Anna Simona Sasdelli1, Maria Letizia Petroni1,2, Anna Delli Paoli1, Giulia Collini1, Simona Calugi3, Riccardo Dalle Grave3, Giulio Marchesini4. 1. Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy. 2. Obesity Unit, "Solatrix" Private Hospital, Via Bellini 11, 38068, Rovereto, Italy. 3. Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, 37016, Garda, Verona, Italy. 4. Unit of Metabolic Diseases and Clinical Dietetics, "Alma Mater Studiorum" University, S. Orsola-Malpighi Hospital, Via Massarenti, 9, 40138, Bologna, Italy. giulio.marchesini@unibo.it.
Abstract
PURPOSE: We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
PURPOSE: We aimed to determine cognitive drivers, expected to play a role in target reach and/or attrition in obesity programs. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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