Expected benefits and motivation to weight loss in relation to treatment outcomes in group-based cognitive-behavior therapy of obesity
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We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs.
We recorded the expected benefits of weight loss, weight targets, primary motivation for weight loss, perceived treatment needs, readiness and self-confidence to be successful and a battery of psychopathology questionnaires in 793 subjects with obesity (68% women; mean age 48.7; 46% obesity class III) enrolled into a group-based cognitive-behavioral treatment program. Their relevance on attrition and successful weight loss outcome were tested by logistic regression analysis.
The expected benefits of weight loss scored very high in all physical, psychological and social areas, with differences between genders. Attrition rate was 24, 41 and 65% at 6-, 12-, and 24-month follow-up. Average weight loss was 5.8 ± 7.1 kg (− 4.8%) at 6 months, with 17% of cases (32% of continuers) maintaining weight loss > 10% at 24 months. After adjustment for confounders, attrition was reduced by concern for present health, motivation/consciousness of the importance of physical activity and need for support; treatment discontinuation was favored by concern for body image, by expectations for drug treatment or bariatric surgery, and by high-challenging weight loss targets. Male gender, higher BMI and concern for present health predicted weight loss > 10%, whereas concern for body appearance was associated with lower probability of attaining the desired weight loss targets.
A more precise definition of needs and expectations might help tailor treatment to individual patients, but attrition rates and target reach remain difficult to predict.
Level of evidence
Level V, descriptive studies.
KeywordsAttrition Expectations Psychological distress Treatment needs Weight targets
Planned the study: ASS, LP, RDG, SC; Collected the data: ADP, GC; Made statistical analyses: SC, GM; Drafted the manuscript: RDG, GM: Critically reviewed the manuscript: LP, RDG, SC, LP. All authors approved the final version of the article.
The study received financial support from “Alma Mater Studiorum” University of Bologna, RFO 2013-5.
Compliance with ethical standards
Conflict of interest
All authors declared that they have no competing interests.
The audit of collected data and their statistical evaluation was carried out after complete anonymization and was approved by the senior staff committee of the department, due to the retrospective nature of the study.
Patients provided their informed consent to data collection prior to receiving clinical services, in addition to standard obligation for privacy.
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