Who will lose weight? A reexamination of predictors of weight loss in women

Abstract

BACKGROUND: The purpose of this study was to analyze pretreatment predictors of short-term weight loss in Portuguese overweight and obese women involved in a weight management program. Behavioral and psychosocial predictors were selected a priori from previous results reported in American women who participated in a similar program. METHODS: Subjects were 140 healthy overweight/obese women (age, 38.3 +/- 5.9 y; BMI, 30.3 +/- 3.7 kg/m2) who participated in a 4-month lifestyle weight loss program consisting of group-based behavior therapy to improve diet and increase physical activity. At baseline, all women completed a comprehensive behavioral and psychosocial battery, in standardized conditions. RESULTS: Of all starting participants, 3.5% (5 subjects) did not finish the program. By treatment's end, more than half of all women had met the recomended weight loss goals, despite a large variability in individual results (range for weight loss = 19 kg). In bivariate and multivariate correlation/regression analysis fewer previous diets and weight outcome evaluations, and to a lesser extent self-motivation and body image were significant and independent predictors of weight reduction, before and after adjustment for baseline weight. A negative and slightly curvilinear relationship best described the association between outcome evaluations and weight change, revealing that persons with very accepting evaluations (that would accept or be happy with minimal weight change) lost the least amount of weight while positive but moderate evaluations of outcomes (i.e., neither low nor extremely demanding) were more predictive of success. Among those subjects who reported having initiated more than 3-4 diets in the year before the study, very few were found to be in the most successful group after treatment. Quality of life, self-esteem, and exercise variables did not predict outcomes. CONCLUSIONS: Several variables were confirmed as predictors of success in short-term weight loss and can be used in future hypothesis-testing studies and as a part of more evolved prediction models. Previous dieting, and pretreatment self-motivation and body image are associated with subsequent weight loss, in agreement with earlier findings in previous samples. Weight outcome evaluations appear to display a more complex relationship with treatment results and culture-specific factors may be useful in explaining this pattern of association.

Figure 1

Individual Weight Change After 4 Months. Red bars indicate subjects who lost more than 3.3% of their initial weight; grey bars indicate subjects who did not lose weight or who gained weight.

Figure 2

Relationship Between Weight Outcome Evaluations and Weight Loss. Dashed line shows curvilinear (quadratic term) and solid line shows linear relationship between weight outcomes evaluations (average of "happy" and "acceptable" values) and weight loss (% of initial). Regression equation includes both linear and quadratic terms and R² change refers to the addition of the quadratic term into the model, after the linear term was already in the model.

Figure 3

Comparison of Success Groups for Previous Dieting and Pretreatment Self-motivation. Groups based on tertiles for 4-month weight loss. F for ANOVA. Error bars show 95^th confidence interval. Different letters indicate significant group differences in post-hoc analysis (p < 0.05).