A systematic type review of attrition in weight reduction groups that fulfil BDA Weight-Wise criteria
In 2007 nearly two thirds of the UK adult population were classified as obese or overweight (GOS 2007). Weight reduction groups are recommended by Obesity Guidelines (NICE 2006) to tackle this, but attrition poses a serious threat to the efficiency of these strategies. The aim of this systematic type review was to determine the level of attrition in weight loss groups, and to determine reasons for attrition. Methods:
The review process was systematic and in line with guidance from the Centre for Reviews and Dissemination (2009). Relevant studies were identified by a methodical search of six bibliographic databases (Academic Search Complete, Cinahl, Medline, PsycInfo, Cochrane, and Scopus). The Mesh terms used were obesity, weight control, weight-reduction programs, research dropouts, patient dropout, and program evaluation. It was a poorly defined topic and the final search contained many key words with truncations, to yield sensitive search results. Reference and citation lists were searched and key journals hand-searched for relevant articles. The grey literature was searched using online databases (Zetoc, Biosis Preview, networked digital library of thesis and dissertations, Cinahl dissertations database, and Pro-quest). The inclusion criteria were; the intervention fulfilled BDA Weight Wise criteria (BDA 2006), adult participants (aged 18 years or more), overweight or obese subjects (BMI >25 kg m−2), validated questionnaires used, quantified attrition, evaluated reasons for patterns of attrition. The exclusion criteria were; other co-morbidities as the focus of the study, anti-obesity agents used. The results were assessed for quality using an appropriate tool (CASP, 2004). The discounted studies were documented, with reasons, to increase transparency (CRD, 2009). Results:
Eight cohort studies and one qualitative study were evaluated (2251 participants) with levels of attrition ranging between 6.5 and 76.6%; however definitions of attrition varied (differing levels of attendance/absence), preventing reliable comparisons of the data. Quality assessment of the studies indicated studies were well conducted, however, some techniques were used (such as subgroup analysis) which threatened internal validity. Patterns of attrition were found indicating non-completers were likely to lose less weight during the programme and have higher goals (Table 1). Cited reasons for non-completion were practical issues, lost motivation, unsatisfactory results or previous failures. Discussion:
A standard definition of attrition from weight management groups is needed to facilitate better analysis of the literature. Greater consideration should be given to client motivation during group programmes and to whether attrition can be reduced by assessing in-programme motivation and implementing strategies to address lost motivation (Teixeira et al., 2004). Further investigation into the characteristics of non-completers and reasons cited would strengthen knowledge of how best to support those at risk of non-completion to optimise the effectiveness of group programme interventions (Garaulet et al., 1999). Conclusion:
The level of attrition varied greatly between different but suitable weight reduction programmes, and further research into strategies, which improve support given to potential non-completers, could decrease these levels. References:
British Dietetic Association (2006) Options for Support finding the right approach for you. Available at http://www.bdaweightwise.com/support/support_approach.html.
Critical Appraisal Skills Programme (2004) 12 questions to help you make sense of a cohort study. Available at http://www.phru.nhs.uk.
Centre for Reviews and Dissemination (2009) Systematic Reviews: CRD Guidance for Undertaking Reviews in Healthcare, 3rd edn. University of York: CRD.
Garaulet, M., Pérez-Llamas, F., Zamora, S. & Tebar, F.J. (1999) Weight loss and possible reasons for dropping out of a dietary/behavioural programme in the treatment of overweight patients. J. Hum. Nutr. Diet.12, 219–227.
Government Office for Sciences (2007) Foresight Tackling Obesities Future Choices Project Report, 2nd edn. London: Government Office for Sciences.
NICE (2006) Obesity. Available at: http://www.nice.org.uk/guidance/CG43.
Teixeira, P.J., Going, S.B., Houtkooper, L.B., Cussler, E.C., Metcalfe, L.L., Blew, R.M., Sardinha, L.B. & Lohman, T.G. (2004) Pretreatment predictors of attrition and successful weight management in women. Inter. J. Obes. Relat. Metab. Disord.28, 1124–1133.
Document Type: Research Article
Affiliations: 1: Nutrition and Dietetic Department, Alexandra Hospital, Redditch, Worcestershire, UK and 2: Department of Physiotherapy and Dietetics, Coventry University, Priory Row, Coventry, UK, Email: [email protected]
Publication date: 01 June 2011