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Gary D. Foster, PhD; Thomas A. Wadden, PhD; Suzanne Phelan, PhD; David B. Sarwer, PhD; Rebecca Swain Sanderson, BA

Arch Intern Med. 2001;161:2133-2139.

Background  Despite considerable professional consensus that modest weight losses of 5% to 10% are successful for reducing the comorbid conditions associated with obesity, obese patients often desire weight losses 2 to 3 times greater than this. Examining ways to reduce the disparities between treatment expectations and subsequent outcomes, this study evaluated the role of physical characteristics, treatment setting, and mood in patients' evaluations of treatment outcomes.

Methods  This study was conducted in a university outpatient weight loss clinic with a sample of 397 obese individuals seeking weight loss by a variety of modalities. Before treatment, participants' heights and weights were measured, and the Beck Depression Inventory and the Goals and Relative Weight Questionnaire were administered.

Results  Outcome evaluations ranged from 64.4 ± 11.1 kg (mean ± SD) for dream weight to 90.1 ± 19.1 kg for disappointed weight. Initial body weight was the strongest predictor of disappointed, acceptable, and happy weights ( = .90, .76, and .57, respectively). Sex ( = -.37) and height ( = .37) were the strongest determinants of dream weight. Heavier participants chose higher absolute weights, but the weight loss required to reach each of the outcomes was greater for heavier than for lighter patients.

Conclusions  These data signal a therapeutic dilemma in which the amount of weight loss produced by the best behavioral and/or pharmacologic treatments is viewed as even less than disappointing. Patients with the highest pretreatment weights are likely to have the most unrealistic expectations for success.

From the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia.

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