Is drop-out from obesity treatment a predictable and preventable event?

Abstract

BackgroundAttrition is an important but understudied issue that plays a vital role in the successful treatment of obesity. To date, most studies focusing on attrition rates and/or its predictors have been based on pretreatment data routinely collected for other purposes. Our study specifically aims at identifying the predictors of drop-out focusing on empirically or theoretically-based factors.MethodsWe conducted a retrospective observational study in an academic outpatient clinical nutrition service in Pavia, Italy. We examined a total of 98 adult obese patients (36 males, 62 females) who underwent a 6-month dietary behavioral weight-loss treatment at our Center. Pre-treatment and treatment-related variables were collected or calculated from clinical charts in order to discriminate those subjects who completed treatment from those who abandoned it before its completion. Multivariable regression analysis was used to identify the independent predictors of drop-out.ResultsThe drop-out rates were 21% at 1 month and 57% at 6 months. Compared with completers, noncompleters were significantly younger in terms of age at first dieting attempt (24.0 ± 10.7 vs. 31.3 ± 11.2 years, P = 0.005), had lower diastolic blood pressure (87.8 ± 9.7 vs. 92.7 ± 11.4 mmHg, P = 0.022), had a lower baseline body fat percentage (38.5 ± 6.4 vs. 41.2 ± 4.4% weight, P = 0.015), and had a lower percentage of early weight loss (-1.8 ± 1.8% vs. -3.1 ± 2.1%, P = 0.035). Moreover, noncompleters significantly differed from completers with regard to type of referral (34.1% vs. 53.3% sent by a physician, P = 0.036) and SCL-90 anger-hostility subscale (0.83 ± 0.72 vs. 0.53 ± 0.51, P = 0.022). A multivariable logistic regression analysis including pre-treatment variables showed that body fat percentage (P = 0.030) and SCL-90 anger-hostility subscale (P = 0.021) were independently associated with attrition. In a multivariable model considering both pre-treatment and treatment-related factors, attrition was found to be independently related to the age at first dieting attempt (P = 0.016) and the achievement of early weight loss (P = 0.029).ConclusionsOur data confirm that psychopathological tracts, early dieting attempts, and a poor initial treatment response are key independent predictors of drop-out from obesity treatment.

Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review

“…The most prominent predictors of adherence identified were: early weight loss success , lower baseline BMI , better baseline mood , being male and older age .…”

Poly is more effective than monounsaturated fat for dietary management in the metabolic syndrome: The muffin study

“…Another notable highlight was the high percentage of African American (79%) participants, a group that is commonly underrepresented in clinical studies. Moreover, the prior studies that included subjects of African descent were generally observational, employing food-frequency questionnaires rather than a randomized intervention clinical trial (39). Unfortunately, the group samples were too small for a race-specific analysis.…”

Predictors of Retention Among African Americans in a Randomized Controlled Trial to Test the Healthy Eating and Active Living in the Spirit (HEALS) Intervention

“…Previous studies showed that community-based participatory research (CBPR) approaches lead to increased recruitment and retention rates. [11][12][13][14][15] In fact, use of CBPR approaches to promote health is recognized as a critical strategy in addressing health inequities among socially disadvantaged and Predictors of retention among african americans in a randomized controlled trial to test the healthy eating and active living in the sPirit (heals) intervention Oluwole A. Babatunde, MPH 1,3 ; Swann Arp Adams,PhD [1][2][3] ; Michael D. Wirth, PhD 1,3,4 ; Jan M. Eberth,PhD 1,3 ; Jameson Sofge, MPH 1,3 ; Seul Ki Choi, PhD 3,5 ; Brook E. Harmon,PhD 3,6 ; Lisa Davis, MS 3 ; Ruby Drayton, MS 3 ; Thomas G. Hurley, MS 3 ; Heather M. Brandt, PhD 3,5 ; Cheryl A. Armstead,PhD 3,7 ; James R. Hébert, ScD 1,3,4,8 Introduction: Retention of racial/ethnic minority groups into research trials is necessary to fully understand and address health disparities. This study was conducted to identify participants' characteristics associated with retention of African Americans (AAs) in a randomized controlled trial (RCT) of a behavioral intervention.…”

“…This attrition rate ranges from 10% to 80% depending on the study population, study period, and the intervention. [7][8][9][10] Factors that have been identified by previous research studies as contributing to retention of AAs in randomized controlled trials (RCT) should be incorporated into study design and approaches. Previous studies showed that community-based participatory research (CBPR) approaches lead to increased recruitment and retention rates.…”