International Journal of Obesity (2007) 31, 1731–1738 & 2007 Nature Publishing Group All rights reserved 0307-0565/07 $30.00 www.nature.com/ijo ORIGINAL ARTICLE Defined weight expectations in overweight women: anthropometrical, psychological and eating behavioral correlates V Provencher1, C Bégin2, M-P Gagnon-Girouard2, HC Gagnon1, A Tremblay3, S Boivin4 and S Lemieux1 1 Department of Food Science and Nutrition, Institute of Nutraceuticals and Functional Foods, Laval University, Québec, Canada; 2School of Psychology, Laval University, Québec, Canada; 3Department of Preventive and Social Medicine, Division of Kinesiology, Laval University, Québec, Canada and 4Eating Disorders Treatment Program, CHUL, CHUQ, Laval University, Québec, Canada Objective: To examine associations between defined weight expectations and anthropometric profile and to identify psychological and eating behavioral factors that characterize women having more realistic weight expectations. Methods: A nonrandom sample of 154 overweight/obese women completed the ‘Goals and Relative Weight Questionnaire’, which assessed four weight expectations: (1) dream weight (whatever wanted to weight); (2) happy weight (would be happy to achieve); (3) acceptable weight (could accept even if not happy with it); and (4) disappointed weight (would not view as a successful achievement). Psychological assessments evaluated dysphoria, self-esteem, satisfaction with one’s body (i.e., body esteem) and weight-related quality of life. The ‘Three-Factor Eating Questionnaire’ assessed eating behaviors: (1) cognitive dietary restraint (control of food intake), (2) disinhibition (overconsumption of food with a loss of control), and (3) susceptibility to hunger (food intake in response to feelings and perceptions of hunger). Results: Women’s expectations for their dream (60.676.0 kg), happy (65.276.4 kg) and acceptable (67.976.8 kg) weights corresponded to higher percentages of weight loss (24.276.6% or 19.877.1 kg, 18.675.8% or 15.276.0 kg and 15.275.7% or 12.675.8 kg, respectively) than goals recommended for overweight individuals. Defined weight expectations were positively associated with current weight and body mass index (BMI; 0.37prp0.85; Po0.0001). When women were matched one by one for their current BMI, but showing different happy BMI, women with a more realistic happy BMI were older (P ¼ 0.03) and were characterized by a greater satisfaction towards body weight (P ¼ 0.04), a higher score for flexible restraint (P ¼ 0.003) and a lower score for susceptibility to hunger (P ¼ 0.02) than women with a less realistic happy BMI. Conclusion: These findings suggest that having more realistic weight expectations is related to healthier psychological and eating behavioral characteristics. International Journal of Obesity (2007) 31, 1731–1738; doi:10.1038/sj.ijo.0803656; published online 5 June 2007 Keywords: weight status; psychological profile; eating behaviors; treatment goals Introduction There is no doubt that the prevalence of obesity is increasing in industrialized countries,1,2 and efforts have been engaged to raise awareness among the general population about the importance of having a healthy weight. In a culture that emphasizes thinness and weight control, preoccupation about Correspondence: Dr S Lemieux, Institute of Nutraceuticals and Functional Foods, Laval University, 2440, Hochelaga Blvd., Québec, Québec G1K 7P4, Canada. E-mail: Simone.Lemieux@aln.ulaval.ca Received 14 October 2006; revised 11 March 2007; accepted 10 April 2007; published online 5 June 2007 weight may be related to dissatisfaction with one’s body weight and shape as well as an overconcern about reaching an ideal weight.3 This is particularly observed in women compared to men who appear to be much more comfortable with their weight.4 A study performed in Canadian women having a body mass index (BMI) within acceptable limits (acceptable BMI defined as being between 20 and 24 kg/m2 for the purpose of that study), showed that the proportion of those who desire to lose weight was quite elevated with 35% considering themselves above their desired weight.5 A considerable discrepancy exists between recommended weight loss goals (5–10% of initial weight6) and patient’s expectations (average of 30% of initial weight7) among Factors related to weight expectations V Provencher et al 1732 overweight and obese individuals. Previous studies have shown that measured BMI was positively related to higher weight expectations as defined in absolute weight or in BMI units.7–9 Moreover, measured weight has been identified as a strong determinant of dream, happy, acceptable and disappointed weights.10 Individuals having a higher weight status are thus more likely to choose higher weights in kilograms to define their weight expectations.7–10 In addition to unmodifiable factors such as age and sex,9,10 other modifiable factors have been suggested to explain the determinants of patient’s expectations. Psychological characteristics such as higher level of dysphoria,10 lower selfesteem7 and poorer satisfaction with body image7 have been found to be related to more stringent weight expectations. As