain types of cancer. These conditions can be life-threatening and require long-term management.

• Heat Intolerance: Overweight dogs struggle with regulating their body temperature, particularly in hot weather. They are at a higher risk of heatstroke and other heat-related conditions due to the additional insulation from the fat, which inhibits efficient cooling through panting.

• Emotional and Behavioral Issues: Canine obesity can have psychological implications for dogs, leading to decreased self-esteem, depression, anxiety, and aggression. The social and emotional well-being of the dog can be negatively affected, impacting their overall quality of life.

Causes of Obesity in Dogs

Several factors can contribute to obesity in dogs. Here are some common causes:

Poor Diet

Feeding your dog a diet high in calories, unhealthy fats, and carbohydrates can contribute to obesity. Low-quality commercial dog foods or excessive table scraps can lead to weight gain. Feeding your dog a balanced & nutritious diet is important to maintain a healthy weight.

Breed Predisposition

Certain dog breeds are prone to weight gain and obesity. Breeds such as Labrador Retrievers, Beagles, and Cocker Spaniels are known to have a higher risk of obesity. Its important to be mindful of the specific needs of your dogs breed and adjust their diet and exercise accordingly.

Age

Older dogs have a slower metabolism and decreased activity levels, making them more susceptible to weight gain. As dogs age, their calorie requirements decrease, and if their diet isnt adjusted accordingly, they can gain weight.

Medical Conditions

Specific medical conditions can lead to weight gain in dogs. Hypothyroidism, Cushings disease, and insulin resistance can contribute to obesity. If you doubt a medical condition is causing your dogs weight gain, its important to consult with a veterinarian.

Feeding Habits and Environment

Inconsistent feeding schedules, leaving food out all day, or free-feeding can contribute to overeating and weight gain in dogs. Additionally, an environment with multiple pets where one dog monopolizes the food can result in weight gain in the less dominant dog.

How Can I Get My Cute Beagle to Lose Weight?

To help your adorable Beagle shed those extra pounds, heres a paw-some plan:

• Get moving: Schedule regular exercise sessions for your Beagle. Engage in activities like brisk walks, jogs, or even fun games of fetch. Moreover, make exercise enjoyable for both of you!

• Treat wisely: Treats are great for training, but opt for healthier options like low-fat, grain-free treats or small pieces of fresh fruits & vegetables. Remember, moderation is key!

• Slow & steady wins the race: Gradually reduce the portion sizes rather than making sudden changes. This allows your Beagles body to adjust without feeling deprived.

• Toy time: Keep your Beagle mentally stimulated with interactive toys like treat puzzles or Kong toys stuffed with healthy snacks. However, this can distract them from overeating and provide an entertaining workout for their jaws!

• Regular check-ups: Schedule regular visits with your veterinarian to monitor your Beagles progress and adjust the weight loss plan if needed. Moreover, they can give valuable guidance & support throughout the journey.

Wrap Up

In conclusion, helping your Beagle lose weight is a worthwhile endeavor that requires dedication, patience, and a well-rounded approach. You can set your furry friend on a healthier and happier life by implementing a balanced diet, providing regular exercise, and ensuring mental stimulation. Remember, a slimmer beagle is a happier beagle, so lets embrace this journey together and watch those pounds melt away. Heres to a long and active life filled with tail wags and slobbery kisses!

Quality of life and psychological wellbeing in obesity management: improving the odds of success by managing distress

Introduction

Obesity: a growing health concern

Obesity is rapidly becoming one of the most important health concerns in developed countries worldwide. In Canada, the proportion of adults meeting the accepted criterion for obesity [Body mass index (BMI) 30 mg/m²] has more than doubled over the past 40 years, from 10% in 1970 to 26% in a 2009/2011 survey 1. Similar increases in rates of overweight and obesity (abnormal or excessive fat accumulation that may impair health) have been observed in other industrialised countries 2.

