Before enrolling any patient in a weight-loss program, the clinician must have a clear idea of that individual’s expectations. A patient with unrealistic expectations should not be enrolled until these are changed to realistic and attainable goals. The clinician should guide the patient who seeks weight reduction to create goals that fit the mnemonic SMART: Specific, Measurable, Attainable, Realistic, and Timely.

A specific goal has a much greater chance of being accomplished than a general goal does. To set a specific goal, the patient must answer the following 6 W questions:

Who - Who is involved?

What - What do I want to accomplish?

Where - Identify a location.

When - Establish a time frame.

Which - Identify requirements and constraints.

Why - Identify specific reasons for or purpose or benefits of the goal.

Another crucial step is a clear assessment of the patient's level of motivation regarding the changes in diet, exercise, and behavior required to maintain weight loss. This assessment should be completed before the patient is enrolled in a weight-loss program.

Comprehensive, written, informed consent must be obtained and should address details of the expected weight loss and the required changes. Clinical judgment may support a less stringent approach in some situations.