underlined by Foster et al.,10,11 data concerning modifiable factors related to body weight expectations are still scarce, and this issue is central for the development of interventions that aimed at modifying patient’s expectations. Among those potential modifiable factors, we may consider the contribution of eating behaviors in the determination of patient’s expectations because eating behaviors are closely related to psychological characteristics, such as well-being,12 and they are also significantly associated with weight status.13–16 Given that both psychological characteristics and weight status are related to weight expectations, it could therefore be suggested that eating behaviors may be involved as significant determinants of weight expectations. Even if moderate weight losses of 5–10% of initial weight are recommended for overweight and obese individuals who are attempting to lose weight,6 controversy is still observed in the literature regarding the possible consequences of having greater weight loss expectations or in other words, expecting a higher percentage of body weight loss. Some authors reported that subjects who expected a highest percentage of body weight loss were those who lost the most significant body weight without being psychologically distressed,17,18 suggesting that less realistic weight loss goals are not hampering efforts to lose weight, and may rather increase motivation to lose weight. On the opposite, other studies have shown that individuals who expressed more important weight-loss expectations were experiencing a higher attrition rate during a weight-loss program, suggesting that not being able to reach defined weight-loss goals may create dissatisfaction regarding weight-loss attempts.9,19,20 Teixeira et al.20 reported a curvilinear relationship between weight expectations and weight changes. More precisely, having either too high weight-loss expectations or too low weight-loss expectations were related to a lower percentage of body weight loss. On the other hand, previous pilot studies aiming at changing weight-loss expectations were generally effective in producing more realistic weight-loss expectations at the end of the intervention, without however enhancing weight-loss maintenance.11,21 Inconsistent results reported in the literature therefore stress the relevance to understand better factors related to patient’s weight expectations. International Journal of Obesity Considering the meaningful impact of obesity, psychological distress and eating behaviors on health status together with the discrepancy observed between recommended weight-loss goals and patient’s expectations, it appears of relevance to understand better the associations between weight status, weight expectations, psychological profile and eating behaviors. The primary objective of this study was to examine associations between defined weight expectations and anthropometric profile in a sample of premenopausal overweight and obese women studied at baseline of a research intervention on weight management. In addition, this study proposed to identify psychological and eating behavioral factors that characterize women having more realistic BMI expectations defined in terms of happy BMI. Materials and methods Participants This study was conducted among a nonrandom sample of 154 premenopausal women (mean age of 42.475.6 years). In response to advertisement through different media in the Quebec City metropolitan area (for example, newspapers and Internet), women voluntarily accepted to participate in the research project. All women included in this study were overweight or obese (BMI between 25 and 35 kg/m2), had a stable weight for at least 2 months (72.5 kg), were not currently dieting, were not pregnant or lactating and were not presenting chronic diseases or taking medication that could impact on measurements performed. Women were also characterized by a preoccupation with their weight and eating.22 Before their participation to the study, each woman signed an informed consent document which was approved by the Laval University Research Ethics Committee. Study design Women who participated in this study were recruited during four equal phases of testing and intervention (September 2003, January 2004, September 2004 and January 2005). A total of 194 women were met for a screening interview and 154 of them accepted to take part in the study and were tested at baseline. This paper presents results obtained at baseline and does not report results from the intervention part of the study. Women were tested during the follicular phase of their menstrual cycle to control for the potential impact of hormonal variation on nutritional and psychological variables. However, some women were exceptionally tested at another moment of their cycle mainly because they had an irregular cycle (N ¼ 4). When these women were excluded from the present analyses, similar results were observed. Measurements of dependent variables Defined weight expectations. A French version of the Goals and Relative Weights Questionnaire (part II)7 was used to Factors related to weight expectations V Provencher et al 1733 identify