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‘Self-fulfilling prophecy’ of weight gain hinders effect of weight-loss drug
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Patients prescribed a weight-loss drug attributed weight regain to an innate inability to lose weight, according to interviews; researchers suggest that a better understanding of side effects and necessary dietary changes may help these patients succeed.
“At present, the so called ‘side effects’ of orlistat are seen as unpleasant and intrusive. If health professionals can highlight that such ‘side effects’ are actually the consequences of eating high-fat foods while taking the drug, it could help ensure a change in diets,” Amelia Hollywood, PhD, of the University of Surrey in the United Kingdom, said in a press release.
Hollywood and Jane Ogden, PhD, interviewed two men and eight women (mean age, 51.7 years) who were prescribed orlistat (Xenical, Roche) and had gained an average of 14.95 kg at 18 months post-prescription (average BMI at baseline, 40 kg/m2). All but one patient had discontinued use of the medication at the time of the interviews.
Patients were asked the following questions:
1. How did you find taking Xenical?
2. Do you think it helped you to lose weight (Prompts: how and why)?
3. Do you intend to take it again in the future?
4. Do you feel you still have a weight problem?
Using thematic analysis, the researchers showed common themes and one overarching idea behind the failure of the medication in these patients.
“They conceptualise themselves as an overweight person who cannot lose weight, and rather than using the medication as a tool that needs to be worked with, they hand over all responsibility to the medication which is therefore seen as a failure. Accordingly, their identity as a perpetual failed dieter remains unchallenged. Similarly, when focusing on barriers to weight loss, all selected barriers are external and beyond their control, and their descriptions of all other failed attempts enables them to conceptualise themselves as someone who cannot and will not lose weight,” they wrote.
This concept was deemed a “self-fulfilling prophecy” by the researchers.
“The failure of orlistat was understood as one of many failed attempts at weight loss within a long history of being a failed and ongoing dieter,” they wrote. “The results indicate that many participants started each new weight-loss attempt with the expectation that it would fail; they had a self-fulfilling prophecy of failure which in turn influenced the outcome.”
In the study and the press release, researchers suggested that these patients saw the side effects of the medication and the subsequent failure to complete the course of medication as beyond their control.
“Our results have significant implications for [physicians] and how they should communicate with the patients about this drug,” Hollywood said in the release. “By alerting patients to these consequences and emphasizing the need for dietary change, patients may be in a better position to make an informed judgment as to whether they wish to be prescribed this medication. [Physicians] may likewise be able to make a more informed decision as to whether the medication should be prescribed, which could have cost implications for the [National Health Service] by reducing the waste of medications.”
Disclosure: This study was supported by the University of Surrey and Roche Ltd.
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