January 2017

The Influence of Weight-Loss Expectations on Weight Loss and of Weight-Loss Satisfaction on Weight Maintenance in Severe Obesity

Summation:

Maintenance of weight loss following an intervention is necessary to sustain health benefits for participants. Yet, commonly weight loss is not maintained for an extended period of time. Therefore, factors affecting weight maintenance require consideration; including biological and cognitive mechanisms. The study by Calugi, Marchesini, Ghoch, Gavasso, and Grave, examined the effect weight loss expectations had upon initial weight loss and the effect weight loss satisfaction had upon weight maintenance (2017).  Both relationships have been reported in existing literature. However, additional studies have negated this literature. In example, a study by Finch, Linde, Jeffery, Rothman and King, which sought to manipulate and heighten weight loss expectations in an intervention group found no significant difference in weight loss from their control group after eight weeks (2005). The conflict of results found throughout published works leaves the question vibrant. 

 Utilizing a sample of 88 patients of an Eating and Weight Disorders Inpatient Unit of Villa Garda Hospital with weight designations of Class II or III obesity researchers of the study Calugi et al. assigned participants to one of two energy restricted diets. The first diet was a high protein energy restricted diet with 1,200 kcal/day for women and 1,500 kcal/day for men; and a macronutrient distribution of 20% energy from fats (<10% from saturated fats) 34 % of energy from proteins and 46% from carbohydrates. The second diet was a high carbohydrate energy restricted diet with 1,200 kcal/day for women and 1,500 kcal/day for men; and a macronutrient distribution of 20% energy from fats (<10% from saturated fats) 17 % of energy from proteins and 63% from carbohydrates. Patients’ weight, height, weight loss expectations, weight loss satisfaction and adherence to treatment were assessed at intervention transition points, such as baseline, week 3 (end of inpatient cognitive behavior and diet therapy), week 27 (end of weight loss phase), and week 51 (end of weight maintenance phase).

Data analysis included t tests or Mann-Whitney U tests to compare weight-loss expectation and satisfaction between the two groups. Pearson or Spearman correlations were used to evaluate the relationships among the continuous variables included in the study.  Mixed models were used to assess weight-loss expectations as predictors of weight loss.

Participants of either diet had similar weight expectations, so all further analysis were performed upon the whole sample. Ten patients dropped out of treatment during the weight loss phase. No association was found between dropped participants and the percentage weight loss necessary to achieve the acceptable and disappointing weight-loss goals. Researchers found a significant association between dropped participants and the percentage weight loss necessary to reach dream and happy weight-loss goals. Results showed weight loss at Week 27 was predicted by all the expected weight targets measured in kilograms.

Weight-loss satisfaction was similar in the high protein and high carbohydrate energy restricted diets, so all further analysis was performed upon the whole sample. Satisfaction with weight loss was associated with weight loss and adherence to diet, but not with weight loss expectations. Weight maintenance at study’s conclusion were reported by researchers to be significantly predicted by factors of disappointing weight loss expectations, weight loss, weight loss satisfaction, and the number of food diaries completed.

The researchers came to four primary conclusions in their discussion.

1. Higher weight-loss goals, not % weight loss needed to reach goals was associated with greater weight loss. This conclusion was supported by existing literature.

2.  There is no correlation between weight-loss expectations and attrition rates, or number of dropped participants. This conclusion was supported by existing literature. Researchers noted that the conclusion did not match real-world observational studies. In these studies, attrition was associated with higher weight-loss expectations. This study found only the percentage weight losses necessary to attain dream and happy weights were correlated with dropout, whereas the expected acceptable and disappointing weight-loss goals do not affect attrition.

3.  Type of diet does not influence participant satisfaction with weight loss.

4.  Weight-loss satisfaction and weight loss independently predict weight maintenance. This conclusion was supported by existing literature.

The researchers concluded the study results confirmed an association between higher weight-loss targets and greater weight loss and weight loss satisfaction, and that the amount of weight loss achieved by treatment is linked to subsequent weight maintenance (Calugi et al., 2017).

AND Continuing Education Article:

Calugi, S., Marchesini, G., Ghoch, M.E., Gavasso, I., Grave, R.D. (2017). The Influence of Weight-Loss Expectations on Weight Loss and of Weight-Loss Satisfaction on Weight Maintenance in Severe Obesity. Journal of the Academy of Nutrition and Dietetics, 117(1), 32-38.
CEU Article web link:

http://www.andjrnl.org/article/S2212-2672(16)31069-3/fulltext

Supplemental Article 1 (reference #17 in CEU article):

Finch, E.A., Linde, J.A., Jeffery, R.W., Rothman, A.J., King, C.M. (2005). The Effects of Outcome Expectations and Satisfaction on Weight Loss and Maintenance: Correlational and Experimental Analyses- A Randomized Trial. Health Psychology. 24 (6), 608-616.

Supplement 1 web link: 

http://eds.a.ebscohost.com.libproxy.lib.ilstu.edu/eds/pdfviewer/pdfviewer?vid=4&sid=72c71937-2462-47c6-babe-427c81f495b5%40sessionmgr4008&hid=4102

Discussion Questions Resource Article 1 (Question 1)
Mayo Clinic Staff. (2015). Weight Loss Goals: Set Yourself Up for Success. Mayo Clinic.
< http://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20048224>

Discussion Questions Resource 2 ( Question 3)Hansen, A.C. (2012). Cognitive-behavioural and other psychological techniques in the dietetic consultation: Suggestions for practice. Nutrition & Dietetics. 69. 236-241. DOI: 111/j.1747-0080.2012.01645.x