Patient Engagement and Attrition in Pediatric Obesity Clinics and Programs: Results and Recommendations

Abstract

Pediatric tertiary care institutions are well positioned to provide multidisciplinary, intensive interventions for pediatric obesity known as stage 3 treatment. One contributor to the difficulty in administering this treatment is the high rate of patient attrition. Little is known about the practices used by pediatric weight-management clinics and groupbased programs to minimize attrition. Hospital members and nonmembers of FOCUS on a Fitter Future were surveyed on the methods used to engage and retain obese children in their clinics and programs. Shortly thereafter, a benchmarking activity that centered on rates of patient nonattendance at initial and follow-up clinic visits was initiated among FOCUS-group-participating hospitals. Clinic-and group-based program results were contrasted. Staff from groupbased programs reported that the majority of patients did not complete even 50% of program follow-up visits. Multiple patient/family-and clinic/program-level barriers to retention were identified. Attention to successful techniques should be paid during planning for new programs and improvement of established ones. Pediatrics 2011;128:S59-S64

Getting to More Effective Weight Management in Antipsychotic-Treated Youth: A Survey of Barriers and Preferences

“…The results of this study are consistent with other reports of parental preferences and perceived barriers to health behavior change, 15,16,26 and additionally provide insight into the factors that may enable versus hinder participation in behavioral weight loss treatments in the population of youth who are high weight and treated with antipsychotic medications. First, we found that families reported a high level of motivation to participate in a weight loss program, but only a minority of families had completed treatment recommended by a healthcare provider.…”

“…Finally, many caregivers noted pragmatic barriers to participation, such as appointment availability and time constraints, as well as the time and difficulty related to the homework involved in most behavioral weight loss interventions (e.g., logging of food intake and PA). These results are similar to those reported in non-mentally ill obese pediatric populations, 15,26 and suggest that potential strategies to decrease pragmatic barriers to participation in the general population might also be useful in the population of obese youth with psychiatric conditions. These might include the use of telemedicine for remote access to providers and use of mobile device applications to simplify treatment-related homework.…”

“…Questions were generated based on a review of existing research regarding adult or parent/caregiver preferences and barriers to participation in weight loss programs 15,16,28 and in mental health treatment, 29 the research team's previous experience working with obesity and metabolic disorders in mentally ill populations, and consultation with experts in community behavioral obesity treatment and in dissemination-implementation research methodology.…”

“…However, rates of treatment nonadherence in behavioral weight loss interventions can be as high as 50% in non-mentally ill individuals. 15 Reasons for attrition in behavioral weight loss treatment studies include psychosocial and socioeconomic factors, 16 which may be more prevalent in mentally ill individuals. Nonetheless, adult weight management programs located within community mental health clinic settings have been successfully implemented.…”

Primary Care Interventions for Pediatric Obesity: Need for an Integrated Approach

“…[4][5][6] Although effective for certain patients/ families, weight management clinics often are not feasible because of barriers associated with accessibility, transportation, and cost. [7][8][9] Clearly, novel approaches are necessary to enhance interventions in primary care settings, extending the impact of weight management clinics and thereby avoiding progression to tertiary care referrals. Interventions included usual care, MI from a PCP (4 sessions), and MI from both a PCP (4 sessions) and an RD (6 sessions).…”