The increasing prevalence of obesity places significant burdens on individuals and healthcare systems. Obesity is a risk factor for numerous medical conditions, including endocrine/metabolic disorders, certain cancers and cardiovascular disease 3, 4. More than half of cases of type 2 diabetes and more than a third of pulmonary embolisms are attributed to obesity, as are many cases of gallbladder disease, colorectal and pancreatic cancers, osteoarthritis and chronic back pain 3.

As a result of the primary effects of obesity and the health impact of these comorbidities, overall and causespecific mortality increases with BMI in the obese range. Metaanalysis of prospective studies from North America and Western Europe suggests that a BMI between 30 and 45 confers a 2 to 10year decrease in life expectancy; individuals with a normal BMI had almost an 80% chance of living to age 70, compared with ~60% with BMI 3540, and ~50% with BMI 4050. Much of this excess mortality was attributable to obesityrelated complications including vascular causes, diabetes, and kidney or liver disease 5. Clearly, the management of obesity is of great clinical importance.

In addition to its clear clinical effects, obesity carries a substantial burden in personal terms, as measured by reduced daily functioning, and by general, healthrelated and obesityspecific qualityoflife (QoL) metrics. Individuals living with obesity are subject to considerable stigma, which they may internalise and experience as shame, depression and anxiety 6, 7. As argued below, patient affect is intimately connected to the success or failure of weight loss interventions and therefore needs to be acknowledged by clinicians and dealt with as part of a weight management programme. Here, I focus on one crucial dimension of this psychological burden, namely distress over obesity, which should be understood as the degree to which an individual is concerned and unhappy about his/her body and the impact of excess weight. I also introduce tools for evaluating a patient's experience of distress and offer suggestions about effective use of these tools in the clinical setting.

Obesity management means behaviour change

As obesity is a chronic and often progressive condition, its management requires longterm behavioural change 8, 9, 10. Indeed, for all obesity intervention strategies (i.e. behavioural interventions, medication and surgery), an individual's commitment to new habits and practices is crucial to success. Behavioural intervention requires the individual to implement new behaviours and maintain them after initial weight loss is achieved 8, 10. Maintenance of behaviour change continues to be an issue even when other strategies are introduced. Currently available pharmacological treatments generally do not stand alone, but are used as part of an integrated strategy that includes behaviour change 11, 12. Medication adherence is a key behaviour that determines treatment success. Indeed, even with bariatric surgery, longterm success in maintaining weight loss is influenced by behaviour postsurgery (e.g. emotional eating), and, in some cases, by the steps taken ahead of surgery to prepare for the procedure 13, 14. Thus, in all cases, it is essential to help the patient adopt the new behaviours (e.g. healthy eating, physical activity, medication adherence, protein supplementation following surgery) as part of their normal routine 8. Both in primary and specialty care, these efforts should be tailored to the patient's strengths and barriers, with a clear understanding of the distress that he or she experiences as a result of obesity.

Methods

Literature on psychological and behavioural issues in obesity treatment was queried using the following PubMed search terms: distress over obesity, psychological/behavioural/social mediators of obesity, obesityspecific quality of life scale and the major weight management strategies (surgical, behavioural modification, pharmacological) along with QoL or psychological impact. For key papers, a forward search was conducted through Web of Science to identify additional literature building on relevant concepts.

Obesity and psychological health a complex, bidirectional relationship

Psychological, social and behavioural mediators of obesity

The relationship between excess weight and psychological wellbeing is complex, encompassing physical, social and psychological factors (Figure ) 15. Furthermore, this relationship is bidirectional: living with obesity impairs QoL and increases the risk of psychiatric and affective disorders; conversely, patients with psychological troubles may become obese as a medication side effect and/or because they use food as a coping strategy 15, 16, 17, 18, 19, 20. Many individuals living with obesity experience selfblame, low selfesteem, and general negativity towards themselves and their situation 15. Managing distress over obesity has the potential to directly improve QoL and indirectly affect health behaviours such as treatment adherence. For this reason, distress should not be regarded as strictly a matter of mental health, but rather as a critical factor in successful longterm weight management.

