Weight loss expectations in obese patients and treatment attrition: an observational multicenter study

Abstract Objective: To investigate the influence of weight loss expectations (Expected One-Year BMI Loss, Dream and Maximum Acceptable BMI) on attrition in obese patients seeking treatment. Research Methods and Procedures: 1,785 obese subjects (1,393 females; median age 46 years; median BMI, 36.7 kg/m2), 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 CheckList-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, dropouts had a significantly lower age, a lower age at first dieting, lower Dream BMI, a higher Expected One-Year BMI Loss, and a higher Weight Phobia. At logistic regression analysis, the strongest predictors of attrition at 12 month were lower Age, and higher Expected One-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 – 1.20; P = 0.0018). The risk was particularly elevated in the first 6 months. Discussion: 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 since the very beginning of treatment.