Improvement, not perfection

Philip J. Goscienski, M.D.

November 2005

The Dove Company may be onto something. Their Campaign for Real Beauty features women with more curves than angles, images that the company feels are in line with reality. A couple of the models appear to be a few pounds overweight but not by much. They may not be perfect but they are an improvement compared to about two-thirds of the U.S. population.

High aspirations are commendable but unrealistic expectations are not. Based on actual interviews, the typical weight loss clinic enrollee expects to lose 30 to 40 percent of their current weight. For obese persons that means losing 50 to 75 pounds, perhaps 100. That requires a stronger commitment than most people can muster and it may be the single biggest reason why almost all diet programs fail.

Most Americans diet in order to look better, not to become healthier. Better health doesn't become a priority until the first heart attack, or a routine check-up uncovers sugar in the urine or a sky-high blood cholesterol. The reality is that it doesn't take losing 30 percent of one's body weight to reduce the risk of the lifestyle-related diseases that are killing most of us.

Modest weight loss, perhaps 20 pounds over 5 or 6 months, leads to very significant risk reduction. It decreases the risk of a heart attack by roughly 20 percent, can bring blood sugar back to normal and lower systolic blood pressure (the upper number) by 20 points.

That modest weight loss may not bring you down to what you weighed at your senior prom but it improves the chances that you can be around when your granddaughter goes to hers. Your 18-year old figure wasn't realistic anyway. A woman's skeleton is still maturing at that age and a man may not yet have reached his maximum height and weight.

Whether you're interested in simply looking better in a bathing suit or in avoiding the so-called diseases of aging your objective should be to lose fat, not to lose weight. Getting rid of belly fat is probably the first thing your friends will notice when you've been managing your food intake and becoming more physically active. It's also one of the best things that you can do to avoid heart disease, stroke and diabetes. The fat that accumulates around your middle, both outside and inside the abdomen, is clearly associated with a high risk of heart attack and stroke.

It's unrealistic and frustrating to weigh yourself frequently. As you lose fat and gain muscle your weight may stay the same but your waist size will get smaller. If you look better and feel better it doesn't matter what number appears on the scale.

If you want improvement, not perfection, don't give up baked goods but do switch to whole-grain versions. If you have the urge for a couple of snacks a day, keep some fresh fruit or protein bars at your desk, on the kitchen counter or in your purse or briefcase. If you can't do without soft drinks entirely, only buy sugar-free versions. Burn a few more calories by parking at the other end of the lot at work.

Aim for improvement. Leave perfection to the fashion models.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at