What is a reasonable weight loss? Patients' expectations and evaluations of obesity treatment outcomes.

Abstract

Expert panels and governmental guidelines now recommend that obese persons seek modest (i.e., "reasonable") reductions in body weight rather than striving for "ideal" weights. Little is known, however, about patients' views of what is a "reasonable" weight loss. This study assessed patients' goals, expectations, and evaluations of various outcomes before, during, and after 48 weeks of treatment. Before treatment, 60 obese women (99.1 +/- 12.3 kg; body mass index of 36.3 +/- 4.3 kg/ m2) defined their goal weight and 4 other weights: "dream weight"; "happy weight"; "acceptable weight"; and "disappointed weight." Goal weight averaged a 32% reduction in body weight. A 17-kg weight loss was defined as disappointed; a 25-kg loss, was acceptable. After 48 weeks of treatment and a 16-kg weight loss, 47% of patients did not achieve even a disappointed weight. These data illustrate the dramatic disparity between patients' expectations and professional recommendations and the need to help patients accept more modest weight loss outcomes.

The role of patients' expectations and goals in the behavioral and pharmacological treatment of obesity

“…Our findings, however, are consistent with the results of several other clinical trials, which found modest positive, if any, relationships between participants' expected and achieved weight losses 4,5,10 and no relationship between failure to meet expectations and attrition. 1 This study found that the intensity of the therapy provided did not appear to influence weight loss expectations or goals to a significant degree. Participants appeared to come to treatment with predetermined expectations and goals, which they did not modify in response to being assigned to different therapies or told to expect a loss of only 5-15% of initial weight.…”

“…[1][2][3][4][5] The losses they expected after 1 year of behavioral 19,20 There was a small positive relationship between participants' expected and achieved weight losses at week 26. Thus, participants with higher expectations lost more weight in the first 6 months of treatment.…”

“…Such goals were either unrelated to weight loss 5,[10][11][12] or were associated with slightly greater losses. 4 In contrast to Dalle Grave et al, 9 Foster et al 1 found no relationship between weight loss goals and attrition from treatment.…”

“…[1][2][3][4] Dieters maintain these expectations even when repeatedly informed that they are likely to lose only 5-15% of initial weight, 5 which is the size of the losses typically induced by current behavioral and pharmacological interventions. 6 Investigators disagree concerning the consequences of patients' unrealistic goals and expectations.…”

“…Prior studies of weight loss goals have had several limitations including small sample sizes, 1,5,13 as well as the provision of relatively brief therapies, 4,12 only one type of therapy, 1,10 or unspecified therapies. 3,9 It is possible that the importance of goals and expectations differs across treatment approaches.…”