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Complexity of attrition in the treatment of obesity: clues from a structured telephone interview

International Journal of Obesity volume 30, pages 1132–1137 (2006)Cite this article

Abstract

Objectives:

To investigate the causes of attrition reported by obese patients treated by medical centres.

Design:

Observational study.

Setting:

Obese patients enrolled in a long-term study involving 18 Italian medical centres.

Participants:

A total of 940 obese patients (727 female; mean age, 49 years; mean BMI, 38.6 kg/m2).

Measurements:

Causes of attrition reported by dropouts during a structured telephone interview.

Results:

After a median observation period of 41 months (range, 25–50), 766 of 940 patients (81.5%) discontinued treatment. Sixty-two per cent of total dropout occurred in the first year of follow-up. Seventy-four per cent of dropouts reported a single primary reasons for treatment interruption. Two primary reasons were reported by 22.4% of patients, and three reasons by 3.4%. Practical difficulties, alone or in combination, were reported by more than half of dropouts (55%), and were the leading cause of attrition followed by perceived failure of treatment. Among practical difficulties, family problems or problems at work and logistics, coupled with health problems other than obesity, were the most frequent reasons of attrition, but also a perceived sense of abandonment or a bad interaction with therapists were frequently reported.

Conclusion:

Practical difficulties and psychological problems are the most important reasons of attrition reported by patients. A therapeutic alliance addressing these issues has a large potential to reduce treatment interruption and to improve outcome in obesity.

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References

  1. Farley RL, Wade TD, Birchmore L . Factors influencing attendance at cardiac rehabilitation among coronary heart disease patients. Eur J Cardiovasc Nurs 2003; 2: 205–212.

    Article  Google Scholar 

  2. Perri MG, Sears Jr SF, Clark JE . Strategies for improving maintenance of weight loss. Toward a continuous care model of obesity management. Diabetes Care 1993; 16: 200–209.

    Article  CAS  Google Scholar 

  3. Dalle Grave R, Melchionda N, Calugi S, Centis E, Tufano A, Fatati G et al. Continuous care in the treatment of obesity. An observational multicentre study. J Intern Med 2005; 258: 265–273.

    Article  CAS  Google Scholar 

  4. Wadden TA, Letizia KA . Predictors of attrition in weight loss in patients treated by moderate and severe caloric restriction. In: Wadden TA, VanItallie TB (eds). Treatment of the Seriously Obese Patients. The Guilford Press: New York & London, 1992. pp 383–410.

    Google Scholar 

  5. Ho KS, Nichaman MZ, Taylor WC, Lee ES, Foreyt JP . Binge eating disorder, retention, and dropout in an adult obesity program. Int J Eat Disord 1995; 18: 291–294.

    Article  CAS  Google Scholar 

  6. Clark MM, Guise BJ, Niaura RS . Obesity level and attrition: support for patient-treatment matching in obesity treatment. Obes Res 1995; 3: 63–64.

    Article  CAS  Google Scholar 

  7. Inelmen EM, Toffanello ED, Enzi G, Gasparini G, Miotto F, Sergi G et al. Predictors of drop-out in overweight and obese outpatients. Int J Obes Relat Metab Disord 2005; 29: 122–128.

    Article  CAS  Google Scholar 

  8. Yass-Reed EM, Barry NJ, Dacey CM . Examination of pretreatment predictors of attrition in a VLCD and behavior therapy weight-loss program. Addict Behav 1993; 18: 431–435.

    Article  CAS  Google Scholar 

  9. Teixeira PJ, Going SB, Houtkooper LB, Cussler EC, Metcalfe LL, Blew RM et al. Pretreatment predictors of attrition and successful weight management in women. Int J Obes Relat Metab Disord 2004; 28: 1124–1133.

    Article  CAS  Google Scholar 

  10. Andersson I, Rossner S . Weight development, drop-out pattern and changes in obesity-related risk factors after two years treatment of obese men. Int J Obes Relat Metab Disord 1997; 21: 211–216.

    Article  CAS  Google Scholar 

  11. Lantz H, Peltonen M, Agren L, Torgerson JS . A dietary and behavioural programme for the treatment of obesity. A 4-year clinical trial and a long-term posttreatment follow-up. J Intern Med 2003; 254: 272–279.

    Article  Google Scholar 

  12. Melchionda N, Marchesini G, Apolone G, Cuzzolaro M, Mannucci E, Grossi E, the QUOVADIS Study Group. The QUOVADIS study. Features of obese Italian patients seeking treatment at specialist centers. Diabetes Nutr Metab 2003; 16: 115–124.

    CAS  Google Scholar 

  13. Siegel K, Mesagno FP, Karus DG, Christ G . Reducing the prevalence of unmet needs for concrete services of patients with cancer. Evaluation of a computerized telephone outreach system. Cancer 1992; 69: 1873–1883.

    Article  CAS  Google Scholar 

  14. Miller SM, Siejak KK, Schroeder CM, Lerman C, Hernandez E, Helm CW . Enhancing adherence following abnormal Pap smears among low-income minority women: a preventive telephone counseling strategy. J Natl Cancer Inst 1997; 89: 703–708.

