Theoretically, the goal of obesity treatment is to reduce body weight to normal. However, unsatisfactory results have prompted a change in the final outcome from large weight loss to moderate weight loss and control of obesity related risk factors, that is, hypertension, dyslipidemia and diabetes. Studies have shown that the morbidity related to these risk factors is significantly decreased by a 5% to 10% weight reduction, even if patients remain in the obesity range.
When goals are not reached or the progress toward them is unsatisfactory, people have impaired performance and often tend to abandon their attempt to achieve the unreachable goals. To improve the understanding of the weight loss expectations of obese subjects and of the factors that influence them, some Italian researchers analyzed the data of a large observational study that was recently established in Italy for a comprehensive measurement of health-related quality of life, psychological distress, and eating behavior in obese patients.
A total of 1891 obese patients seeking treatment in 25 Italian medical centers were included in this study. Diet and weight history, weight loss expectations and primary motivation for seeking treatment (health or improved appearance) were recorded via a detailed case report and a set of questionnaires. Psychiatric distress, binge eating, and body image dissatisfaction were tested by self-administered questionnaires (Symptom CheckList-90, Binge Eating Scale and Body Uneasiness Test).
In 1011 cases, the one-year expected BMI loss was > 9kg/[m.sup.2], dream BMI was 26 and maximum acceptable BMI was 29.3. The expected one-year BMI loss was significantly related to the maximum BMI loss during previous attempts. Age was also a strong predictor of weight goals. Psychiatric distress, body dissatisfaction and binge eating did not predict weight loss expectations. The primary motivation for weight loss was concern for future (33.4%) or present health (>50%), and only 15.2% wanted to improve appearance. Women seeking treatment to improve appearance had a lower grade of obesity, were younger and had first attempted weight loss at a younger age.
This study confirms a large disparity between physicians' recommendations and patients' expectations of outcomes in the treatment of obesity, a disparity that might account for the high dropout rate in weight loss. Obese Italian patients had unrealistic weight loss expectations. Some limitations of this study were the findings were restricted to obese subjects seeking treatment in a medical setting and therefore, do not provide information on the large number of obese subjects who do not seek treatment or who seek help in non-medical settings. Future research should evaluate how weight loss expectations may vary across different settings and how unrealistic weight loss expectations may be changed to achievable ones.
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