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

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.