A model of the moderating and mediating psychological factors that contribute to the relationship between obesity and wellbeing (Adapted from Gatineau and Dent 15)

The social aspects of obesity play important roles in distress over obesity. One of the most damaging is stigma, which in many cases is both external (i.e. stemming from others) and selfdirected. Pervasive negative attitudes towards people who are obese pose a significant challenge to individuals access to employment, education, social opportunities and healthcare 6. Many individuals living with obesity internalise these feelings of stigmatisation and feel shame or distress about their own size and habits; this can contribute to low selfesteem, impaired work and social life, and diminished overall psychological wellbeing 21.

Behaviours strongly tied to psychological and motivational attitudes also have a significant impact on weight loss outcomes. Many individuals with obesity get stuck in a cycle of yoyo dieting, where any weight lost with a given intervention is soon regained. This cycle can be mediated for many by the distress associated with not achieving either the desired amount of weight loss or the desired body shape 22. These experiences often colour the patients attitudes towards and persistence with any future management strategies 9, especially as QoL may yoyo along with weight 23. For individuals with obesityrelated conditions causing pain or mobility restrictions (e.g. osteoarthritis, cardiovascular disease, chronic back or joint pain), physical disability may contribute to a vicious cycle of inactivity, depressed mood and further weight gain 19, 24, 25.

Distress over obesity: a key mediator to appreciate and quantify

Distress over obesity is both a contributor to and a result of obesity, influences selfesteem and the individual's motivation to initiate and maintain behavioural changes 21, 26, 27. As a general principle, it would be prudent for healthcare providers to assess the degree of negative impact of living with obesity on psychological functioning. Physicians can choose scales based on the relevance of the content of the scales (e.g. psychological distress vs. functional interference) to the clinical context.

In particular, scales that evaluate distress over obesity can contribute valuable insight into patients emotional experience of their condition and how it could motivate them to initiate and maintain change. A diverse set of scales can be used to evaluate the impact of obesity on patient function and QoL (Table ), some designed specifically for use in people with obesity and/or studied and validated in this patient population. Of these, two validated tools are particularly useful for gauging distress over obesity and are brief and easily introduced into clinical care.

Table 1

Scales for evaluating QoL in patients with obesity

The Obesity Adjustment Survey (OAS) is a brief questionnaire designed for use in primary and specialist care to focus specifically on an individual's level of distress over obesity (Table ). This tool was developed and validated in a morbidly obese population [either 100 lbs (45 kg) over ideal weight or 100% over ideal weight)], and can assess individuals overall distress levels at any point. When used to track QoL impacts of interventions 26, the tool's value is most evident in management. For instance, asking a patient to complete the OAS provides valuable information that the physician can share with the patient. Educating the patient about distress over obesity and supporting the patient in pursuing methods to achieve a healthier weight and address issues of obesity distress enables the physician to apply the selfmanagement support perspective the dominant model in chronic disease management 28. As exemplified by largescale campaigns such as Dove's Campaign for Real Beauty and Movement for SelfEsteem 29, a patient with low selfesteem can be encouraged to resist comparing herself to societal norms.

Table 2

The 20 items of the Obesity Adjustment Survey, Short Form (OASSF)

A second tool, the IWQOLLite (Impact of Weight on Quality of LifeLite), also incorporates a measure of distress over obesity. The IWQOL and IWQOLLite have been validated in an overweight population and are commonly used in trials of weight loss interventions to assess public distress, as well as physical functioning, selfesteem, sexual life and work life 30, 31. Their validity and applicability in patients with comorbid psychiatric disorders have also been established 32. Elements of the IWQOL including assessment of public distress have also been incorporated in other obesityspecific QoL tools, including the Laval Questionnaire 33 from Canada and the QOLOD scale 34 from France. A systematic review of obesityspecific QoL scales can be found in Stucki et al. 35.

