Colombo Ottavia, Ferretti Virginia Valeria, Ferraris Cinzia, Trentani Claudia, Vinai Piergiuseppe, Villani Simona, Tagliabue Anna
Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, via A, Bassi, 21, I-27100 Pavia, Italy.
Nutr J. 2014 Feb 3;13:13. doi: 10.1186/1475-2891-13-13.
Attrition is an important but understudied issue that plays a vital role in the successful treatment of obesity. To date, most studies focusing on attrition rates and/or its predictors have been based on pretreatment data routinely collected for other purposes. Our study specifically aims at identifying the predictors of drop-out focusing on empirically or theoretically-based factors.
We conducted a retrospective observational study in an academic outpatient clinical nutrition service in Pavia, Italy. We examined a total of 98 adult obese patients (36 males, 62 females) who underwent a 6-month dietary behavioral weight-loss treatment at our Center. Pre-treatment and treatment-related variables were collected or calculated from clinical charts in order to discriminate those subjects who completed treatment from those who abandoned it before its completion. Multivariable regression analysis was used to identify the independent predictors of drop-out.
The drop-out rates were 21% at 1 month and 57% at 6 months. Compared with completers, noncompleters were significantly younger in terms of age at first dieting attempt (24.0 ± 10.7 vs. 31.3 ± 11.2 years, P = 0.005), had lower diastolic blood pressure (87.8 ± 9.7 vs. 92.7 ± 11.4 mmHg, P = 0.022), had a lower baseline body fat percentage (38.5 ± 6.4 vs. 41.2 ± 4.4% weight, P = 0.015), and had a lower percentage of early weight loss (-1.8 ± 1.8% vs. -3.1 ± 2.1%, P = 0.035). Moreover, noncompleters significantly differed from completers with regard to type of referral (34.1% vs. 53.3% sent by a physician, P = 0.036) and SCL-90 anger-hostility subscale (0.83 ± 0.72 vs. 0.53 ± 0.51, P = 0.022). A multivariable logistic regression analysis including pre-treatment variables showed that body fat percentage (P = 0.030) and SCL-90 anger-hostility subscale (P = 0.021) were independently associated with attrition. In a multivariable model considering both pre-treatment and treatment-related factors, attrition was found to be independently related to the age at first dieting attempt (P = 0.016) and the achievement of early weight loss (P = 0.029).
Our data confirm that psychopathological tracts, early dieting attempts, and a poor initial treatment response are key independent predictors of drop-out from obesity treatment.
治疗中断是一个重要但研究不足的问题，在肥胖症的成功治疗中起着至关重要的作用。迄今为止，大多数关注治疗中断率和/或其预测因素的研究都是基于为其他目的常规收集的治疗前数据。我们的研究专门旨在确定基于经验或理论因素的治疗中断预测因素。
我们在意大利帕维亚的一家学术门诊临床营养服务中心进行了一项回顾性观察研究。我们检查了总共98名成年肥胖患者（36名男性，62名女性），他们在我们中心接受了为期6个月的饮食行为减肥治疗。从临床图表中收集或计算治疗前和与治疗相关的变量，以便区分完成治疗的受试者和在治疗完成前放弃治疗的受试者。使用多变量回归分析来确定治疗中断的独立预测因素。
1个月时的治疗中断率为21%，6个月时为57%。与完成治疗者相比，未完成治疗者首次节食尝试时的年龄显著更小（24.0±10.7岁对31.3±11.2岁，P = 0.005），舒张压更低（87.8±9.7对92.7±11.4 mmHg，P = 0.022），基线体脂百分比更低（38.5±6.4对41.2±4.4%体重，P = 0.015），早期体重减轻的百分比更低（-1.8±1.8%对-3.1±2.1%，P = 0.035）。此外，未完成治疗者在转诊类型（医生转诊的比例为34.1%对53.3%，P = 0.036）和SCL-90愤怒-敌意子量表方面与完成治疗者有显著差异（0.83±0.72对0.53±0.51，P = 0.022）。包括治疗前变量的多变量逻辑回归分析表明，体脂百分比（P = 0.030）和SCL-90愤怒-敌意子量表（P = 0.021）与治疗中断独立相关。在一个考虑治疗前和与治疗相关因素的多变量模型中，发现治疗中断与首次节食尝试时的年龄（P = 0.016）和早期体重减轻的实现情况（P = 0.029）独立相关。
我们的数据证实，心理病理学特征、早期节食尝试和较差的初始治疗反应是肥胖症治疗中断的关键独立预测因素。
