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.
Highlights
The treatment of obesity continues to present major challenges, including poor adherence to diet, inadequate and unsatisfactory weight loss, weight regain, and high rates of attrition
Most studies focusing on attrition rates and/ or its predictors have been based on pre-treatment data routinely collected for other purposes [3,4,5,6,7,8]
The present study aims at identifying the predictors of drop-out from obesity treatment focusing on empirically or theoretically-based factors
Summary
The treatment of obesity continues to present major challenges, including poor adherence to diet, inadequate and unsatisfactory weight loss, weight regain, and high rates of attrition. Most studies focusing on attrition rates and/ or its predictors have been based on pre-treatment data (e.g., weight and presence of comorbidities) routinely collected for other purposes (e.g., identifying predictors and correlates of weight loss) [3,4,5,6,7,8]. Previous studies have reported high rates of psychopathology both in obese [20,21,22] and normal-weight persons [23] wishing to lose weight. These findings suggest that factors related to the psychological well-being need to be carefully considered so that obese patients keep attending their weight loss program. Our study aims at identifying the predictors of drop-out focusing on empirically or theoretically-based factors
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