It bears mentioning that there are many other QoL scales that provide an overall snapshot of psychological wellbeing, not tied to obesity or other particular conditions. Some such nonspecific scales (e.g. the SF36 36 and the Beck Depression Inventory 37) have been validated in obese populations. Although they are not designed to highlight drivers of obesityrelated distress 31, these more general scales can be useful in screening for psychopathology or overall QoL. In such circumstances, if a person were to be screened as a case, the physician would need to explore the extent to which obesity determines or contributes to the symptoms identified.

Qualitative patient research

Additional insights into the lived experience of obesity can be gained through studies that take a qualitative approach to describing patients experiences in living with obesity. In this area, the DAWN/DAWN2 (Diabetes Attitudes, Wishes, and Needs) studies in individuals with type 1 and type 2 diabetes may serve as a useful model 38, 39. These studies collected patients selfreports regarding their levels of diabetes selfmanagement, their experiences of distress in dealing with their condition, the quality of their relationships with healthcare providers and their satisfaction with treatment. Study populations included a high proportion of individuals with type 2 diabetes, most of whom were overweight or obese 8. In the Canadian arm of DAWN2, over 80% of obese respondents reported feeling very anxious about their weight; high levels of concern over weight were associated with lower selfrated health, more diabetesrelated distress, poorer psychological wellbeing and higher rates of psychological treatment compared with patients who were not distressed about their weight 40. Significant negative correlations were found between BMI and all QoL indicators, including selfreported health status (EQ5D VAS), overall QoL (WHOQOLBREF) and psychological wellbeing (WHO5). The questions and themes explored in DAWN/DAWN2 and the preliminary findings in the subpopulation of overweight respondents provide a framework that could easily be extended to the general population of individuals living with obesity, to provide a more comprehensive picture of the psychosocial implications of excess weight in particular, psychosocial factors including distress over obesity, and the impact of weight management interventions on psychological wellbeing.

Obesity management in clinical practice

Impact of weight management strategies on distress over obesity

As excess weight can have a significant and multifaceted impact on psychological wellbeing, interventions leading to or helping maintain weight loss can improve various aspects of QoL. In trials of surgical and nonsurgical methods, weight loss is associated with improvements in overall scores for validated QoL instruments (e.g. SF36, IWQOLLite) and in key subscales related to physical wellbeing and public distress 13, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51. Behavioural interventions and bariatric surgery have also been shown to moderate distress over obesity along with depressive symptoms 13, 46, 47, 51.

The relationship between weight management and the key psychological parameter of distress over obesity is particularly illuminating, in that it has evolved along with our understanding of how best to assess the impact of obesity on patients psychological wellbeing. In the past, patients with the greatest psychological burden (obesityrelated and otherwise) were specifically excluded from surgical and behavioural treatment 52, 53. The introduction of QoL scales specific to the concerns and circumstances of the obese population has allowed us to broadly stratify subjects into three groups (high, moderate or poor functioning) and compare outcomes after surgical or other management. We now know that baseline distress level does not affect the degree of weight loss achieved with bariatric surgery, and that patients in the most distressed group can see a normalisation of their distress scores to levels similar to those in higher functioning groups 48. The exclusion of patients with lower function at baseline was therefore based on a misunderstanding, and we now appreciate that obesity treatment should not be withheld because of psychological burden; indeed, doing so can be considered a form of obesity bias.

Limitations of the minimally clinically important difference

The relationship between the degree of weight loss and improvements in QoL (including psychological wellbeing) is a subject of considerable debate. While some studies have suggested that the relationship is linear, in that a greater amount of lost weight yields a greater improvement in psychological wellbeing 44, other analyses have found that surgical and nonsurgical interventions can produce QoL benefits, regardless of the degree of weight loss 46, 47. In particular, interventions that incorporate cognitivebehavioural strategies appear to improve depressive symptoms independently of weight loss, by encouraging selfacceptance and selfesteem 47.