    Article  CAS  Google Scholar 

  15. Jeffery RW, Sherwood NE, Brelje K, Pronk NP, Boyle R, Boucher JL et al. Mail and phone interventions for weight loss in a managed-care setting: Weigh-To-Be one-year outcomes. Int J Obes Relat Metab Disord 2003; 27: 1584–1592.

    Article  CAS  Google Scholar 

  16. Lowe MR, Miller-Kovach K, Phelan S . Weight-loss maintenance in overweight individuals one to five years following successful completion of a commercial weight loss program. Int J Obes Relat Metab Disord 2001; 25: 325–331.

    Article  CAS  Google Scholar 

  17. Bergenmar M, Tornberg S, Brandberg Y . Factors related to non-attendance in a population based melanoma screening program. Psychooncology 1997; 6: 218–226.

    Article  CAS  Google Scholar 

  18. Elkind A, Eardley A, Haran D, Spencer B, Smith A . Computer-managed call and recall for cervical screening: a typology of reasons for non-attendance. Commun Med 1989; 11: 157–162.

    CAS  Google Scholar 

  19. DiLillo V, Siegfried NJ, West D . Incorporating motivational interviewing into behavioral obesity treatment. Cogn Behav Pract 2003; 10: 120–130.

    Article  Google Scholar 

  20. Miller WR, Rollnick S . Motivational Interviewing. The Guilford Press: New York, 2002.

    Google Scholar 

  21. Smith DE, Heckemeyer CM, Kratt PP, Mason DA . Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM. A pilot study. Diabetes Care 1997; 20: 52–54.

    Article  CAS  Google Scholar 

  22. Woollard J, Beilin L, Lord T, Puddey I, MacAdam D, Rouse I . A controlled trial of nurse counselling on lifestyle change for hypertensives treated in general practice: preliminary results. Clin Exp Pharmacol Physiol 1995; 22: 466–468.

    Article  CAS  Google Scholar 

  23. Wilson GT, Schlam TR . The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clin Psychol Rev 2004; 24: 361–378.

    Article  Google Scholar 

  24. Dalle Grave R, Calugi S, Magri F, Cuzzolaro M, Dall'Aglio E, Lucchin L, et al., the QUOVADIS Study Group. Weight loss expectations in obese patients seeking treatment at medical centers. Obes Res 2004; 12: 2005–2012.

    Article  Google Scholar 

  25. Byrne S, Cooper Z, Fairburn C . Weight maintenance and relapse in obesity: a qualitative study. Int J Obes Relat Metab Disord 2003; 27: 955–962.

    Article  CAS  Google Scholar 

  26. Foster GD, Phelan S, Wadden TA, Gill D, Ermold J, Didie E . Promoting more modest weight losses: a pilot study. Obes Res 2004; 12: 1271–1277.

    Article  Google Scholar 

  27. Bandura A . Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84: 191–215.

    Article  CAS  Google Scholar 

  28. Rogge MM, Greenwald M, Golden A . Obesity, stigma, and civilized oppression. ANS Adv Nurs Sci 2004; 27: 301–315.

    Article  Google Scholar 

  29. Constantino MJ, Arnow BA, Blasey C, Agras WS . The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa. J Consult Clin Psychol 2005; 73: 203–211.

    Article  Google Scholar 

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Acknowledgements

We thank Dr Giovanni Apolone, Mario Negri Intitute, Milan; Professor Nazario Melchionda, Dr Elena Centis and Dr Alessandro Suppini (Unit of metabolic Disease, University of Bologna) and Dr Franco Tomasi (Unit of Dietetics and Clinical Nutrition, S Anna Hospital, Ferrara) for their active contribution in the development of the telephone interview, and the researchers of all centres who made possible the QUOVADIS study. The study was supported by an unrestricted grant from Bracco SpA, Milan.

Author information

Authors and Affiliations

  1. Bracco SpA Medical Department, Milan, Italy

    E Grossi

  2. Villa Garda Hospital, Garda (VR), Italy

    R Dalle Grave

  3. Department of Endocrinology and Metabolic Diseases, University of Florence, Florence, Italy

    E Mannucci

  4. Clinical Psychology Service, San Giuseppe Hospital, Piancavallo (VB), Italy

    E Molinari & A Compare

  5. Department of Psychiatry, ‘La Sapienza’ University, Rome, Italy

    M Cuzzolaro

  6. Unit of Metabolic Diseases, ‘Alma Mater Studiorum’ University, Bologna, Italy

    G Marchesini

Authors
  1. E Grossi
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  2. R Dalle Grave
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  3. E Mannucci
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  4. E Molinari
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  5. A Compare
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  6. M Cuzzolaro
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  7. G Marchesini
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Corresponding author

Correspondence to G Marchesini.

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Grossi, E., Dalle Grave, R., Mannucci, E. et al. Complexity of attrition in the treatment of obesity: clues from a structured telephone interview. Int J Obes 30, 1132–1137 (2006). https://doi.org/10.1038/sj.ijo.0803244

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  • DOI: https://doi.org/10.1038/sj.ijo.0803244

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