How Do You Make a Plan to Lose Weight?

By Shawn Stevenson, DO, FACS – Chief of Bariatric and Foregut Surgery, Dignity Health

One of the most common questions I hear from patients is, “Where do I even start?”

For many people, weight loss feels overwhelming because they’ve tried plans before. Diets, programs, or quick fixes may have worked temporarily or didn’t work at all.

In my experience, the key isn’t finding the perfect plan. It’s building the right plan for you, based on your health, your biology, and your long-term goals. A good weight-loss plan is thoughtful, realistic, and supported. It should never feel rushed.

Step One: Start With the Whole Picture

Before talking about calories, medications, or surgery, I start by looking at the full picture. That includes your medical history, current health conditions, medications, lifestyle, and past weight-loss attempts.

Weight is regulated by complex systems in the body, including hormones, metabolism, insulin response, and how the brain processes hunger and fullness. For many people, those systems are working against them. Understanding that helps remove blame and allows us to focus on solutions that actually make sense.

The goal at this stage isn’t judgment. It’s clarity.

Step Two: Define What Success Really Means

A good plan starts with realistic expectations. For some patients, success means gradual, steady weight loss. For others, it may mean improving blood sugar control, lowering blood pressure, reducing joint pain, or preparing safely for another procedure.

Weight loss isn’t just about a number on the scale. It’s about improving health, function, and quality of life, and that looks different for every person.

Step Three: Build a Foundation With Nutrition

Nutrition is an essential part of any weight-loss plan, but it doesn’t need to be extreme to be effective.

I focus on helping patients build structure, not perfection. That means realistic eating patterns, consistent habits, and guidance that fits real life. Dietitians and nutrition specialists play a critical role here by helping translate medical recommendations into day-to-day decisions that can be sustained long term.

A plan that only works short term isn’t really a plan at all.

Step Four: Address Behavior and Support Systems

Weight loss is personal. Stress, routines, emotions, and habits all play a role in how we eat and how we take care of ourselves.

For some patients, behavioral support such as coaching, counseling, or accountability is an important part of the plan. This isn’t about discipline or willpower. It’s about recognizing that lasting change is easier when you’re supported rather than pressured.

Step Five: Consider Medical Tools, Including GLP-1 Medications

For the right patient, medications such as GLP-1 therapies can be helpful. These medications work by reducing hunger, improving fullness, and supporting better metabolic control.

At the same time, they are not a stand-alone solution. GLP-1 medications don’t permanently change anatomy, and weight regain can occur if they’re stopped without a broader plan in place. I view medication as one tool, sometimes a bridge and sometimes part of a longer-term strategy, that works best when combined with nutritional guidance, medical oversight, and realistic expectations.

Step Six: Understand When Surgery May Be Part of the Plan

For patients who meet medical criteria, bariatric surgery may be an appropriate option. I view bariatric surgery as metabolic surgery, not just weight-loss surgery, because it changes how the body processes food, hormones, and energy.

Surgery can lead to durable weight loss and improvement in conditions like diabetes and high blood pressure, but it’s never a decision made in isolation. The strongest outcomes come when surgery is part of a comprehensive plan that includes long-term follow-up, nutritional support, and a strong partnership between the patient and care team.

Step Seven: Commit to the Long Term

A weight-loss plan isn’t a single visit or a single decision. It’s a process that evolves over time.

I want patients to know that we’re in this together for the long haul. There is no simple solution, and there’s no one right path for everyone. What matters most is having a plan that’s thoughtful, medically sound, and built to last.

The Bottom Line

The best weight-loss plan is one that’s tailored to you, your health, your goals, and your life.

It’s not about doing everything at once.
It’s about taking the right steps, in the right order, with the right support.

That’s how real, lasting change happens.