four different categories of weight expectations: (1) dream weight (‘A weight you would choose if you could weight whatever you wanted’); (2) happy weight (‘This weight is not as ideal as the first one. However, it is a weight that you would be happy to achieve’); (3) acceptable weight (‘A weight that you would not be particularly happy with, but one you could accept since it is less than your current weight’; and (4) disappointed weight (‘A weight that is less than you are at your current weight, but one that you would not view as successful in any way. You would be disappointed if this were your final weight after the program’). All women involved in the study (except one woman who did not answer this questionnaire; N ¼ 153) identified their four weight expectations (in pounds or in kilograms) and these absolute weight values were used in the analyses. In addition, weight expectations were also transformed into BMI units to permit adequate comparison between women from different statures. Expected weight loss and percentages of weight loss that would be required to reach the four defined weight expectations were also calculated according to initial body weight for each woman. Anthropometrical profile. Height, body weight and BMI were determined according to standardized procedures, as recommended at the Airlie Conference.23 Briefly, height was measured to the nearest millimeter with a stadiometer, and body weight was measured to the nearest 0.1 kg on a calibrated balance. Participants were asked to dress lightly and to remove their shoes for these measurements. Diet and weight history. Data regarding previous attempts to lose weight and changes in weight status were collected through a general questionnaire on diet and weight history. In this study, two questions on diet history and two questions on weight history were of particular interest. Women had to indicate at which age they first attempted to lose weight. They also had to indicate the number of times they previously experienced dieting (from 0 to 5 times). Finally, they had to recall their highest and lowest weight ever during adult life (excluding weight reached during pregnancies for the highest weight). Psychological variables. Different validated questionnaires were administrated to assess psychological variables. Dysphoria was evaluated by the Beck Depression Inventory during the screening interview.24 Weight-related quality of life was measured by the Impact of Weight on Quality of Life Questionnaire (IWQOL-Lite),25 according to five dimensions of quality of life (Physical Function, Self-Esteem, Sexual Life, Public Distress, and Work). Self-esteem (general, social and personal) was assessed with the Culture-Free Self-esteem Inventories.26 Body esteem (appearance, weight and attribution) were measured by the Body-Esteem Scale.27 Eating behaviors. The Three-Factor Eating Questionnaire is a 51-item validated questionnaire,28–30 which assesses three factors that refer to cognitions and behaviors associated with eating: cognitive dietary restraint (conscious control of food intake with concerns about shape and weight), disinhibition (overconsumption of food in response to a variety of stimuli associated with a loss of control on food intake), susceptibility to hunger (food intake in response to feelings and perceptions of hunger). More specific subscales can also be derived from these three general eating behaviors:31,32 rigid restraint (dichotomous, all-or-nothing approach to eating, dieting and weight), flexible restraint (gradual approach to eating, dieting and weight), habitual susceptibility to disinhibition (behaviors that may occur when circumstances predispose to recurrent disinhibition), emotional susceptibility to disinhibition (disinhibition associated with negative affective states), situational susceptibility to disinhibition (disinhibition initiated by specific environmental cues), internal hunger (hunger interpreted and regulated internally) and external hunger (triggered by external cues). Statistical analysis Pearson’s correlation analyses were performed to quantify the univariate relationships between defined weight expectations (in kilograms and in BMI units), anthropometric profile (current weight and BMI) and age. As Foster et al.7 have previously shown that happy weight was the body weight expectation that was the most closely associated with weight-loss goal, further analyses were conducted with happy weight expectations. To allow adequate comparison between women from different statures,10 further analyses assessing differences in psychological variables and eating behaviors were performed with current BMI and happy weight expectation expressed in BMI units (referred to as happy BMI). In the two groups of women formed on the basis of their current BMI (BMI above or below the median value of 30.4 kg/m2), coefficients of correlation observed for the relationship between current BMI and happy BMI were computed and then compared using MedCalc statistical software (version 8.2.1.0). Women were also matched one by one for their current BMI (70.95 kg/m2, which refers to the stable weight inclusion criteria (72.5 