Elsevier

Eating Behaviors

Volume 4, Issue 3, September 2003, Pages 265-282
Eating Behaviors

The early identification of poor treatment outcome in a women's weight loss program

https://doi.org/10.1016/S1471-0153(03)00029-1Get rights and content

Abstract

Research examining factors associated with program attrition or failure to lose weight during active treatment has yielded mixed findings. The goal of the current investigation was to confirm and extend prior research on the predictors and correlates of attrition and failure to lose weight during treatment. This investigation examined whether baseline characteristics, early weight loss, attendance, weight-related quality of life, confidence and difficulties with eating and exercise, and diet-related thoughts and feelings during the final week of treatment were associated with percentage change in body weight. Forty-four, obese, sedentary, postmenopausal women were recruited to participate in a 24-session weight loss intervention. Poor treatment outcome (i.e., percentage change in body weight) was significantly associated with several baseline characteristics including higher body mass index (BMI), greater fat and lower carbohydrate consumption, poor body image, and greater expectations for program success. Poor treatment outcome was also significantly associated with poor program attendance, unsatisfactory early weight loss, unsatisfactory improvements in weight-related quality of life, and lower self-control and self-confidence. By the end of active treatment, women with poor treatment outcome evidenced significantly higher levels of guilt and feelings of failure. The need for early identification and intervention with participants at risk for treatment failure is discussed.

Introduction

From a public health perspective, the increased incidence of obesity is alarming because obesity is a risk factor for a number of serious health problems (heart disease, hypertension, diabetes; NHLBI, 1998). Despite the potential health benefits of weight loss programs, several recent reviews have noted that these programs are often plagued by poor compliance and high rates of relapse Jeffrey et al., 2000, Marcus et al., 2000. For example, early research by Foreyt, Goodrick, and Gotto (1981) revealed that drop out rates from weight control studies ranged from 0 to 66% (i.e., M=35%). Treatment failure may take the form of program attrition, failure to lose weight during active treatment, or a failure to maintain weight loss following treatment. Considerable attention has focused on the factors that contribute to weight regain following treatment (e.g., resting metabolic rate, accessibility to highly palatable, high-fat foods) as well as treatment factors that encourage weight maintenance (e.g., Jeffrey et al., 2000).

Research examining factors associated with program attrition or a failure to lose weight during active treatment has yielded mixed findings. Among the most common factors associated with poor treatment outcome are poor program attendance (e.g., Jeffrey et al., 1984, Wadden & Letizia, 1992) and unsatisfactory early weight loss (e.g., Kaplan & Atkins, 1987, Perri et al., 1984, Wadden & Letizia, 1992). While self-efficacy (i.e., an individual's conviction or belief that he or she can successfully execute the behavior(s) required to produce desirable outcomes; Bandura, 1977) has been associated with favorable treatment outcomes in several studies Bernier & Avard, 1986, Bernier & Poser, 1984, Edell et al., 1987, Forster & Jeffrey, 1986, outcome expectancies for weight loss success (i.e., assessed prior to treatment) have been associated with negative outcomes Bennett & Jones, 1986, Fowler et al., 1985. Other participant characteristics less frequently examined, such as the ability to generate coping responses to hypothetical high-risk situations (Drapkin, Wing, & Shiffman, 1995), use of direct coping (Dohm, Beattie, Aibel, & Striegel-Moore, 2001), favorable body image, and fewer lifetime bouts of repeated weight loss and gain (Kiernan, King, Kraemer, Stefanick, & Killen, 1998) have also been associated with better treatment outcomes. Finally, a number of pretreatment patient characteristics (i.e., age, body fat, mood, weight cycling, psychopathology) have failed to reliably predict attrition and poor treatment outcome (e.g., Wadden & Letizia, 1992).

The goal of the current investigation was to confirm and extend prior research on the predictors and correlates of attrition and failure to lose weight during treatment. Specifically, this investigation examined whether baseline characteristics, program progress (assessed during the early stages of the intervention), and diet-related thoughts and feelings during the final week of treatment were associated with treatment outcome (i.e., percentage change in body weight by the end of treatment for program completers and percentage change in body weight using the last recorded weight prior to treatment dropout for program noncompleters). Factors associated with poor treatment outcome were selected based on prior research or their plausible association with poor treatment outcome. Baseline factors included psychological distress, expectations for success, perceived level of commitment, perceived body image, history of repeated weight loss and gain, diet, physical activity, and body composition. Program progress included weight loss, program attendance, weight-related quality of life, diminished confidence and self-control, and difficulties maintaining eating and exercise habits. Finally, we wanted to examine several proximal correlates of poor treatment outcome (only for participants completing the program).

Using ecological momentary assessment techniques (described in Methods) during the final week of the weight loss intervention, we examined whether mood, coping, and abstinence violation effects during dietary temptations, lapses, and times of minimal dietary consequence (i.e., random prompts throughout the day) were associated with treatment outcome.

Section snippets

Participants

Forty-four, obese, sedentary, postmenopausal women were recruited to participate in a weight loss intervention. Participants were, on average, 54.7 (S.D.=7.9) years of age. Approximately two-thirds of the women had an annual income that exceeded US$30,000 a year, about one-half (49%) had at least a baccalaureate college degree, and slightly over one-half (56.8%) worked full-time. Participants were recruited through local advertisements (e.g., newspaper) and fliers (e.g., distributed at women's

Weight loss and adherence

Of the 44 participants, 37 participants (84.1%) completed the study. Participant demographic and baseline characteristics are reported in Table 1. Percentage change in body weight was not associated with any demographic characteristics. Percentage change in body weight at Session 6 was significantly associated with percentage change in body weight by the end of treatment (P<.01). To further examine the nature of this relationship, univariate analysis of variance was used to examine percentage

Discussion

The goal of the current investigation was to confirm and extend prior research on the predictors and correlates of unsatisfactory weight loss and attrition during a weight loss program. In this investigation, poor treatment outcome was associated with several baseline characteristics, including greater BMI, poor body image, greater expectations for program success, a greater percentage of total calories consumed from fat, and a lower percentage of total calories consumed from carbohydrates.

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