The question of how much weight patients need to lose in order to experience improvements in psychological wellbeing has been further complicated by a recent analysis 54. For many of the available QoL scales, the developers have calculated a minimal clinically important difference score (MCID) that is, the number of points of improvement (or deterioration) on a particular scale that a patient would have to experience to show a noticeable change in QoL. A recent study sought to define how much weight individuals living with obesity would have to lose to achieve these predefined MCIDs on the IWQOLLite and several nonobesityspecific QoL scales. The findings showed that in order to achieve a clinically significant change, as defined by the MCIDs, subjects had to lose anywhere from 9% to 25% of their starting weight, depending on the QoL scale used. This degree of weight loss was routinely achieved over the 2year study by patients undergoing bariatric surgery, but seldom by those who underwent behavioural/diet counselling only 54. However, it should be noted that the only obesityspecific scale evaluated was the IWQOLLite and the scores on its subscales were not analysed; this could have masked important effects on specific concerns such as public distress. The MCIDs for the general QoL instruments have been calculated primarily in chronic medical conditions, where physical symptoms are treated with specific medications and a direct link can usually be made between the treatment effect (i.e. symptom relief) and QoL. Conversely, the links between obesity interventions, weight loss and psychological effects are more complex and indirect, and it is possible to improve selfimage and outlook independently of weight loss. For all these reasons, it is likely that the extent of weight loss required to achieve an important clinical difference was overestimated in this study.

While the concept of MCID is reasonable in certain situations, it is not likely that this construct can be validly assessed until subjects expectations regarding weight loss can be brought into line with what is realistically achievable.

Setting appropriate expectations

A key factor for success in weight management is the setting of realistic, measurable targets for the magnitude and rapidity of weight loss. Indeed, this is a core element of the 5A's model of behavioural change (Ask, Assess, Advise, Agree, Arrange), an established framework that can be adapted for obesity management 8: the fourth A consists of Agreement between healthcare providers and patients about key elements of the plan, including weight loss expectations and the sustainable behavioural changes required to reach those goals 55. Unless appropriate expectations are set, patients are likely to continue to experience distress over obesity when their expectations for weight and shape are not realised 56.

Setting reachable goals is particularly important because many individuals with obesity have unrealistic expectations about the amount of weight they can hope to lose. In a classic study from 1997, subjects defined their ideal weight loss as an average 32% reduction in their starting weight, and most patients said they would be disappointed with a 17kg weight loss; a 25kg loss would be considered acceptable but not ideal 57. While this magnitude of weight loss may be possible for some patients undergoing bariatric surgery, not all surgical patients will achieve or maintain these types of improvements. Furthermore, these expectations are not accurately reflective of the weight loss potential of the currently available nonsurgical methods (e.g. behavioural interventions with or without adjunctive pharmacotherapy).

In many cases, excessive weight loss expectations and patients perceptions of unsatisfactory progress towards those overambitious goals can lead to treatment discontinuation and failure to achieve or maintain an appreciable level of weight loss 58. Additionally, individuals who report lower overall psychological wellbeing (as assessed by the mental health scales of the SF36) before starting their weight loss intervention tended to have still higher and thus less reasonable expectations about the degree to which weight loss would improve their QoL 59.

It is therefore important for healthcare providers to help their patients ground their expectations in reality and avoid making the perfect the enemy of the good. Patients should be encouraged to appreciate that the clinical benefits of weight loss (including effects on comorbidities such as cardiovascular disease and diabetes) actually begin in the range of 510% loss of starting body weight 60, 61. This degree of weight loss is easier to achieve than patients might expect 62, and setting relatively modest weight loss targets in this range will increase the odds of success 9. Furthermore, patients who meet their own expectations with regard to the QoL effects of weight loss report greater improvements in overall wellbeing than subjects whose expectations are not met 59.

Another important aspect to consider, apart from the absolute weight loss in kilograms, is the issue of body shape and body satisfaction. Individuals with obesity who are hopeful that they will achieve the body shape they most desire (e.g. turning a pear shape into an hourglass shape) are likely to be disappointed. Interventions based on the approaches of health at every size are likely to help individuals with obesity to set reasonable expectations and successfully achieve their weight management goals 63.