kg) for the mean height in our sample (1.6270.05 m)). Each pair was formed so that a noticeable difference in their value of happy BMI was observed (number of pairs formed was N ¼ 57; 39 women were not included in the analysis because it was not possible to match them for these specifications). More specifically, each pair showed a difference of at least 1.73 kg/m2 for their happy BMI, which corresponds to the standard deviation (s.d.) for the mean happy BMI value. This matching procedure also resulted in similar values for weight and height when the two groups were compared. For the purpose of these analyses, women with a more realistic happy BMI were determined as follows. For a given current BMI, women who defined their happy BMI as being closer to their current International Journal of Obesity Factors related to weight expectations V Provencher et al 1734 BMI were considered as having a more realistic happy BMI than women who defined their happy BMI as being further from their current BMI (less realistic happy BMI). Psychological variables and eating behaviors were compared between these two groups of women by performing a Student’s unpaired t-test analysis. For variables not normally distributed, a log-transformation was performed. The probability level for significance used for the interpretation of all statistical analyses was set at an a-level of Po0.05. All analyses were performed by using SAS statistical software (SAS Institute, Cary, NC, USA). Results Women from this study had a mean body weight of 80.579.6 kg (BMI: 30.573.0 kg/m2). Their perception of their dream, happy, acceptable and disappointed weights are presented in Table 1. An average woman would have to lose 18.675.8% of her initial weight to reach her happy weight expectation. This value is higher than current recommendations for weight loss (5–10% of initial weight). An average weight loss of 7.875.5% would have been considered as a disappointed result in this sample. Table 2 shows correlations between defined weight expectations and anthropometric profile. Current weight and current BMI were both positively related to dream, happy, acceptable and disappointed weights expressed in kilograms or in BMI units. Age was positively associated with dream weight, dream BMI and happy BMI, and these relationships remained significant after adjustment for weight or BMI. As explained in the Materials and methods section, relationship between current BMI and happy BMI was further examined. As illustrated in Figure 1, the correlation observed between current BMI and happy BMI was stronger in women having a BMI below the median value (p30.4 kg/m2; Figure 1a) than to those with a BMI above the median (430.4 kg/m2; Figure 1b) (r ¼ 0.63, Po0.0001 and r ¼ 0.27, P ¼ 0.02, respectively, with a z statistic ¼ 4.0232; P ¼ 0.0001). Similar differences between groups formed on the basis of their current BMI were also observed for relationships between current BMI and dream BMI, acceptable BMI and disappointed BMI (data not shown). Table 1 Further analyses were performed in women matched one by one for their current BMI, but presenting a significantly different happy BMI, as described in the Materials and methods section. As expected, Table 3 shows no difference for weight and BMI between women having either a lower (less realistic) happy BMI or a higher (more realistic) happy BMI. Moreover, the percentage of weight loss from initial body weight that would be required to reach happy weight (percentage of weight loss) was greater in women with a less realistic happy BMI than in women with a more realistic happy BMI. Women with a less realistic happy BMI were also younger than women having a more realistic happy BMI. However, no significant differences were observed with regard to diet and weight history between these two groups. More specifically, women with a less realistic happy BMI were comparable to those with a more realistic happy BMI regarding the age at which they first attempted to lose weight (23.778.2 years vs 23.277.7 years, respectively; P ¼ 0.77) as well as the number of times they experienced dieting (3.272.0 vs 3.471.7, respectively; P ¼ 0.59). Women from these two groups also reported similar highest and lowest weight during adult life (82.778.4 and 56.376.9 kg for women with a less realistic happy BMI vs 85.079.7 and Table 2 Pearson correlation coefficients for the association of defined weight expectations with body weight, BMI and age (N ¼ 153) Weight (kg) BMI (kg/m2) Age (years) 0.67*** 0.78*** 0.80*** 0.85*** 0.39*** 0.59*** 0.58*** 0.63*** 0.37*** 0.48*** 0.53*** 0.68*** 0.49*** 0.67*** 0.71*** 0.80*** 0.16*a 0.13 0.09 0.11 0.23**b 0.19*b 0.13 0.14 Dream weight Happy weight Acceptable weight Disappointed weight Dream BMI Happy BMI Acceptable BMI Disappointed BMI Abbreviation: BMI, body mass index. Significant correlation: *Po0.05; **Po0.01; ***Po0.0001. aRemained significant after adjustment for weight. b Remained significant after adjustment for BMI. Dream weight: ‘A weight you would choose if you could weight whatever you wanted’; happy weight: ‘This weight is not as ideal as the first one. However, it is a weight that