Patients seeking weight loss treatment frequently set goals and expectations of losing ≥25% of their initial body weight (Foster et al. 1997; Wadden et al. 2003). Weight loss of this magnitude greatly exceeds the typical weight loss achieved during behavioral treatment. A weight goal is defined as the amount of weight patients would ideally like to lose during treatment (Fabricatore et al. 2008; Fabricatore et al. 2007) whereas a weight loss expectation is defined as how much weight patients think they can lose during treatment. Weight loss expectations tend to be more moderate than weight goals (e.g., ultimate or dream weight) although they are still significantly greater than the 5-10% reduction in initial body weight that is typically achieved with behavioral treatment (Fabricatore et al. 2007). To date, studies examining the influence of weight expectations have yielded mixed results. In the short-term, unrealistic weight expectations do not appear to have deleterious effects for patients participating in controlled clinical trials (Ames et al. 2005; Fabricatore et al. 2007; Moore et al. 2011; Wadden et al. 2003). However, much less is known about the long-term effects when weight loss falls short of initial expectations for patients who are paying for treatment in “real world” settings (Dutton et al. 2010).
One potential problem is that if patients are unable to reach a weight that they expect to achieve, they may be more likely to drop out of treatment. Previous research has shown that higher expectations for weight loss at baseline among patients seeking a variety of obesity treatments in a medical setting (e.g., nutrition education, cognitive behavioral therapy, medication) were associated with higher rates of attrition from treatment at 12-months. (Dalle Grave et al. 2005). A significant problem related to attrition is treatment failure. In other words, when patients discontinue participation in treatment, they are significantly more likely to regain lost weight (Ames et al. 2014). Further research is needed to determine what variables are associated with attrition such as weight loss expectations and satisfaction with weight in medical settings where patients are paying for treatment (Dalle Grave et al. 2005). Weight loss expectations, among other variables, could potentially be targeted for intervention in an effort to reduce rates of attrition.
This study was conducted during an investigation of a 52-week Small Changes Maintenance intervention (SCM) for patients who had completed a medically-supervised commercial liquid meal replacement program (LMR). Details about SCM have been described previously (Ames et al. 2014). The present study had two primary goals. First, based on findings from a previous research (Dalle Grave et al. 2005), we hypothesized that specific patient variables would be associated with attrition from SCM. Those variables included percent of initial weight lost during LMR, satisfaction with weight pre-SCM, expectation for further weight loss pre-SCM, and duration of time expected to achieve desired weight loss. Second, we were interested in investigating if patients’ expectations for further weight loss would decrease after 52-weeks of maintenance treatment. We hypothesized that expectations for further weight loss would decrease to reflect actual body weight after patients attempted to sustain weight lost during LMR for 52 weeks.