Setting achievable weight loss goals has several important benefits for both physicians and individuals with obesity. First, it shifts the focus of weight management from weight loss towards stopping regain. Second, once an individual develops confidence in his or her ability to maintain previously lost weight, it becomes possible to set another achievable weight loss goal. This process can lead to repeated cycles of realistic weight loss followed by behavioural adaptation to protect this new weight. With three to four of these cyclical initiatives, substantial overall weight loss would be possible over an extended period. Physicians can play a major role in supporting patients as they adopt this slow and steady approach to sustainable weight management.

The current US 64 and Canadian 10 guidelines recognise that a modest loss of 510% of starting body weight is beneficial for most patients and that in most cases this goal should be achievable through a loss of 0.51 kg of body weight per week over a period of 6 months. The longterm goals should then be to maintain weight and avoid weight regain.

Unmet needs and future directions

To date, the most significant changes in distress over obesity and healthrelated QoL in individuals living with obesity have been achieved through bariatric surgery 41, 43, 46. However, in most countries surgery is available and appropriate for only a small proportion of individuals struggling with obesity; most guidelines limit its use to individuals with a BMI 40 or higher, or 35 if there is at least one obesityrelated comorbidity 65. For many patients, behavioural interventions and/or pharmacological management will therefore play a dominant role, either on their own or as part of an integrated, multidisciplinary strategy. Obesity management guidelines support and recommend the use of multidisciplinary strategies, which combine behavioural approaches with pharmacologic or surgical interventions 64. With our everevolving understanding of the behavioural, psychological and motivational challenges of obesity and how they affect QoL, physicians have a growing range of options from which to personalise the weight management approach for each individual, to maximise the chances of success and offer the patient a greater sense of agency.

The role of medications in weight management is an evolving one. Although several pharmacological agents have been introduced in recent years, the options to date have been only modestly effective, and some have had significant safety concerns such that they have been withdrawn from the market 66, 67. The pharmaceutical options currently available for longterm obesity management in Canada are orlistat (Xenical, Alli) and liraglutide (Saxenda) 68; the range of options in the United States is broader and includes these two medications as well as lorcaserin (Belviq), phentermine/topiramate (Qsymia) and bupropion/naltrexone (Contrave). Medications could have an important role to play in an integrated weight loss plan, as a means to support and sustain the weight loss that patients achieve through behavioural changes.

Medications can enhance the impact of behavioural change in two specific aspects. First, if adding medication to behaviour change increases the magnitude of weight loss, this can be used as a motivational enhancement strategy. All behavioural choices are associated with potential benefits and pitfalls, or advantages and disadvantages 69. Increasing the amount of weight lost increases the advantages of engaging actively in weight management. In turn, this will directly help shift the decisional balance towards change. Adding medication to behaviour change can further reinforce this decisional balance as it clearly increases the advantages of change.

Second, increasing the amount of weight lost via behaviour change reinforces the value of those behaviours. In other words, people experience more payoff for their effort, which is positively reinforcing. Greater investment in the behaviours that produced the outcome increases selfefficacy, which, in turn, predicts longer maintenance of behaviour over time. This can increase the likelihood that positive health behaviours will be maintained after the medication for weight loss is stopped. Thus, truly integrating behaviour change and weight loss medication has the potential to potentiate both treatments and might mitigate weight regain following stopping the medication.

When physicians consider patients distress over obesity and expectations about weight loss and associated QoL changes, it becomes possible to set achievable, realistic goals and develop a manageable plan to achieve them; this provides the framework to increase patientcentred obesity management. Any future developments either in medical management options, behavioural techniques or other insights into the psychological factors behind weight loss success that make it easier to achieve these goals should be made widely available to all patients in need, in order to help them turn a vicious cycle of failure into a virtuous cycle of success.