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

Ottavia Colombo, Virginia Valeria Ferretti, Cinzia Ferraris, Claudia Trentani, Piergiuseppe Vinai, Simona Villani, Anna Tagliabue, Ottavia Colombo, Virginia Valeria Ferretti, Cinzia Ferraris, Claudia Trentani, Piergiuseppe Vinai, Simona Villani, Anna Tagliabue

Abstract

Background: Attrition 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.

Methods: We 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.

Results: The 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).

Conclusions: Our data confirm that psychopathological tracts, early dieting attempts, and a poor initial treatment response are key independent predictors of drop-out from obesity treatment.

Figures

Figure 1
Figure 1
Percentage of weight change in the 98 study participants observed during the entire study period (weight registered at the last visit attended vs. weight at the first visit).

References

    1. Moroshko I, Brennan L, O'Brien P. Predictors of dropout in weight loss interventions: a systematic review of the literature. Obes Rev. 2011;12:912–934. doi: 10.1111/j.1467-789X.2011.00915.x.
    1. Dansinger ML, Gleason JA, Griffith JL. et al.Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction; a randomized trial. JAMA. 2005;293:43–53. doi: 10.1001/jama.293.1.43.
    1. Gunnarsdóttir I, Sigurgeirsdóttir GK, Thórsdóttir I. Predictors of dropping out in a weight loss intervention trial. Ann Nutr Metab. 2010;56:212. doi: 10.1159/000279224. Epublication 11 March 2010.
    1. Lim SS, Norman RJ, Clifton PM. et al.Psychological effects of prescriptive vs. general lifestyle advice for weight loss in young women. J Am Diet Assoc. 2009;109:1917–1921. doi: 10.1016/j.jada.2009.08.008.
    1. Messier V, Hayek J, Karelis AD. et al.Anthropometric, metabolic, psychosocial and dietary factors associated with dropout in overweight and obese postmenopausal women engaged in a 6-month weight loss programme: a MONET study. Br J Nutr. 2010;103:1230–1235. Epublication 24 November 2009.
    1. Elfhag K, Rossner S. Initial weight loss is the best predictor for success in obesity treatment and sociodemographic liabilities increase risk of drop-out. Patient Educ Couns. 2010;79:361–366. doi: 10.1016/j.pec.2010.02.006.
    1. Chang MW, Brown R, Nitzke S. Participant recruitment and retention in a pilot program to prevent weight gain in low-income overweight and obese mothers. BMC Public Health. 2009;9:424. doi: 10.1186/1471-2458-9-424.
    1. Inelmen EM, Toffanello ED, Enzi G. et al.Predictors of drop-out in overweight and obese outpatients. Int J Obes. 2005;29:122–128. doi: 10.1038/sj.ijo.0802846.
    1. Fabricatore AN, Wadden TA, Moore RH. et al.Predictors of attrition and weight loss success: Results from a randomized controlled trial. Behav Res Ther. 2009;47:685–691. doi: 10.1016/j.brat.2009.05.004. Epublication 20 May 2009.
    1. Gripeteg L, Karlsson J, Torgerson J. et al.Predictors of very-low-energy diet outcome in obese women and men. Obes Facts. 2010;3:159–165. Epublication 11 June 2010.
    1. Dalle Grave R, Calugi S, Molinari E. et al.Weight loss expectations in obese patients and treatment attrition: an observational multicenter study. Ob Res. 2005;13:1961–1969. doi: 10.1038/oby.2005.241.
    1. Bradshaw AJ, Horwath CC, Katzer L. et al.Non-dieting group interventions for overweight and obese women: what predicts non-completion and does completion improve outcomes? Public Health Nutr. 2010;13:1622–1628. doi: 10.1017/S1368980009992977.
    1. Greenberg I, Stampfer MJ, Schwarzfuchs D. et al.Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial (DIRECT) J Am Coll Nutr. 2009;28:159–168. doi: 10.1080/07315724.2009.10719767.
    1. Busetto L, Mazza M, Salvalaio S. et al.Obesity treatment in elderly outpatients: predictors of efficacy and drop-out. Eat Weight Disord. 2009;14:e56–e65. doi: 10.1007/BF03327801.
    1. Kong W, Langlois MF, Kamga-Ngandé C. et al.Predictors of success to weight-loss intervention program in individuals at high risk for type 2 diabetes. Diabetes Res Clin Pract. 2010;90:147–153. doi: 10.1016/j.diabres.2010.06.031. Epublication 24 July 2010.
