Abstract
To investigate the influence of weight loss expectations (expected 1-year BMI loss, dream and maximum acceptable BMI) on attrition in obese patients seeking treatment. Obese subjects (1,785; 1,393 women; median age, 46 years; median BMI, 36.7 kg/m(2)) seeking treatment in 23 medical Italian centers were evaluated. Baseline diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested at baseline by self-administered questionnaires (Symptom Check List-90, Binge Eating Scale, and Body Uneasiness Test). Attrition and BMI change at 12 months were prospectively recorded. At 12 months, 923 of 1,785 patients (51.7%) had discontinued treatment. Compared with continuers, drop-outs had a significantly lower age, a lower age at first dieting, lower dream BMI, a higher expected 1-year BMI loss, and a higher weight phobia. At logistic regression analysis, the strongest predictors of attrition at 12 months were lower age and higher expected 1-year BMI loss. The risk of drop-out increased systematically for unit increase in expected BMI loss at 12 months (hazard ratio, 1.12; 95% confidence interval, 1.04 to 1.20; p = 0.0018). The risk was particularly elevated in the first 6 months. Baseline weight loss expectations are independent cognitive predictors of attrition in obese patients entering a weight-losing program; the higher the expectations, the higher attrition at 12 months. Unrealistic weight goals should be tackled at the very beginning of treatment.
Highlights
IntroductionStudies carried out in the United States [5,6,7] and Europe [8] found that the majority of treatment-seeking obese patients consider the recommended 10% weight loss a highly unsatisfactory goal
In 1998, the National Heart, Lung and Blood Institute recommended a 10% weight loss as the general goal of obesity management [1]
Present BMI and age were the strongest predictors of weight goals, whereas psychological distress, body image dissatisfaction, and eating behavior (SCL-90, Body Uneasiness Test (BUT), and Binge Eating Scale (BES) scores) did not significantly predict weight loss expectations
Summary
Studies carried out in the United States [5,6,7] and Europe [8] found that the majority of treatment-seeking obese patients consider the recommended 10% weight loss a highly unsatisfactory goal. On the basis of these observations, a few authors put forward the hypothesis that encouraging obese patients to accept more realistic weight loss goals might improve both psychological outcome and weight loss [5,16,17] This task might be difficult in subjects seeking treatment for appearance-related reasons, who have a lower BMI [8,18], but a greater body dissatisfaction and a lower self-esteem [18]
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