Dr. Zentner & SMART Goals
Who Is the Best Obesity Doctor in Vancouver? A Personal Reflection
By Dr. Ryan Oughtred, Obesity Doctor in Vancouver
About a year ago, I had what I thought would be the pleasure of meeting the famous obesity doctor, Dr. Ali Zentner. Given that much of my work lies in supporting patients in making behaviour changes, I was eager to discuss her thoughts around behavioural therapy as a treatment.
When I asked about her perspective on behaviour therapy, she interrupted, "You mean cognitive behavioural therapy?" I agreed, noting that I was referring to that and other behaviour change strategies. Our conversation went like that from there, and we delved into the components of behavioural therapy - I mentioned the concept of SMART goals. She questioned the practicality of using SMART goals with patients facing significant life challenges, such as single working mothers with two kids. “What are you going to do, just sit around with that woman and talk about SMART goals?” She then went on to tell me how most patients would be so much better off seeing herself rather than seeing me - fun stuff.
To be honest, I was taken aback by this attack on SMART goals and behaviour therapy in general. I hadn't anticipated needing to defend these evidence-informed, time-tested behaviour change strategies. It prompted me to reflect deeply on how we, as obesity doctors in Vancouver, approach patient care.
If I could go back to that moment, I would certainly respond differently. I would emphatically say that HELL YES, I would use SMART goals—when the patient is ready for them of course. Before introducing SMART goals, it's essential to develop a respectful relationship where the doctor seeks to understand the patient's values and reasons for behaviour change. It's about being comfortable sitting beside an individual with their ambivalence, acknowledging both the desire to change and the barriers that exist.
When a person is ready to move toward changes, setting vague or didactic goals can set them up for failure. SMART goals—Specific, Measurable, Achievable, Relevant, and Time-bound—are all about helping make success more likely. They empower you by involving you in the goal-setting process, tailoring objectives to your unique circumstances. SMART goals are a powerful contextual change that positively impact behaviour change and weight management success.
The Importance of Behavioural Therapy in Obesity Medicine
In my practice, I've noticed that standard behaviour therapy methods, well-established worldwide as the standard of care in obesity medicine, are sometimes underutilized in weight management clinics in Vancouver. Perhaps due to the way billing systems work, it's challenging to allocate time for comprehensive behavioural support under MSP. As a result, the emphasis often shifts to education and prescribing obesity medications like Semaglutide (Ozempic, Wegovy) or Tirzepatide (Mounjaro, Zepbound), with occasional follow-ups. This is not to slight obesity mediations, they are an absolute game changer, and I prescribe them to my patients in a similar format. However, I also offer behaviour therapy as a potential treatment moving forward, and unlike most clinics, I can implement it intensively and maximize it’s benefits for patients.
In Vancouver weight loss clinics, I have noticed there is often not enough time for discussing SMART goals, exploring readiness and ambivalence to change, or providing the skilled follow-ups focused on helping patients do the hard work of "getting to behaviour” and closing the gap between intention and action.
“Getting to Behaviour” is often what is missing in obesity clinics. Ambivalence is normal, and change is hard. It takes time and patience to learn to walk the steps toward action, but maybe not as much time as people think. Think of how much time is wasted on treatment approaches that don’t work and health professionals telling patients what to do with no results. I am a firm believer in the benefits of behaviour therapy for ABCD/ Obesity, as well in supporting all patients in adopting healthier lifestyles.
About Dr. Ali Zentner
Dr. Ali Zentner is renowned as one of the best obesity doctors in Vancouver. With numerous accolades, she has significantly contributed to highlighting the biases we hold toward people in larger bodies. Dr. Zentner is a strong advocate for increased access to obesity medications like Semaglutide or Ozempic/ Wegovy. She emphasizes the importance of medical interventions in treating obesity and has been instrumental in promoting understanding of ABCD/ Obesity, especially in B.C. and greater Vancouver.
Behaviour Therapy is an Evidence Informed Treatment
While medications like Semaglutide (Ozempic, Wegovy) and Tirzepatide (Mounjaro, Zepbound) have revolutionized obesity treatment, behavioral therapy is also an effective tool. It also the center of all therapies, as all therapies work by helping patients get to behaviours. As obesity doctors in Vancouver, I think we should strive to offer a balance of medical interventions and evidence-based behavioral strategies.
Techniques like SMART goals are not just theoretical—they are practical tools that, when used appropriately, can significantly enhance a patient's likelihood of success.
If you're seeking support from an obesity doctor in Vancouver, know that comprehensive care is available. Whether it's through medication, behavioural therapy, or a combination of both, I am here to help you achieve your health goals.
If you're ready to take the next step in your weight management journey, please reach out. Together, we can create a personalized plan that empowers you to succeed