A path model analysis on predictors of dropout (at 6 and 12 months) during the weight loss interventions in endocrinology outpatient division

Dropout in cognitive behavioral treatment in adults living with overweight and obesity: a systematic review

Obesity is a chronic, complex, and multifactorial disease resulting from the interaction of genetic, environmental, and behavioral factors. It is characterized by excessive fat accumulation in adipose tissue, which damages health and deteriorates the quality of life. Although dietary treatment can significantly improve health, high attrition is a common problem in weight loss interventions with serious consequences for weight loss management and frustration. The strategy used to improve compliance has been combining dietary prescriptions and recommendations for physical activity with cognitive behavioral treatment (CBT) for weight management. This systematic review determined the dropout rate and predictive factors associated with dropout from CBT for adults with overweight and obesity. The data from the 37 articles selected shows an overall dropout rate between 5 and 62%. The predictive factors associated with attrition can be distinguished by demographics (younger age, educational status, unemployed status, and ethnicity) and psychological variables (greater expected 1-year Body Mass Index loss, previous weight loss attempts, perceiving more stress with dieting, weight and shape concerns, body image dissatisfaction, higher stress, anxiety, and depression). Common reasons for dropping out were objective (i.e., long-term sickness, acute illness, and pregnancy), logistical, poor job conditions or job difficulties, low level of organization, dissatisfaction with the initial results, lack of motivation, and lack of adherence. According to the Mixed Methods Appraisal quality analysis, 13.5% of articles were classified as five stars, and none received the lowest quality grade (1 star). The majority of articles were classified as 4 stars (46%). At least 50% of the selected articles exhibited a high risk of bias. The domain characterized by a higher level of bias was that of randomization, with more than 60% of the articles having a high risk of bias. The high risk of bias in these articles can probably depend on the type of study design, which, in most cases, was observational and non-randomized. These findings demonstrate that CBT could be a promising approach for obesity treatment, achieving, in most cases, lower dropout rates than other non-behavioral interventions. However, more studies should be conducted to compare obesity treatment strategies, as there is heterogeneity in the dropout assessment and the population studied. Ultimately, gaining a deeper understanding of the comparative effectiveness of these treatment strategies is of great value to patients, clinicians, and healthcare policymakers. Systematic review registration: PROSPERO 2022 CRD42022369995 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022369995.

A clinically managed weight loss program evaluation and the impact of COVID-19

Introduction

With the prevalence of obesity increasing, many weight-loss programs were created to aid in combating the trend. The Weight Loss Clinic (WLC) was created to provide personalized support for lifestyle changes using a multidisciplinary team with medical oversight. This study evaluated the clinically-managed weight loss program at the Wellness Institute.

Methods

This was a prospective evaluation of a newly established program between January 2019-August 2020. Participants who entered the weight loss program were approached to learn about the evaluation. A total of 41 participants were included. The primary outcomes included changes in body weight and achievement of more than 5% initial body weight loss. Outcome measures were collected pre-and post-program and the data was analyzed through paired t-tests on R studio.

Results

Greater body weight-loss was seen in completers pre-COVID-19 compared to those who completed during the pandemic (Mean, ±SD; 7.51 ± 6.24 kg n = 13 p < 0.001 vs. 1.75 ± 4.43 kg n = 9, p = 0.02). Completers pre-COVID-19 demonstrated improvements in waist circumference, Framingham risk score, blood pressure, hemoglobin A1C, and body fat percentage.

Conclusions and implications

Though the sample size was small to show definitve evidence, the results may suggest the program worked well prior to the pandemic but the pandemic created barriers to weight-loss for participants.

Evaluation of the Success of Weight Loss Programs Using the Fit for Performance Curriculum

INTRODUCTION

Overweight and obesity rates continue to rise among U.S. Army soldiers, which impacts their overall readiness status and puts them at greater risk for musculoskeletal injury and development of chronic disease. To address the concern with obesity and ensure that Soldiers are meeting body composition standards, the Army offers Fit for Performance-Weight Loss Strategies curriculum, a program of standardized material on nutrition and physical activity presented over six 1-hour sessions. This study aimed to evaluate the success and attrition of weight loss programs using the Fit for Performance curriculum in an Army setting among TRICARE regions.

MATERIALS AND METHODS

This retrospective cohort study consolidated data on participants in weight loss programs using the Fit for Performance curriculum. It examines attrition rates, weight loss, change in body mass index (BMI), factors influencing weight loss, and attrition based on geographical location. Statistical analysis was completed using R Core Team software, version 3.6.1, for t-tests, linear regression, and analysis of variance. Significance was set at P ≤ .05. This study was determined to be exempt by the Walter Reed National Military Hospital Institutional Review Board.

RESULTS

In total, 8,336 U.S. Army soldiers (80% male, mean age = 26.2 ± 6.9 years) participated in the program. Attrition rates were high (96.4%). Those who attended 4-6 sessions lost significantly more weight than those who attended 1-3 sessions (0.72 kg [1.60 lbs], P < .001); however, weight lost was not clinically significant. Sex, age, and number of sessions attended influenced to the amount of weight lost, but only accounted for 4% of the variation. Among TRICARE regions there was a significant difference in attrition rates, with those in the Western (1.2 sessions, P < .001) and Overseas (1.6 sessions, P < .001) regions attending statistically fewer sessions than those in the Eastern region.

