Weight Loss Goals of Patients in a Health Maintenance Organization
Gareth Dutton1, Melissa Dancer-Brown2, Krystin Reuter1, Michelle Harper1, Erika O’Neil1, Mary Goble2, Nancy Van Vessem2, & Michael Perri3
1
Florida State University College of Medicine 2 Capital Health Plan 3 University of Florida
Background
• Current guidelines recommend weight loss of 510% • Weight loss participants have more ambitious goals.
▫ Dream or ideal weights = 24-38% losses ▫ Disappointed weights = 8-16% losses
Background: Mixed Results
Some found unrealistic expectations associated with: Others found no relationship between expectations and:
• • • •
Less weight loss Higher attrition Poor body image Treatment dissatisfaction
• Treatment response • Attrition • Relevant psychological constructs
Fabricatore et al., 2007; Linde et al., 2004; 2005
Dalle Grave et al., 2005; Foster et al., 1997; Teixeira et al., 2002; 2004
Background & Purpose
• Most of past research involves:
▫ University-affiliated specialty clinics ▫ Patients enrolled in weight loss RCT’s
• The purpose of this investigation:
▫ Examine weight loss expectations of patients’ in weight loss program implemented in general medical setting ▫ Examine variables associated with patients’ goals
Participants & Setting
• Managed care organization serving approximately 110,000 members • Offers group-based behavioral weight loss program
▫ Weekly group sessions ▫ Modified from Diabetes Prevention Program
• 154 participants recruited to complete weight goals survey during initial session
Measures
Portions of the Goals and Relative Weights Questionnaire (Foster et al., 1997) Dream weight A weight you would choose if you could weigh whatever you wanted. This weight is not as ideal as the previous one. It is a weight, however, that you would be happy to achieve. A weight that you would not be particularly happy with, but one that you could accept, since it is less than your current weight. A weight that is less than your current weight, but one that you could not view as successful in any way. You would be disappointed if this were your final weight after the program.
Happy weight
Acceptable weight
Disappointed weight
Sample Characteristics (N=154)
Characteristic Age (years) Weight (kg) BMI (kg/m2) Female Caucasian College graduate M + SD, or N (%) 46.7 + 12.5 99.5 + 24.3 36.2 + 7.8 137 (89%) 98 (64.5%) 83 (59.7%)
Results: Weight Loss Expectations
Weight Loss Expectations
Group Differences in Expectations (% weight loss required)
*
* p < 0.001
* p < 0.01
Predictors of Weight Loss Expectations
Outcome Dream BMI Gender Ethnicity # Dr visits/year Happy BMI Age Gender Ethnicity # Dr visits/year Predictor β 0.30 -0.57 -0.28 0.21 0.54 0.14 -0.50 -0.24 0.21 p <0.001 <0.001 <0.001 <0.001 <0.001 0.02 <0.001 <0.001 <0.001 0.66 <0.001 R2 0.53 p <0.001
Predictors of Weight Loss Expectations
Outcome Acceptable Predictor BMI Gender Ethnicity # Dr visits/year Disappointed BMI Gender Ethnicity # Dr visits/year β 0.54 -0.39 -0.16 0.27 0.71 -0.23 -0.20 0.17 p <0.001 <0.001 0.01 <0.001 <0.001 <0.001 <0.001 0.01 0.70 <0.001 R2 0.61 p <0.001
Discussion
• Findings consistent with past research:
▫ Patients would be happy to lose nearly 1/4th of their body weight ▫ 9% weight loss would be disappointing ▫ Heavier patients endorse higher weight goals ▫ Women and men have different expectations
• Unique contributions:
▫ General medical sample in applied clinical setting ▫ Frequency of physician visits related to more reasonable goals
Limitations & Future Directions
• Limitations:
▫ Cross-sectional design ▫ Small subset of men in sample ▫ Limited number of predictors in analyses ▫ Are patients’ goals related to clinical outcomes? ▫ How close do patients come to reaching goals in “real world” program? ▫ Inclusion of other psychosocial constructs as predictors ▫ Should treatment target patients’ goals in applied settings/programs?
Weight loss Adherence/attrition
• Future directions:
Questions? Comments?