Early dropout predictive factors in obesity treatment

Abstract

Diet attrition and failure of long term treatment are very frequent in obese patients. This study aimed to identify pre-treatment variables determining dropout and to customise the characteristics of those most likely to abandon the program before treatment, thus making it possible to modify the therapy to increase compliance. A total of 146 outpatients were consecutively enrolled; 73 patients followed a prescriptive diet while 73 followed a novel brief group Cognitive Behavioural Treatment (CBT) in addition to prescriptive diet. The two interventions lasted for six months. Anthropometric, demographic, psychological parameters and feeding behaviour were assessed, the last two with the Italian instrument VCAO Ansisa; than, a semi-structured interview was performed on motivation to lose weight. To identify the baseline dropout risk factors among these parameters, univariate and multivariate logistic models were used. Comparison of the results in the two different treatments showed a higher attrition rate in CBT group, despite no statistically significant difference between the two treatment arms (P = 0.127). Dropout patients did not differ significantly from those who did not dropout with regards to sex, age, Body Mass Index (BMI), history of cycling, education, work and marriage. Regardless of weight loss, the most important factor that determines the dropout appears to be a high level of stress revealed by General Health Questionnaire-28 items (GHQ-28) score within VCAO test. The identification of hindering factors during the assessment is fundamental to reduce the dropout risk. For subjects at risk, it would be useful to dedicate a stress management program before beginning a dietary restriction.

Predicting dropout in dietary weight loss trials using demographic and early weight change characteristics: Implications for trial design

“…Where a relationship does exist it appears that females may be more likely to drop out than males 2 , although a more recent study has shown that males are more likely to drop out than females 23 . The 2011 systematic review found roughly equal (but small n=4-5) numbers of papers supporting a relationship between high or low initial weight and attrition compared with 18 reporting no relationship more recent papers continue to differ with some supporting the relationship between higher initial weight 18,20 and attrition and some lower initial weight 15 (although no relationship is still the most frequent 9,17,19 ).…”

“…The consideration that analyses investigating attrition are generally post hoc and unplanned also makes the relationship between attrition and gender and attrition and initial weight or BMI unclear as the majority of studies show no relationship 2,15,19 . Where a relationship does exist it appears that females may be more likely to drop out than males 2 , although a more recent study has shown that males are more likely to drop out than females 23 .…”

Abandono de la terapia nutricional y pérdida de peso en pacientes bariátricos: Cohorte retrospectiva en Lima, Perú

“…la cirugía; es decir, cuando debe comenzar el tratamiento nutricional. Para el análisis se utilizó como punto de corte 10% 17,18 y se definieron dos categorías: <10% y ≥10%.…”

“…Asumiendo un nivel de confianza del 95% (IC95%) y una potencia del 80%, se requerían como mínimo 288 participantes (144 participantes en cada grupo de acuerdo a exposición) para detectar una diferencia de 16% en las tasas de abandono, es decir, 46% 17 de abandono en aquellos que pierden menos del 10% de su peso, comparados con 30% 18 de abandono en aquellos que pierden más del 10%. Dos variables resultado fueron evaluadas: los criterios de inclusión para la cirugía bariátrica, definida según las guías americanas y europeas 6,7 , es decir, aquel paciente que tiene un IMC≥40kg/m 2 o ≥35kg/m 2 con comorbilidades como hipertensión y diabetes; y el abandono del tratamiento nutricional, entendido como la consulta y seguimiento llevado a cabo exclusivamente por la nutricionista, profesional que forma parte del equipo multidisciplinario según indicaciones internacionales 6,7,9 .…”

“…Otro estudio determinó una menor edad e IMC como factores de riesgo para abandono de un tratamiento farmacológico en pacientes obesos 13 . La literatura también señala factores de riesgo asociados a un tratamiento para la obesidad a largo plazo como ansiedad, estrés, insomnio y depresión severa 18 , así como resultados insatisfactorios y falta de motivación 25 , pero dichas variables no fueron evaluadas en este estudio.…”