you would be happy to achieve’; acceptable weight: ‘A weight that you would not be particularly happy with, but one you could accept since it is less than your current weight’; and disappointed weight: ‘A weight that is less than you are at your current weight, but one that you would not view as successful in any way. You would be disappointed if this were your final weight after the program’. Defined weight expectations in overweight and obese women (N ¼ 153) Dream weight Happy weight Acceptable weight Disappointed weight Weight (kg) BMI (kg/m2) Expected weight loss (kg) Difference from current weight (%) 60.676.0 65.276.4 67.976.8 74.078.5 23.071.7 24.771.7 25.771.9 28.072.8 19.877.1 15.276.0 12.675.8 6.475.0 24.276.6 18.675.8 15.275.7 7.875.5 Abbreviations: BMI, body mass index; s.d., standard deviation. Data are means7s.d. Dream weight: ‘A weight you would choose if you could weight whatever you wanted’; happy weight: ‘This weight is not as ideal as the first one. However, it is a weight that you would be happy to achieve’; acceptable weight: ‘A weight that you would not be particularly happy with, but one you could accept since it is less than your current weight’; and disappointed weight: ‘A weight that is less than you are at your current weight, but one that you would not view as successful in any way. You would be disappointed if this were your final weight after the program’. International Journal of Obesity Factors related to weight expectations V Provencher et al 1735 Table 4 Differences in variables of the psychological profile between women with either lower or higher happy BMI a 32 r=0.63 p <0.0001 30 28 26 24 22 20 18 24 b 32 25 26 27 28 29 30 31 Higher happy BMI (N ¼ 57) P-value 10.277.0 72.5713.5 11.973.2 6.471.5 4.672.2 1.270.6 0.770.5 1.870.6 9.277.4 76.3712.2 11.873.5 6.771.1 4.872.6 1.470.6 0.970.6 1.870.5 0.48 0.12 0.88 0.27 0.67 0.23 0.04a 0.65 Abbreviations: BMI, body mass index; s.d., standard deviation. Data are means7s.d. aDifference observed between the two groups remained significant after adjustment for age (P ¼ 0.03). BDI ¼ dysphoria (Beck Depression Inventory); total IWQOL ¼ weight-related quality of life (Impact of Weight on Quality of Life-Lite); BES – appearance, weight and attribution ¼ body esteem (Body-Esteem Scale). r=0.27 p =0.02 30 BDI Total IWQOL General self-esteem Social self-esteem Personal self-esteem BES – appearance BES – weight BES – attribution Lower happy BMI (N ¼ 57) 28 26 24 22 Table 5 Differences in eating behaviors between women with either lower or higher happy BMI (N ¼ 114) 20 18 30 31 32 33 34 Current BMI 35 36 37 Figure 1 Pearson correlation between current BMI (kg/m2) and happy BMI (kg/m2) in women below the median value of BMI (a: p30.4 kg/m2) and in women above the median value of BMI (b: 430.4 kg/m2); z statistic ¼ 4.0232; P ¼ 0.0001. Happy BMI refers to the happy weight expectation (in BMI units), which is corresponding to the following definition: ‘This weight is not as ideal as the first one. However, it is a weight that you would be happy to achieve’. Table 3 Differences in age, body weight, BMI and weight loss needed to achieve happy weight between women with either lower or higher happy BMI Age (years) Weight (kg) BMI (kg/m2) Happy weight loss (%) Lower happy BMI (N ¼ 57) Higher happy BMI (N ¼ 57) P-value Cognitive restraint Flexible restraint Rigid restraint 8.574.3 2.471.6 2.771.9 9.473.6 3.371.4 2.871.6 0.25 0.003a 0.75 Disinhibition Habitual Emotional Situational 9.873.0 2.371.6 2.371.0 3.571.3 9.272.9 2.171.4 2.071.2 3.371.5 0.31 0.43 0.19 0.38 Hunger Internal External 6.373.8 2.472.2 2.971.8 4.773.0 1.771.7 2.271.4 0.02 0.06 0.02 38 (kg/m2) Lower happy BMI (N ¼ 57) Higher happy BMI (N ¼ 57) P-value 41.275.8 80.279.2 30.673.0 22.175.1 43.575.2 82.179.0 30.872.9 15.475.0 0.03 0.28 0.71 0.0001 Abbreviations: BMI, body mass index; s.d., standard deviation. Data are means7s.d. Women from the lower happy BMI group had a mean happy BMI of 23.771.4 kg/m2, whereas women from the higher happy BMI group had a mean happy BMI of 26.071.5 kg/m2 (Po0.0001). 58.877.6 kg for women with a more realistic happy BMI; P ¼ 0.17 and P ¼ 0.07, respectively). As observed in Table 4, no significant differences were observed with regard to psychological variables between women presenting either a lower or a higher happy BMI, except for the body image dimension. Women with a more realistic happy BMI showed a greater satisfaction with their weight compared to those having a less realistic happy BMI. Differences observed in eating behaviors between women with less realistic and more realistic happy BMI are presented in Table 5. Women with a more realistic happy BMI were characterized by a higher score for flexible restraint while Abbreviations: BMI, body mass index; s.d., standard deviation. Data are means7s.d. aDifferences observed between the two groups remained significant after adjustment for age (Po0.05), except for external hunger (P ¼ 0.07). they displayed a lower level of susceptibility to hunger (particularly for the external hunger subscale). Because age was significantly different between women with a lower vs those with a higher happy