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Non-scale victories, or NSVs, are improvements or outcomes that are not specifically a change in weight. While a significant amount of people meet with dietitians to change the number of the scale, this should not be the only focus during sessions, even when weight loss is the primary reason for the nutrition visits.
NSVs are especially important for patients whose goals are unrelated to weight loss, such as improving blood sugar management, athletic performance, digestive symptoms, or overall quality of life.
Why Celebrate Non-Scale Victories
All dietitians have seen it – a patient is doing well, then they hop on the scale and see it’s up two pounds from the day before. They feel so defeated and give up.
The scale is bound to go up sometimes – if it’s from excess sodium intake, hormonal fluctuations, constipation, etc. While we know this is normal, patients see it as a lack of progress and can have difficulty persevering.
Celebrating non-scale victories can help patients look at markers besides just their weight that can help keep them motivated. It can also decrease the black-and-white thinking of weight loss means success and lack of weight loss means failure.
According to the idea of “change talk” in motivational interviewing, the more we get patients to talk about the positives of change, the more likely they are to follow through with said changes. The more we talk about NSVs, the more they are verbalizing the benefits of change, increasing the likelihood they are to carry out these behaviors.
Celebrating these successes can help build self-efficacy and the patient’s confidence in their ability to take control of their health. Taking the time to discuss NSVs can improve the patient’s overall satisfaction with their behavior change process and make your job more enjoyable with better retention rates.
Non-Scale Victories Examples
Behavior-Related NSVs
Dietitians should spend a significant amount of time discussing positive changes a patient has made. Remember that weight is not a behavior, but rather an outcome. We need to focus on the positive behavior changes they are making that will eventually create movement on the scale.
Examples include:
- Limiting fast food to once a week
- Buying whole grain pasta instead of white
- Eating fruit daily
- Choosing seltzer water over soda
- Saying no to the second drink at a party
- Joining the gym
- Walking after dinner 5 days a week
- Setting a bedtime and sticking to it most days of the week
Physical Changes Non-Scale Victories
For some people, body composition could be changing while the number on the scale is not. It is important to point this out and celebrate other physical changes besides just weight. Some people get very stuck on the number on the scale!
Examples include:
- Clothes fit differently
- Going down in a clothing size
- Looking more toned
- Down in inches
- Can cross legs more comfortably
- Easier to tie shoes and clip toenails
Fitness Level NSVs
If a patient has increased physical activity, they may see fitness level improvements even if weight loss doesn’t occur. This may be seen while exercising or during daily activities.
Examples include:
- Can walk upstairs without getting winded
- No longer need walker or cane for shorter distances
- Easier to pick up and hold children or grandchildren
- Increasing weight when doing strength training
- Can go a higher speed on the treadmill
- Ability to do 1 pullup
- Ran a 5K in under 28 minutes
Changes in Symptoms, Health, and Medical Status
With improvement in diet and exercise, patients often report that they feel better, even without significant weight changes. Evaluating changes related to health such as lab values and other biomarkers can be very impactful for clients.
Examples include:
- Increased energy levels
- Feel less bloated after meals
- Headaches are happening less frequently
- Less joint pain
- Needing to use over-the-counter reflux medications less frequently
- Improved menstrual cycles
- Lower home readings of blood pressure or glucose
- Lower resting heart rate
- Improved lipid panel
- Lower fasting glucose and/or A1C
- Improved liver function tests
- Discontinuation of medication(s) for blood pressure, cholesterol or blood sugars
Psychosocial NSVs
Working on overall health, nutrition and exercise can also bring a lot of psychosocial benefits.
Examples include:
- Improved overall confidence
- Less depressive symptoms
- Able to play with children or grandchildren on the floor
- Saving money by ordering out less
- Reduced guilt and shame around eating
- More confidence around meal planning and nutrition choices
- Less emotional eating
- No more black-and-white thinking around food
- Creating healthier habits with spouse and children
- Improved confidence regarding physical intimacy
- Finding healthier coping mechanisms
Non-Scale Victories Conversation Starters
With some patients, they are going to have no problem sharing their non-scale victories with you. Some people walk right through the door beaming, proud and ready to share their progress For others, this might feel unnatural as they have always felt the scale was the end-all-be-all, or they are just not used to sharing these kinds of things.
Here are some conversation starters to elicit responses around NSVs:
- Tell me about a win since our last nutrition session.
- What feels easier now than it did three months ago?
- Tell me what healthy habit you are most proud of lately.
- What has improved besides your weight?
- What can you do now that you couldn’t do before?
- How has your relationship with food changed?
Keep the Conversation Going
Make sure to ask open ended questions after clients have shared their NSVs. This will get them to elaborate on their successes and keep them talking. You might get them talking about things they haven’t even thought about before!
Don’t forget to use the rest of your counseling skills as well. Provide reflections and summaries to really highlight their NSVs – when patients hear their own words back to them, this can be really powerful. Be sure to provide affirmations as well, to further boost self-efficacy which could potentially encourage even further behavior change.
Final Thoughts on Non-Scale Victories for Dietitians
Patients often overlook meaningful progress because they are waiting for the scale to validate their hard work. Helping clients identify and celebrate NSVs can improve motivation, self-efficacy, adherence, and overall satisfaction with the behavior change process. Sometimes the most important progress is happening in ways the scale simply cannot measure.
While NSVs are important, dietitians should avoid using them to invalidate a patient’s disappointment about lack of weight loss. Both can exist at the same time. Patients can feel frustrated while still acknowledging meaningful progress in other areas.
Think about reflecting these contradictory thoughts back to them – “You are disappointed you haven’t lost any weight despite all your hard work, and you’ve seen several non-scale victories including improved energy levels, several PRs at the gym, and now your pants are too big in the waist.” This validates their frustration, but still moves the conversation towards change talk as this is what you ended the reflection with.
NSVs can also be especially important for patients whose goals are unrelated to weight loss, such as diabetes management, athletic performance, gastrointestinal symptoms, or overall quality of life.
References:
The Elevated Nutrition Counseling Blueprint Workbook