Predictors of attendance at an obesity clinic and subsequent weight change

Abstract

BackgroundThere is conflicting evidence regarding characteristics of patients most likely to have poor outcomes after referral to a multidisciplinary weight loss clinic. The aim of this study was to identify patient characteristics associated with poor attendance and poor weight outcomes at a weight management clinic based in an Australian tertiary hospital.MethodsPatient characteristics including age, sex, referral source, postcode of residence, weight, body mass index (BMI) and the presence of specific comorbidities were recorded. Outcome measures included questionnaire return following referral (a requirement prior to a first appointment being scheduled), percentage of appointments attended and rate of weight change (kg/month). Continuous variables were expressed as mean ± standard deviation and compared using a t-test. Categorical data were presented as proportions and a chi-squared test was used to test significance. Statistical significance was set as p < 0.05.ResultsOf 502 patients referred to the Comprehensive Metabolic Care Centre (CMCC), 231 (46%) did not return their questionnaire. Patients referred by their GP, compared to those with only internal hospital referrals, were more likely to return their questionnaire (86.0% cf. 77.9%; p = 0.02) as were those who had their BMI recorded in their referral letter (58% cf 45% p = 0.011). 28.1% of patients attended half or less of their scheduled appointments at the CMCC but none of the parameters analysed was associated with attendance. Weight loss was associated with residence in a rural location (p = 0.016) and hypercholesterolaemia (p = 0.03) and weight gain was associated with obstructive sleep apnoea (p = 0.04).ConclusionsA large proportion of the patients referred to a weight management clinic never had an appointment scheduled. Clinicians should not anticipate greater compliance in one patient demographic than another; all groups need focus, particularly at the referral stage, and likely poor compliance must be anticipated and better managed.

Evaluation of Aintree LOSS, a community‐based, multidisciplinary weight management service: outcomes and predictors of engagement

“…The issue of poor initial engagement and high subsequent attrition is well established in medical weight loss programmes . The follow‐up at Aintree LOSS, although funded for 2 years, is open to patient preference; therefore, no particular follow‐up period is designated a success.…”

The effects of mindfulness training on weight-loss and health-related behaviours in adults with overweight and obesity: A systematic review and meta-analysis

“…Selection bias has been observed in many studies (e.g., 46 Blevins 2009, Fletcher 2012) and presents a considerable challenge to research in health-47 related behavioral interventions that consistently relies on self-nomination of eligible 48 individuals when it comes to recruitment to RCTs. Previous investigations of patients' 49 motivation to attend weight loss interventions showed that (1) even if referred by their general 50 practitioner, the majority of individuals with obesity are unlikely to schedule an appointment 1 in a weight management clinic [71], and (2) patients' motivation to attend a treatment is the 2 best predictor of weight loss and weight-loss maintenance following weight-loss interventions 3 [72]. Systematic baseline assessment of prior intentions or motivation to participate in 4 psychological interventions could be a strategy to control selection bias, as well as a potential 5 moderator or mediator of the observed effect.…”

Gender perceptions and their impact when referring obese patients for exercise

“…The exercise I guess comes in more with the men who have high blood pressure'. These views on diet are in stark contrast to those of Brook et al (2014) and Rohde et al (2014) who found that GPs refer more female than male patients for weight management schemes. The problem with women being the focus of GP referral for weight-loss is that it makes men an even harder-to-reach group, as they attend fewer GP consultations than women in England (ICHSC, 2009;Hale et al, 2010).…”

“…For example, a recent Australian study has shown that 69% (n= 351) of referrals for a weight management scheme were for female patients (Brook et al, 2014). In a study of over 1000 Danish GPs, it was found that irrespective of the gender of the GP concerned, GPs referred more female than male patients for weight management programmes (Rohde et al, 2014).…”