BMI, adjustment for age was also performed. Significant differences were still observed for satisfaction with their weight (P ¼ 0.03), flexible restraint (P ¼ 0.003) and susceptibility to hunger (P ¼ 0.03), whereas the difference noted for external hunger was no longer significant (P ¼ 0.07). Discussion The main objectives of this study were to examine associations between defined weight expectations and anthropometric profile as well as to identify psychological and eating behavioral factors that characterize women having a more International Journal of Obesity Factors related to weight expectations V Provencher et al 1736 realistic definition of what would be a happy BMI. As previously reported,7,8,10 women with higher weight and BMI were likely to choose higher defined weight expectations. In this present study, 57 pairs of women having a similar current BMI, but showing significantly different happy BMI expectations were formed. Women with a more realistic happy BMI were older and were characterized by a greater satisfaction towards their body weight together with a higher score for flexible restraint and a lower score for susceptibility to hunger. These findings suggest that, in addition to unmodifiable factors such as age and sex,9,10 modifiable factors such as body image and eating behaviors are also related to weight expectations. Defined values for dream, happy and acceptable weights reported by women from this study represented higher weight-loss goals than current recommendations (5–10% of initial weight).6 The values corresponding to actual recommendations were rather considered as disappointing results for women in the present sample. This discrepancy between women’s definitions and health definitions of successful weight loss has been observed previously in other studies.7–10 Socio-cultural context and norms in which women are living, such as value of thinness, may contribute to explain the important deviation between current recommendations and defined expectations in terms of weight loss.33,34 In this study, percentages of weight loss needed to achieve each defined weight were lower than those observed previously in other samples.7,10,11 Considering that defined weight expectations are positively related to BMI, as observed in the present and previous studies,7,8,10 this difference could be explained by a relatively lower BMI observed in our sample (mean BMI of 30.573.0 kg/m2 in this study vs 36.374.3 kg/m2 in the study of Foster et al.7). As previously demonstrated,10 age was also positively related to weight expectations, where older women were showing more realistic values for happy BMI. However, after adjustment for the confounding effect of age, similar results were observed suggesting that differences noted for body weight satisfaction, flexible restraint and susceptibility to hunger between women with different happy BMI expectation could not be explained solely by differences in age. Finally, in accordance with previous studies,10 the amount of initial weight to lose to reach defined weight expectations (percentage of weight loss) were also positively related to weight and BMI (data not shown), which could mean that even if heavier women choose higher absolute weights, they would still have to lose higher amount of weight to reach their expected body weight. It has been previously shown that more positive selfesteem and body image as well as lower weight phobia and dysphoria were associated with more realistic defined weights, when adjusted for BMI.7,8,10 In line with these results, women with a more realistic happy BMI were characterized by a greater satisfaction towards their weight, whereas no other differences were noted for psychological variables. This is suggesting that body image is a consistent International Journal of Obesity psychological factor closely related to women’s definition of their happy weight. Although we know that, in general, body image dissatisfaction is highly prevalent among overweight and obese individuals,34,35 the present results showed that, among our overweight and obese samples, there is a specific group of women who, independent of their BMI, are more dissatisfied with their weight and present higher expectations towards weight loss. In accordance with results from Teixeira et al.,19 these women would be more likely to experience unsuccessful weight-loss attempts. In fact, Teixeira et al.19 showed that a lower body cathexis (i.e., more negative feelings towards one’s body) and a less realistic happy weight were both predictors of poorer success in weight loss on a long-term basis. It is therefore of relevance to understand better why for a given current BMI, some women are more susceptible to be less satisfied by their weight and to have less realistic weight expectations. One possible explanation may be that these women associate negatively weight and happiness.36 In that sense, the influence of body dissatisfaction on weight-loss attempt could be related to unrealistic expected changes in body image. If we referred to Stice’s model, we may suppose that those who are less satisfied with their body and present less realistic expectations