CONCLUSIONS

Consistent attendance in a weight loss program promotes changes in BMI, which may improve the health of the force. However, the factors influencing these changes are unclear. The results indicate opportunities to re-examine current processes and the program elements to encourage increased or complete participation and determine if program element changes are warranted for the Fit for Performance-Weight Loss Strategies Program. Attrition rates were high, indicating opportunities to research reasons for attendance and attrition in the future. Finally, these findings highlight an opportunity for educating the military leadership on the increased success with increased attendance.

Two, Six, and Twelve-Month Dropout Rate and Predictor Factors After a Multidisciplinary Residential Program for Obesity Treatment. A Prospective Cohort Study

Introduction

The aim of the present study was to assess the dropout rate at 2, 6, and 12 months after an inpatient multidisciplinary residential program (MRP) for the treatment of obesity. Furthermore, this study assessed anthropometric and biochemical predictors associated with the dropout.

Methods

Adult and elderly patients (age 59 ± 14 years) with obesity had undergone an MRP, were followed up from 2 to 12 months. Biochemical and anthropometric markers have been assessed at the beginning of the follow-up period after the MRP.

Results

The study enrolled 178 subjects, 117 women and 61 men. The overall dropout rate at 2 months was 21.3%, after 6 months was 44.4%, and after 1 year was 68.5%. There was no difference by gender recorded. Furthermore, patients under medical treatment with psychiatric disorders did not show an association with the dropout rate. Patients with a higher level of body mass index (BMI) at the discharge of MRP showed +48% of dropout at 6 months. After the MRP, the baseline values of uricemia and white blood cells (WBCs) resulted as predictors of dropout at 2 months (p > 0.05). Furthermore, the excess percentage of fat mass lost during the MRP was associated with the risk of dropout at 2, 6, and 12 months (p > 0.05).

Conclusion

The MRP for obesity is an opportunity for losing weight for patients with established criteria. The future challenge will be addressing the best strategic plans in order to reduce the dropout rate after this intervention. Investigating deeply the main predictors could be an opportunity to improve the long-term efficacy of MRP.

Predictors of attrition from a weight loss program. A study of adult patients with obesity in a community setting

PURPOSE

Obesity unit attrition is frequent and contributes to treatment failure. Many studies evaluating attrition predictors were part of randomized trials, and different terminology and criteria were used in the engagement field. We aimed to investigate the factors potentially implicated in early (< 12 weeks) and late (> 12 weeks) attrition from an obesity unit in a community setting METHODS: This was a retrospective cohort study of 250 patients with obesity who were followed-up at our obesity unit. Our program included at least 6 meetings in 12 months. Sociodemographic and anthropometric data, and psychometric questionnaires were collected from all participants.

RESULTS

One-hundred thirty-four (53.6%) participants dropped out. Those individuals showed lower BMI, lower overall health status, and increased depression scores. In a multiple regression model, BMI (inversely; OR = 0.90; 95%CI 0.84-0.96) and depression score (directly, OR = 1.05; 1.00-1.10) were associated with attrition risk. Early dropouts (n = 47) had lower weights, smaller waist circumferences and worse mental health scores than late dropouts (n = 87) and more frequently lived alone. When compared to completers, early dropouts had lower weights, BMIs, waist circumferences, overall health and mental status scores, increased depression scores and percentage of individuals living alone. In a multiple regression, lower BMI (OR = 0.83; 0.75-0.92), lower mental status score (OR = 3.17; 1.17-8.59) and living alone (OR = 2.25; 1.02-4.97) were associated with early attrition risk.

CONCLUSION

Lower BMI and increased depression score were associated with attrition. Early attrition was associated with lower weight, decreased mental well-being, and living alone. Individuals with these characteristics might need tailored approaches to enhance their engagement.

LEVEL OF EVIDENCE

Level V, retrospective descriptive study.

Employee perseverance in a "no phone use while driving" organizational road-safety intervention

INTRODUCTION

This interdisciplinary study explores factors that contribute to the perseverance of participants in an organizational "no phone use while driving" road-safety intervention.

METHOD

The study sample comprised 200 employees (mean age 43 years; 104 females [52 %], 96 males [48 %]) from 8 organizations in Israel. Subjects completed a 4-month organizational intervention using a smartphone application that monitored smartphone use, operationalized as taps per minute, where each tap represents a single instance of contact with the screen (e.g., touching, tapping or swiping). The app also silenced notifications during the intervention stage. Changes over time in tapping-while-driving behavior were examined through self-report questionnaires and objectively through the application's monitoring function. Validated measures were used to examine factors associated with perseverance in the program.

RESULTS

Organizational safety climate and gender (male) were positively related to perseverance in the intervention. Contrary to our hypothesis, safety motivation was not found to influence perseverance.

CONCLUSIONS

The present intervention is most effective for employees with high safety climate perceptions and for male employees.

PRACTICAL APPLICATIONS

The organizational intervention presented in the current study was shown to be effective in reducing smartphone use (touching, tapping or swiping) while driving. Our findings show that people will download and use an app that actively reduces their incentive to use their phones at the wheel by silencing incoming notifications. The findings support calls to harness the positive potential of information and communications technologies for organizational interventions.