title: Weight loss expectations in obese patients and treatment attrition: an observational multicenter study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Villa Garda Hospital, Garda, Verona, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Dalle Grave
authors.forename: Simona
authors.initials: S
authors.lastname: Calugi
authors.forename: Enrico
authors.initials: E
authors.lastname: Molinari
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Petroni
authors.forename: Mario
authors.initials: M
authors.lastname: Bondi
authors.forename: Angelo
authors.initials: A
authors.lastname: Compare
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
mesh_terms: D000328:Adult; D000367:Age Factors; D001828:Body Image; D015992:Body Mass Index; D002032:Bulimia; D005260:Female; D005544:Forecasting; D006040:Goals; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009765:Obesity / Q000523:psychology* / Q000628:therapy*; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors; D016312:Treatment Refusal / Q000523:psychology*; D015431:Weight Loss