Predictors of attrition from a pediatric weight management program

Zeller, Meg H.; Kirk, Shelley; Claytor, Randal P.; Khoury, Philip R.; Grieme, Jennifer; Santangelo, Megan; Daniels, Stephen R.

doi:10.1016/j.jpeds.2003.12.031

Cited by 269 publications

(292 citation statements)

References 18 publications

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“…This difficulty is multilevel; there are patient-, provider-, institutional-, managed care-, and community-level barriers that affect the achievement of successful outcomes. One such barrier is the high rate of patient attrition from stage 3 weight-management clinics and programs [7][8][9] in both the initial treatment and maintenance phases of these programs. 10 Minimizing attrition is crucial for individual patient success.…”

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confidence: 99%

“…A small but significant literature exists regarding patient-level predictors of attrition. Common predictors of attrition include Medicaid status, black ethnicity, older age, depression, lower self-concept, 8 elevated parental BMI, race/ethnicity, 9 overall health status, overall quality of care, difficulty with medical insurance coverage, location and timing of program visits, unfulfilled parental expectations, and a child's desire to leave the program. 7,11 In the adult literature, women who had more previous weight-loss attempts were more likely to not complete a program.…”

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confidence: 99%

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

et al. 2011

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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

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

et al. 2011

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“…148 Depression impairs patients' ability to implement behavior change and medical recommendations 149 and is associated with higher rates of attrition from pediatric weight management programs. 150 Recommended primary care screening methods 151 include the 9-item Patient Health Questionnaire-9 152 and the 2-item Patient Health Questionnaire-2 153 for adolescents and the internalizing subscale items of the Pediatric Symptom Checklist for younger children. 154 Positive screens should trigger referral to a mental health specialist for management.…”

Section: Psychiatric Flat Affectmentioning

confidence: 99%

Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review

et al. 2016

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Overweight and obesity affects 1 in 3 US children and adolescents. Clinical recommendations have largely focused on screening guidelines and counseling strategies. However, the physical examination of the child or adolescent with obesity can provide the clinician with additional information to guide management decisions. This expert-based review focuses on physical examination findings specific to children and adolescents with obesity. For each physical examination element, the authors define the finding and its prevalence among pediatric patients with obesity, discuss the importance and relevance of the finding, describe known techniques to assess severity, and review evidence regarding the need for additional evaluation. The recommendations presented represent a comprehensive review of current evidence as well as expert opinion. The goal of this review is to highlight the importance of conducting a targeted physical examination during pediatric weight management visits.

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“…Longitudinal analysis of children with a BMI ≥ 99th percentile indicate that 100% remain extremely obese, with an average adult BMI of 43 kg/m 2 [4]. Though multidisciplinary behavioral programs have resulted in modest and sustained decreases in BMI and health risks in less severely obese children, behavioral or dietary interventions have not resulted in significant or sustained improvements in BMI for extremely obese children and adolescents [5,6].…”

Section: Introductionmentioning

confidence: 99%

Bariatric surgery for extreme adolescent obesity: Indications, outcomes, and physiologic effects on the gut–brain axis

Xanthakos

2008

Pathophysiology

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Objective-This review will summarize current indications, limitations and outcomes of bariatric surgery in adolescents, as well as provide an overview of the physiologic effects of bariatric surgery on enteric hormones involved in regulating appetite, satiation and maintenance of weight.Results-Extreme obesity (BMI ≥ 99 percentile) now affects 4% of children and adolescents in the United States. Traditional dietary and behavioral weight management methods have no demonstrated efficacy for extremely obese children and adolescents, in contrast with bariatric surgery which has produced significant and sustainable weight loss and associated improvements in comorbid diseases for the extremely obese. Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) are the most commonly performed bariatric surgical procedures in adolescents, but vertical sleeve gastrectomy may be a promising new option for selected extremely obese adolescents. A mean weight loss of 37-40% is achieved in adolescents after RYGB, with LAGB showing similar results, albeit attained at a slower rate.Conclusion-Alterations in the enteric hormones involved in the gut-brain axis that regulates appetite and energy expenditure may play a role in both the anorexigenic and weight-reducing effects of certain bariatric surgical procedures. In particular, RYGB induces a rise in both fasting and post-prandial peptide tyrosine-tyrosine which could contribute to the more rapid and greater degree of weight loss than is seen with LAGB. Limitations of bariatric surgery however include the potential for post-operative morbidity and mortality, as well as possible weight regain in a small proportion of patients.

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Predictors of attrition from a pediatric weight management program

Cited by 269 publications

References 18 publications

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

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

Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review

Bariatric surgery for extreme adolescent obesity: Indications, outcomes, and physiologic effects on the gut–brain axis

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