Decision-making, sensitivity to reward, and attrition in weight-management

OBJECTIVE Attrition is a common problem in weight management. Understanding the risk factors for attrition should enhance professionals' ability to increase completion rates and improve health outcomes for more individuals. A model that draws upon neuropsychological knowledge on reward-sensitivity in obesity and overeating to predict attrition is proposed. METHODS A total of 52 participants in a weight-management program completed a complex decision-making task. Decision-making characteristics-including sensitivity to reward-were further estimated using a quantitative model. Impulsivity and risk-taking measures were also administered. RESULTS Consistent with the hypothesis that sensitivity to reward predicted attrition, program dropouts had higher sensitivity to reward than completers (P < 0.03). No differences were observed between completers and dropouts in initial BMI, age, employment status, or the number of prior weight-loss attempts (P ≥ 0.07). Completers had a slightly higher education level than dropouts, but its inclusion in the model did not increase predictive power. Impulsivity, delay of gratification, and risk taking did not predict attrition, either. CONCLUSIONS Findings link attrition in weight management to the neural mechanisms associated with reward-seeking and related influences on decision-making. Individual differences in the magnitude of response elicited by rewards may account for the relative difficulty experienced by dieters in adhering to treatment.