Continuous care in the treatment of obesity: an observational multicentre study

Abstract

Interventions. An initial intensive treatment period (3-6 months) was followed by a less intensive continuous care (a follow-up control every 2-4 months).Main outcome measures. Attrition, reasons for treatment interruption and BMI change. Data were recorded by telephone interview in dropouts. Results. Only 157 patients (15.7%) were in continuous treatment at 36 months. The main reasons of attrition were logistics, unsatisfactory results and lack of motivation. The only basal predictor for continuous care was lower Expected One-Year BMI Loss (P ¼ 0.016). The probability of dropout increased systematically for any 5% expected BMI loss (Hazard ratio, 1.05; 96% confidence interval, 1.01-1.09). The mean percentage weight loss was greater in continuers (5.2% vs. 3.0% in dropouts; P ¼ 0.016). However, the dropouts satisfied with the results or confident to lose additional weight without professional help reported a mean weight loss of 9.6% and 6.5% respectively. Discussion. Continuous care produces long-term weight loss only in a subgroup of obese patients seeking treatment in medical centres. The finding that subgroups of dropouts report long-term weight loss has implication for the treatment of obesity.

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

“…Obese patients are considered a category particularly prone to dropout, as also observed in the QUOVADIS study, where nearly 80% of patients were lost to follow-up in a continuous care model of treatment. 3 The possibility to retrieve information also in this specific, highly problematic setting could be of relevance also for other fields of medicine. Telephone contacts have been used in several areas of medicine as preventive counselling strategies to enhance adherence, like cancerscreening programmes, 13,14 but have been rarely utilized for in-depth review of the possible causes of non-adherence.…”

“…24 These unrealistic weight loss expectations were the strongest predictors of attrition at long-term follow-up in subjects under continuous care. 3 A subgroup of patients, however, reported that the interruption of treatment was motivated by the satisfactory results achieved with treatment. This reason for premature programme termination is definitely not a treatment failure, since these patients reported an even larger mean weight loss than Continuers.…”

“…In obesity trials, the attrition rates range from 10 to 80%, 1 and vary from study to study according to clinical setting, experimental design (randomized vs observational study) and type of treatment (drugs, behaviour, bariatric surgery). Adherence to the planned programme is a key component of long-term success, 2,3 and strategies are needed to reduce dropout rates. These strategies can only rely on a precise identification of factors leading to premature programme termination.…”

“…Attrition was negatively associated with binge eating, 5 was both positively 6 and negatively 7 associated with depression, was negatively associated with previous dieting, 8 was positively associated with emotional disturbance, 8 full-time job 7 and recently with greater weight loss expectations. 3,9 Very few studies are available on the reason for attrition as reported by obese patients during structured interviews after dropout. The most frequently reported reasons were personal problems, lack of motivation or moving into another treatment plan, 10 various family-related problems, 11 lack of time, dissatisfaction with the programme or the staff, personal life issues and health limitations.…”

A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects

“…The relationship between REE, the number of steps per day, and weight loss maintenance are also in keeping with the hypothesis that the beneficial effects of the fitness program were not merely due to the continuous care and prolonged contact with therapists. A continuous care model of treatment definitely helps maintaining weight loss is subjects who keep on the contact with the obesity centers, 43,44 but in the present series any advantage appears to be somehow related to a change from a sedentary to an active lifestyle.…”