What is a reasonable weight loss? Patients' expectations and evaluations of obesity treatment outcomes.

Expert panels and governmental guidelines now recommend that obese persons seek modest (i.e., "reasonable") reductions in body weight rather than striving for "ideal" weights. Little is known, however, about patients' views of what is a "reasonable" weight loss. This study assessed patients' goals, expectations, and evaluations of various outcomes before, during, and after 48 weeks of treatment. Before treatment, 60 obese women (99.1 +/- 12.3 kg; body mass index of 36.3 +/- 4.3 kg/ m2) defined their goal weight and 4 other weights: "dream weight"; "happy weight"; "acceptable weight"; and "disappointed weight." Goal weight averaged a 32% reduction in body weight. A 17-kg weight loss was defined as disappointed; a 25-kg loss, was acceptable. After 48 weeks of treatment and a 16-kg weight loss, 47% of patients did not achieve even a disappointed weight. These data illustrate the dramatic disparity between patients' expectations and professional recommendations and the need to help patients accept more modest weight loss outcomes.