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

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          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.

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          Most cited references31

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          The assessment of binge eating severity among obese persons

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            Predictors of dropout in weight loss interventions: a systematic review of the literature.

            Attendance and completion of weight loss intervention is associated with better weight loss outcomes; however, attrition is neither consistently reported nor comprehensively explored in the weight loss literature. A systematic review was undertaken to identify factors associated with attrition in weight loss interventions involving overweight or obese (body mass index ≥ 25) adults (18-65 years). Sixty-one studies published before May 2011 and addressing factors associated with weight loss programme attrition were identified. Conclusions were limited by the large number of variables explored, the small number of studies exploring each variable, the large variety of study settings and methodologies used, the inconsistent reporting of results, and the conflicting findings across studies. A consistent set of predictors has not yet been identified. The majority of studies relied on pre-treatment routinely collected data rather than variables selected because of their theoretical and/or empirical relationship with attrition. However, psychological and behavioural patient factors and processes associated with the treatment were more commonly associated with attrition than patient background characteristics. Future research should consider theoretically grounded social-psychological and behavioural processes as potential predictors of dropout. Identification of patients at risk of dropout will contribute to both the effectiveness and the cost-effectiveness of weight loss interventions. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.
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              Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey.

              Data from the Third National Health and Nutrition Examination Survey (1988-1994) were used to examine the relation between obesity and depression. Past-month depression was defined using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, and was measured with the Diagnostic Interview Schedule. Obesity was defined as a body mass index (weight (kg)/height (m)2) of 30 or higher. The authors compared risks of depression in obese and normal-weight (body mass index 18.5-24.9) persons. Obesity was associated with past-month depression in women (odds ratio (OR)=1.82, 95% confidence interval (CI): 1.01, 3.3) but was not significantly associated in men (OR=1.73, 95% CI: 0.56, 5.37). When obesity was stratified by severity, heterogeneity in the association with depression was observed. Class 3 (severe) obesity (body mass index > or =40) was associated with past-month depression in unadjusted analyses (OR=4.98, 95% CI: 2.07, 11.99); the association remained strong after results were controlled for age, education, marital status, physician's health rating, dieting for medical reasons, use of psychiatric medicines, cigarette smoking, and use of alcohol, marijuana, and cocaine. These findings suggest that obesity is associated with depression mainly among persons with severe obesity. Prospective studies will be necessary to clarify the obesity-depression relation but await the identification of potential risk factors for depression in the obese.
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                Author and article information

                Journal
                Nutr J
                Nutr J
                Nutrition Journal
                BioMed Central
                1475-2891
                2014
                3 February 2014
                : 13
                : 13
                Affiliations
                [1 ]Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, via A. Bassi, 21, I-27100 Pavia, Italy
                [2 ]Biostatistics and Epidemiology Unit, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, via Forlanini, 2, I-27100 Pavia, Italy
                [3 ]Studi Cognitivi" Post Graduate Cognitive Psychotherapy School Research Group, Milan, Italy
                [4 ]“GNOSIS” Research and Psychotherapy Group V, Mondovì, Italy
                Article
                1475-2891-13-13
                10.1186/1475-2891-13-13
                3914843
                24490952
                09e110f8-568f-47a8-89b8-d59c63c67eae
                Copyright © 2014 Colombo et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 October 2013
                : 28 January 2014
                Categories
                Research

                Nutrition & Dietetics
                obesity treatment,attrition rate,early weight loss,predictors,drop-out
                Nutrition & Dietetics
                obesity treatment, attrition rate, early weight loss, predictors, drop-out

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