Weight loss expectations in obese patients and treatment attrition: An observational multicenter study
Weight loss expectations in obese patients and treatment attrition: An observational multicenter study
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DOI：
10.1038/oby.2005.241
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发表时间：
2005-11-01
期刊：
影响因子：
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通讯作者：
Marchesini, G
中科院分区：
文献类型：
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作者：
Dalle Grave, R;Calugi, S;Marchesini, G
目的：调查减肥预期（预期 1 年 BMI 下降、梦想和最大可接受 BMI）对寻求治疗的肥胖患者减员的影响。 研究方法和程序：对在 23 个意大利医疗中心寻求治疗的肥胖受试者（1785 名；1393 名女性；中位年龄 46 岁；中位 BMI 36.7 kg/m(2)）进行评估。系统记录基线饮食和体重史、减肥预期以及寻求治疗的主要动机（健康或改善外观）。通过自填问卷（症状检查表 90、暴食量表和身体不安测试）在基线测试精神困扰、暴食和身体形象不满意。前瞻性记录 12 个月时的自然减员和 BMI 变化。结果：12 个月时，1785 名患者中有 923 名 (51.7%) 停止了治疗。与继续者相比，辍学者的年龄明显较低，首次节食的年龄较低，梦想BMI较低，预期1年BMI下降较高，体重恐惧症较高。在逻辑回归分析中，12 个月时磨损的最强预测因素是较低的年龄和较高的预期 1 年 BMI 损失。 12 个月时，随着预期 BMI 损失单位增加，辍学风险系统性增加（风险比，1.12；95% 置信区间，1.04 至 1.20；p = 0.0018）。该风险在前 6 个月尤其升高。讨论：基线减肥预期是进入减肥计划的肥胖患者消耗的独立认知预测因素；期望越高，12 个月后的流失率就越高。应在治疗一开始就解决不切实际的体重目标。
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.Research Methods and Procedures: Obese subjects (1785; 1393 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 1785 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 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.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 at the very beginning of treatment.