are at higher risk to adopt nonnormative eating behaviors to lose their excess weight.37 In fact, this study has demonstrated a significant negative relationship between satisfaction towards weight and susceptibility to hunger (r ¼ 0.20; P ¼ 0.0002). Accordingly, prior studies have shown that body dissatisfaction was related to overeating.37,38 Few studies have examined the relationships between eating behaviors and weight expectations, except for the severity of binge-eating for which no association was observed.8,9 In this study, higher score for flexible restraint together with lower score for susceptibility to hunger were observed in women having a more realistic happy BMI. Successful weight maintenance, which implies that initial weight loss is subsequently kept for at least several months, has been previously related to higher levels of flexible restraint and lower scores for susceptibility to hunger.39–42 This would suggest that having more realistic weight expectations is associated with some eating behaviors related to more successful weight-loss maintenance. This is in line with the work of Westenhoefer,43 who has previously suggested that long-term success in weight maintenance would be enhanced by helping individuals to give up their less realistic expectations about weight loss together with focusing on behavioral changes under the principle of flexible control. In addition, findings from this study suggest that weight expectations and eating behaviors could be related to each other. In this regard, our results may also provide some explanations for the greater attrition rate observed during weight-loss programs in individuals with higher expectations as well as for their lower percentage of body weight loss achieved.9,19,20 In fact, for those overweight and obese women who have less realistic weight Factors related to weight expectations V Provencher et al 1737 expectations, it could be suggested that lower level of flexible restraint as well as higher score of susceptibility to hunger may act as barriers that counteract efforts to lose weight or maintain weight loss achieved. In fact, being able to manage food intake with a more graduated and sustainable approach together with being less triggered by feelings of hunger may help to develop a better relationship with food. Thus, women with more realistic weight expectations could be more successful in their attempts to maintain their weight loss, because they also display more favorable eating patterns. However, the cross-sectional nature of this study has to be considered and at this point, it remains to be established whether eating behaviors are causally involved in relationships observed with weight expectations. In addition, because women involved in this study were not randomly selected, they may not be representative of all overweight and obese women. Accordingly, potential bias such as a higher socio-economical status, which is often observed among research volunteers, may have influenced results obtained. Conclusion In a sample of premenopausal overweight and obese women preoccupied with their weight, more realistic weight expectations were related to less body weight dissatisfaction as well as to higher level of flexible restraint and lower score for susceptibility to hunger. According to the previous literature, these characteristics would be related to more successful weight-loss attempts.19,40 Clinical pilot studies that mainly aimed to promote more modest weight-loss expectations have been conducted previously.11,21 These interventions were effective in producing more realistic expectations while they did not facilitate a better long-term weight-loss maintenance. It might be suggested that to be successful, interventions focusing on more modest weight losses should also include components aiming at improving body image and eating behaviors. Other factors, such as flexible eating and hunger, also seem to be of relevance in the understanding of women’s definitions of weight expectations, as preoccupation about food seems to be closely related to preoccupation about weight, and these psychological and eating behavioral correlates of weight expectations appear to be relevant clinical targets in weight management interventions. Acknowledgements This research project was supported by the Canadian Institutes of Health Research (MOP-64226) and Danone Institute. VP is recipient of a studentship from the Fonds de la recherche en santé du Québec. AT is partly funded by the Canada Research Chair in Physical Activity, Nutrition, and Energy Balance. We would like to underline the excellent work of all research professionals that were involved in this study (Geneviève Alain, Louise Corneau, Julie Doyon and Natacha Godbout) as well as the research nurses (Danielle Aubin and Claire Julien). The authors would like to express their gratitude to the subjects for their participation in this study. References 1 Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723–1727. 2 Tjepkema M, Shields M. Nutrition: Findings from Canadian Community Health Survey – Adult Obesity in Canada. 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