10: Why You Don’t Need a “Goal Weight” with Dr. Sasha High

When it comes to weight loss, our mentality is often driven by diet culture telling us we have to hit a certain number on a scale or a target BMI. Getting caught up in this societal construct of fitting a certain size or looking a certain way can end up completely consuming our life. 

Especially problematic for women, obsessive thoughts about a “goal weight” can occupy every part of your mind, influence your mood, and mean you’re not showing up the way you want to. You become so ingrained in diet mentality and losing that last ten pounds, that if your goal weight isn’t reached, you feel like a failure.

I recently spoke with internist and obesity medicine physician Dr Sasha High, to discuss why not setting a goal weight might just be the most loving thing you ever do.

The dangers of setting a “goal weight”

Despite many programs encouraging people to choose a goal weight and work down to it, I think we need to drop the idea of having a rigid number as a target.

The reason I don't subscribe to that philosophy is because we mistakenly believe that we have the ability to manipulate our bodies down to a number, which simply isn’t the reality. Our weight is influenced by so many different factors.

This is a mentality that has been majorly driven by diet culture; we either target a number on the scale or we target a BMI. If we're treating obesity, it’s not the reality that we're trying to get everyone to a healthy BMI. When we're treating obesity as a chronic medical condition, we're looking at how we can overall improve this person's health, function, mental health, and really support them in living their best life. It may not be realistic at all for them to ever reach a “normal” or “healthy” BMI. 

This is why dropping these artificial targets and instead using the concept of 'best weight' is more beneficial. Your 'best weight' is whatever number your body ends up at when you are doing the parts that you actually have control over. 

Your best weight comes when you’re operating from a place of confidence and an empowered mindset of knowing that you're supporting yourself in a loving and self-compassionate way. You've created an eating plan and a lifestyle that you love and that's sustainable and then you're working on what I describe as the core competencies, which is consistency, sustainability, and resilience.

When you're doing those things, plus or minus getting the medical treatment that you may need, (medication or bariatric surgery), you can take your hands off the scale and you let your body do its thing. 

Why you don’t need to “lose the last ten pounds”

The conversation around losing the last ten pounds can be a particularly damaging one which leads people to contorting themselves massively to achieve a number. In reality, they don’t feel good at all and disordered eating really starts to kick in.

If you actually step back and think about being on your deathbed at 90 years old, you are not going to be worrying about not losing the last ten pounds. Women are especially susceptible to getting caught up in this societal construct of having to look a certain way or weigh a certain number.

What is important is living your life in the healthiest way, feeling great, having the energy that you want, with really great mental health as well. That matters so much more than reaching an arbitrary number on a scale. Waking up with obsessive thoughts about the calories you need to track, the food you need to weigh, what you can't eat, and how deprived you are, is not a fun life for anyone.

The return of negative body thoughts whilst taking anti-obesity medication

So many women think that if they just hit their goal weight, then they'll love their body. But if you dig deeper about when they were at that goal weight in their life, you often find they were still dieting at that point, and still hated their body. If you hate your body now, what makes you think your brain will suddenly think differently and love your body just because you lose weight?

How we think doesn’t change.  Empowering your thinking and changing your mindset in a way that's going to support you and your life is what will really help you thrive.  Weight loss doesn't do that for you. If you have body dysmorphia or body dissatisfaction, that is a separate thing from weight loss and weight loss doesn't fix it.

Your relationship with your body is entirely based on what you're thinking about it. So if you are thinking really negative things all the time, that will continue regardless of whether you lose weight or not.

There are some great Instagram accounts to support with body confidence, such as Alex Light and Lyndi Cohen aka The Nude Nutritionist. 

But it’s also important to remember that cleaning up our social media feeds is a wonderful place to start in terms of body acceptance and getting rid of what you're feeding your brain in terms of what is acceptable about a woman's body and what a woman's body should look like. 

The reemergence of food thoughts whilst taking anti-obesity medication

When you first start anti-obesity medications like Ozempic, Wegovy, Mounjaro etc, it can initially feel like a switch goes off in your brain. You never think about food and rarely eat emotionally. Usually around the 6 month mark, food thoughts start to creep back in, which can be extremely challenging to deal with again, especially if you’re unprepared. 

This situation can be very anxiety inducing because what you thought was a miracle is now all of a sudden making you feel like you could go off the rails again. People have a sudden urge to stop the medication which then leads to weight gain. 

It’s important to remember that these are long-term medications indicated for a chronic medical condition, so start with that expectation when you begin taking these medications. Whilst I’m supportive of using anti-obesity medications in the appropriate context for the right patient, at the right time, they're not the be all and end all. The thought work still has to be practiced to regulate your emotions and to  learn how to make space for emotions rather than eating over them. 

Balancing thought work with anti-obesity medications

I always recommend doing the thought work and the emotional regulation work first because if you start the medication right away, there's no need to do any of that work. How can you work on your emotional eating when you don't have any inclination to emotionally eat? There’s no impetus to do the thought work and learn those skills, so the hard work gets pushed out to a time when you're even more vulnerable. 

After six months, when the food thoughts reappear, you become afraid and have those panic moments where you're terrified of binging again. That's not a good time. You're not in a good mental space to learn and start doing the work, so it's much more effective to do that in the beginning.

We always know medication is available to you. There isn't a rush. If we take that rushed emotion out, it is available to you. Start introducing the thought work and become familiar with listening to your own brain, which is a brand new skill for most people, as well as emotional regulation, distress tolerance, etc. And then we can bring the medication in later if necessary.

The concern is that when you don’t do the thought work, you can end up in a situation where medicines are being layered on top of each other, without addressing the real issue. It gives in to the philosophy of everything always being outside of you and relying on doctors to give the recommendation. But this never lets you figure it out, which is a longer term problem because there will always be another scenario that comes up and you need to be equipped with the cognitive tools to deal with it.  

It actually isn't about the macros and it isn't about the eating plan. It really is how you talk to yourself, how you think about yourself, how you show up for yourself, and how you prioritize yourself every day.

More about Dr. High

Dr. Sasha High is an internist and obesity medicine physician based in Toronto, Canada. She has been practicing obesity medicine since 2012, and over time has pivoted and grown her own program. Originally called High Metabolic Clinic, her program is now ‘Best Weight with Sasha High Md’, a 6-month coaching and medical program that gives you an empowered mindset to lovingly and sustainably optimize your health habits, while getting expert medical supervision and treatment. 

She first undertook a Bachelor of Sciences from the University of Ottawa then completed her medical doctorate (MD) and Internal Medicine residency (FRCPC) at the University of Toronto. She is certified as an American Board of Obesity Medicine (ABOM) diplomate and holds a Lecturer appointment with the University of Toronto.

Dr. High has a special interest in nutrition and mindset and loves empowering people to thrive in their life by transforming from the inside out. She is a certified Life Coach from The Life Coach School, an Advanced Certified Weight Loss Coach, and has additional training in cognitive behavioral therapy (CBT) and acceptance commitment therapy (ACT).

Connect with Dr. Sasha High: You can find her on Youtube, Instagram, Tik Tok, visit her website, or listen to her on the High on Life Podcast.