Weight loss expectations in obese patients and treatment attrition: an observational multicenter study.
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.
Dalle Grave
Riccardo
R
Villa Garda Hospital, Garda, Verona, Italy.
Calugi
Simona
S
Molinari
Enrico
E
Petroni
Maria Letizia
ML
Bondi
Mario
M
Compare
Angelo
A
Marchesini
Giulio
G
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