    1. De Panfilis C, Cero S, Dall’Aglio E. et al.Psychopathological predictors of compliance and outcome in weight-loss obesity treatment. Acta Biomed. 2007;78:22–28.
    1. De Panfilis C, Torre M, Cero S. et al.Personality and attrition from behavioral weight-loss treatment for obesity. Gen Hosp Psychiatry. 2008;30:515–520. doi: 10.1016/j.genhosppsych.2008.06.003. Epublication 3 August 2008.
    1. Komulainen T, Keränen AM, Rasinaho E. et al.Quitting a weight loss program is associated with anhedonia: preliminary findings of the Lifestyle Intervention Treatment Evaluation Study in northern Finland. Int J Circumpolar Health. 2011;70:72–78. Epublication 16 February 2011.
    1. Somerset SM, Graham L, Markwell K. Depression scores predict adherence in a dietary weight loss intervention trial. Clin Nutr. 2011;30:593–598. doi: 10.1016/j.clnu.2011.04.004. Epublication 14 May 2011.
    1. Marchesini G, Bellini M, Natale S. et al.Psychiatric distress and health-related quality of life in obesity. Diabetes Nutr Metab. 2003;16:145–154.
    1. Onyike CU, Crum RM, Lee HB. et obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2003;158:1139–1147. doi: 10.1093/aje/kwg275.
    1. Scott KM, Bruffaerts R, Simon GE. et al.Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obes. 2008;32:192–200. doi: 10.1038/sj.ijo.0803701.
    1. Martinelli V, Colombo O, Nichini C. et al.High frequency of psychopathology in subjects wishing to lose weight: an observational study in Italian subjects. Public Health Nutr. 2011;14:373–376. doi: 10.1017/S1368980010001576. Epublication 11 June 2010.
    1. Teixeira PJ, Scott BG, Houtkooper LB. et al.Weight loss readiness in middle-aged women: psychosocial predictors of success for behavioral weight reduction. J Behav Med. 2002;25:499–523. doi: 10.1023/A:1020687832448.
    1. Teixeira PJ, Palmeira AL, Branco TL. et al.Who will lose weight? A reexamination of predictors of weight loss in women. Int J Behav Nutr Phys Act. 2004;1:1–12. doi: 10.1186/1479-5868-1-1.
    1. NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – the evidence report. National Institutes of Health. Obes Res. 1998;6:51S–209S.
    1. Italian Society of Human Nutrition. Recommended levels of assumption of energy and nutrients for the Italian population (LARN) Rome; 2012. [ ]
    1. Prunas A, Sarno I, Preti E. et al.Psychometric properties of the Italian version of the SCL-90-R: a study on a large community sample. Eur Psychiatry. 2012;27:591–597. doi: 10.1016/j.eurpsy.2010.12.006. Epublication 21 February 2011.
    1. Beck AT. Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press; 1967.
    1. Gormally J, Black S, Daston S. et al.The assessment of binge eating severity among obese persons. Addict Behav. 1982;7:47–55. doi: 10.1016/0306-4603(82)90024-7.
    1. Minniti A, Bissoli L, Di Francesco V. et al.Individual versus group therapy for obesity: comparison of dropout rate and treatment outcome. Eat Weight Disord. 2007;12:161–167. doi: 10.1007/BF03327593.
    1. Burns JW, Higdon LJ, Mullen JT. et al.Relationships among patient hostility, anger expression, depression, and the working alliance in a work hardening program. Ann Behav Med. 1999;21:77–82. doi: 10.1007/BF02895037.
    1. Pope MK, Smith TW, Rhodewalt F. Cognitive, behavioral, and affective correlates of the Cook and Medley Hostility Scale. J Pers Assess. 1990;54:501–514. doi: 10.1207/s15327752jpa5403&4_7.
    1. Smith TW. Hostility and health: current status of a psychosomatic hypothesis. Health Psychol. 1992;11:139–150.
    1. Pugh R. An association between hostility and poor adherence to treatment in patients suffering from depression. Br J Med Psychol. 1983;56:205–208. doi: 10.1111/j.2044-8341.1983.tb01548.x.
    1. Teixeira PJ, Silva MN, Mata J. et al.Motivation, self-determination, and long-term weight control. Int J Behav Nutr Phys Act. 2012;9:22. doi: 10.1186/1479-5868-9-22.

Source: PubMed

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