Jastreboff always asks her patients why they want to lose weight. Their answers help her understand their personal experiences and goals. She believes that there is no “finish line” in treating obesity and that practitioners must be focused on lifelong care and communicate that expectation to the patient as well. She laments that many people attach huge importance to the numbers they see on the scale or their clothes but don’t know about the Enough Point that their biology is constantly pursuing. For instance, at over 200 pounds, a patient named Shayna hated the number on the scale, wishing that she could go back to the 150 pounds she had been over 20 years earlier.

After learning about her patients’ goals, Jastreboff always reacts the same way. She calculates if their goal weight could be a healthy one for them, using the BMI metrics. She then tries to give the patient a “reasonable outlook” to manage their expectations. Everyone has different notions of what their ideal body weight is, and Jastreboff includes them in the decision-making about their treatment plan. Setting a “goal weight” is not merely about the number that patients would like to see on the scale but includes considering their ethnicity, gender, health conditions, and more. Jastreboff hopes that with more research, doctors will be able to develop a more exact “treat-to-target strategy” (160). Jastreboff does not, however, address some of the controversies around BMI, as some medical experts have recently questioned whether or not it is the most useful or accurate metric to use when assessing weight and health (Byker Shanks, Carmen, et al. “BMI or Not to BMI? Debating the Value of Body Mass Index as a Measure of Health in Adults.” International Journal of Behavioral Nutrition and Physical Activity, 25 Feb. 2025). 

Jastreboff and her patients also discuss the many benefits that improving one’s health can bring: better sleep, less pain, healthier organ function, and much more. Overall health is always influenced by both “nature,” or genetics, and “nurture,” or environment. We all live in an environment that promotes obesity, but because of our differences, not everyone develops it. While medication can help people’s weight loss, it cannot bring the benefits of exercise and high-quality food, which Jastreboff always prescribes along with the medications. Stress management and improving sleep are also essential. 

She argues that losing weight must be reimagined as a lifestyle change with qualitative improvements, not simply as a changing number on the scale or clothing size. She often leaves the number reduction up to the medication and collaborates with the patient to, bit by bit, make changes to their overall health. For example, many patients engage in “clean” eating for certain periods of time, but when they break their rules, they revert back to their old habits. Instead, people should have a balanced and realistic approach to eating. Jastreboff’s acknowledgement of the importance of lifestyle changes and permanent dietary changes somewhat contradicts her earlier assertions regarding the relative difficulty of relying on “willpower” and the efficacy of non-medication tactics. Even so, her analysis here suggests that major lifestyle changes are still essential, even with the medications. This stance raises the question of how essential such medications really are if lifestyle factors can make such a dramatic difference and are mandatory either way. 

Jastreboff uses the acronym “SMART” (specific, measurable, achievable, relevant, and time-bound) to guide these strategies. For instance, one patient rarely exercised. Jastreboff identified jogging as an activity he enjoyed and prescribed it three times a week for 20 minutes, making this goal more achievable and specific than “everyday” or “whenever.” Jastreboff argues that it is crucial to overcome “all-or-nothing” thinking when it comes to health—however, her dichotomy of medications versus “willpower” earlier in the text arguably promoted such all-or-nothing thinking when considering techniques like calorie counting, making her views somewhat contradictory. Winfrey echoes her perspective, calling obesity medications one tool that people must combine with every other “tool” in their toolbox. 

Another important consideration is patients’ mental health. People with obesity may have depression, anxiety, or eating disorders such as binge eating. Jastreboff feels that without mental-health help, people’s quality of life may not improve even if they do lose weight. Some people have unrealistic expectations, hoping that their weight-loss medications will fix everything in their lives. Others may experience a sense of dissociation if they lose a lot of weight and don’t really recognize the person in the mirror anymore. She encourages people to work with a mental-health professional while undertaking the huge changes in lifestyle and medication that this treatment involves, but this advice does not consider the socioeconomic factors that might make accessing such support unaffordable for many patients.

Jastreboff laments the shortage of supply when it comes to obesity medications. These new treatments are not familiar and well understood to many doctors, who didn’t learn about them at medical school and may not have time to complete the insurance documents to prescribe them. Many people who want these medications are not covered by their insurance, and paying out of pocket is very expensive. Some people seek imitation treatments through telehealth or spa businesses. Jastreboff warns readers against seeking any kind of medication outside of the health-care system and medical supervision, noting that people have suffered terrible side effects from taking such pills. She hopes that the real, FDA-approved obesity medications will soon become cheaper and more accessible to people of all walks of life. 

Without access to these medications or other viable treatments, people may either cope with the risks and stresses of obesity or pursue other, less credible options. Jastreboff’s disappointment in people’s lack of access to obesity medications reflects her strong opinion about The Medical Necessity of Treating Obesity, but it should be considered in light of her own professional and financial ties to these particular medications.