Personality and Failure to Complete Weight-Loss Programs

Moderate-to-high dropout levels are common in behavioral weight-loss programs. Chiara De Panfilis, MD, and her colleagues at Parma University, Parma, Italy, found that the Temperament and Character Inventory (TCI) helped identify characteristics that placed obese patients at greater-than-normal risk of leaving treatment prematurely (Gen Hosp Psychiatry 2008; 30:515).

The researchers administered the TCI to 92 obese patients with body mass indexes (BMIs) greater than 30 kg/m2 who were applying for a 6-month behavioral weight-loss program. The patients were seeking hospital-affiliated behavioral weight loss treatment, which included decreased caloric intake combined with counseling and recommendations for physical activity. As part of their application, all subjects took the TCI, a 240-item self-report questionnaire designed to assess four dimensions of temperament, including novelty seeking, harm avoidance, reward dependence, and persistence, and three dimensions of character: self-directedness, cooperativeness, and self-transcendence. They also were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P).

Predictors of treatment completion

Six months after entering the study, 62 patients (67.4%) were still in the program, while 30 (32.6%) had been lost to follow-up. The two groups did not differ in weight, pretreatment BMIs, age, gender, or age at onset of obesity. Those who completed the program showed higher ‘harm avoidance’ scores than did the dropouts. The one element that predicted good attendance was pretreatment high reward dependence scores. Reward dependence refers to individual sensitivity to social cues, which helps social relations and communication. Thus, having a tendency toward being sociable, dedicated and highly responsive to social pressure reduced the risk of dropout in this behavioral weight-loss program.

These findings may be helpful for health care professionals treating persons who are obese.