Why Obese Children Often Drop Out of Weight Management Programs
What factors cause obese children and teens to drop out of a weight management program? How can that knowledge contribute to the design of more effective programs?
Those were the questions that psychologist Meg Zeller, PhD, of the Cincinnati Children's Division of Psychology, and her colleagues set out to explore as they conducted a retrospective review of 212 obese children and adolescents enrolled since the inception since the inception of HealthWorks!, the interdisciplinary weight management clinic at Cincinnati Children's.
"We were interested in finding out how HealthWorks! was doing and knew our program evaluation needed to look at both who remains in treatment and who does not. Because we were aware from the beginning that some kids would drop out,we wanted to understand the characteristics of those who were leaving, how that information could inform our care model, and what we could do better," Dr. Zeller explains.
"We know that high attrition rates are common in adult weight management programs. As more pediatric hospitals develop such programs, there will be more interest in who drops out. Attrition affects not only the individual who needs treatment, but also the clinical program, and ultimately, the bottom line," she says.
The researchers looked at the demographics of race, type of insurance, driving distance to the clinic, whether there was a single or dual parent/caregiver, psychological issues including depression or low self-concept, and a whole panel of medical comorbidities.
55 Percent Attrition Rate
They found that 45 percent of patients completed the initial 16-week program, but 55 percent withdrew prematurely, with half of those dropping out within the first three visits. Most likely to withdraw were Medicaid recipients,African- Americans, adolescents or those who self-reported greater symptoms of depression or low self-concept.
Dr. Zeller notes that this attrition rate is similar to that of previously published attrition rates from clinic-based pediatric obesity programs. It is also comparable to drop-out rates for treatment of other pediatric medical conditions and psychological disorders. Further, she emphasized that she and her colleagues are not the first to document that African-Americans and families of lower socioeconomic status are more likely to drop out of a standard behavioral weight management program.
"So while we were not surprised by some of what we learned,we gained important information about how we were doing in meeting the needs of a diverse clinic population. We also learned that kids who are experiencing depressive symptoms and feeling badly about themselves may need more support.
"Essentially,we are learning what may be some of the missing pieces in the puzzle. We developed a program to provide weight management services for youth. We have community physicians making the referrals, but engaging the child and family to make lifestyle changes long-term remains the challenge. That problem is not unique to Cincinnati. That is one of the big questions," she says.
Clinical Trials Needed
These findings raise some important questions."Do they have implications for developing different models of care?" Dr. Zeller asks."For example, do we need culturally tailored treatment programs? What other supports do these kids and families need to stay in obesity treatment programs? Clearly, there is a great need for clinical trials that address these issues."
Since 2001, when she received a K23 Career Development Award from the National Institutes of Health, Dr. Zeller has devoted her efforts to obesity research."My focus is trying to understand the psychosocial barriers that impact the ability of kids and their families to achieve and maintain a healthy weight," she explains.
She recently completed data collection for a study looking at the social functioning, psychological adjustment and family factors associated with obesity in children and teens, compared to non-obese agemates. She will be using the data in her development of clinical intervention trials in the coming years. She is also building a collaborative effort to develop measures of weight-related quality of life in youth. In addition, as part of the bariatric surgery team, Dr. Zeller is tracking the psychosocial outcomes of patients who undergo this weight reduction surgery.
Dr. Zeller is assistant professor of pediatrics in the Division of Psychology. Her paper was published in The Journal of Pediatrics (144[4]:466-470, 2004 April).
