Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment

Abstract

Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment. Clinical Obesity, 6(2), pp. 133-142. (doi:10.1111/cob.12136) This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/118709/ What is already known about this subject?• Baseline depression is associated with greater attrition rates from weight management programmes and is also with poorer weight loss success.• There is little evidence regarding the role of baseline anxiety as a predictor of attrition or weight loss in weight management programmes.• There is some evidence that patients with baseline mood disorders achieve similar weight loss to controls in weight management programmes with an integrated psychological component What this study adds• This study confirms that baseline anxiety and depression (identified using HADS) is associated with higher attrition of patients from a weight management programme with an integrated psychology service.• Despite a significantly less favourable case-mix of risk-factors for poor weight loss:o Patients with severe anxiety at baseline achieve similar weight loss outcomes to those without baseline anxiety.o Significantly greater weight loss is seen in participants with severe baseline depression at all stages of follow-up in the Glasgow and Clyde Weight Management Service. AbstractObjective: To investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme.Design: Prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. Participants:All patients who began a weight management programme between 1 October 2008 and September 2009 (n=1838).Setting: Glasgow and Clyde Weight Management Service (GCWMS) is a specialist multidisciplinary service, which aims to achieve a minimum of ≥5kg weight loss. Patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment/intervention. Results:Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socioeconomically deprived and a higher proportion were female.There was a significant positive correlation between HADS anxiety and depression scores and increasing BMI (r 2 =0.094, p<0.001 and r 2 =0.175, p<0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (p=0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those ...

Tier 3 specialist weight management service and pre‐bariatric multicomponent weight management programmes for adults with obesity living in the UK: A systematic review

“…Two studies reported BMI in stratified groupings which left the accumulative average BMI calculated from 16 studies at 42.54 kg/m 2 . Baseline weight in kilograms was also reported by 90% of included studies except for Morrison et al (2011) and Turner et al (2015) . Turner et al reported participants that lost weight at 12 months, which was their intervention endpoint .…”

“…Baseline BMI was reported by 90% of included studies except for Turner et al (2015) and Wright et al (2012) and ranged from 30.1 to 49.1 kg/m 2 . Two studies reported BMI in stratified groupings which left the accumulative average BMI calculated from 16 studies at 42.54 kg/m 2 .…”

“…In total, eight studies (42%) reported a change in BMI and/or weight at three months from their baseline, and the majority reported statistically significance weight reduction with an accumulative average of 114.48 kg . Six studies (31%) reported a percentage of participants who lost 5% or more of their initial weight (calculated mean: 22.95% of participants) . Jennings et al (2014) was the only study to report a 10% or more weight reduction rate among participants (3.6%) .…”

“…SES was reported in 7 (37%) studies in a five‐level scoring classification . In studies that included SES, the most deprived was reported with the highest rate compared to all other deprivation levels (ranging from 27% to 62%).…”

“…The mean reduction in weight (kg) was reported by ten studies (53%), with a calculated accumulative average of 112.17 kg . Nine studies (47%) reported a 5% or more weight loss rate among participants with a calculated average of 39.2% . Only two studies (11%) reported an average of 10.0% of participants whom lost 10% or more from their initial weight …”