Evidence Service, Public Health Wales, Cardiff, Wales, UK.
Weight Management Service, Nutrition and Dietetics Department, Cwm Taff Morgannwg University Health Board, Merthyr Tydfil, Wales, UK.
J Hum Nutr Diet. 2023 Oct;36(5):1931-1941. doi: 10.1111/jhn.13196. Epub 2023 Jun 26.
High attrition rates in weight management interventions (WMIs) undermine their effectiveness but are poorly understood. This study aimed to identify determinants of completion and early dropout in National Health Service (NHS) WMIs.
In this prospective observational study, 329 patients recruited at initial consultation appointments satisfied the eligibility criteria: age ≥18 years and body mass index (BMI) ≥30 kg/m . Multivariate logistic regression analyses were performed to identify the odds ratios (OR, given with 95% confidence interval) of completion and early dropout.
Intervention completion rate was 39.8% (131 of 329). Variables that increased the likelihood of completion included engagement in support sessions, OR10.6 (4.7-23.6, p < 0.001); male sex, OR2.5 (1.4-4.5, p = 0.002); osteoarthritis, OR1.9 (1.1-3.3, p = 0.014); and one or more missed intervention appointments marked as 'could not attend' (notified nonattendance), OR1.8 (1.1-2.9, p = 0.032). Odds of early dropout were higher for participants with anxiety and depression OR2.0 (1.0-4.0, p = 0.039). Dietetic 1:1 participants were less likely to drop out early compared with group programme participants, OR0.3 (0.2-0.7, p = 0.002), but were less likely to complete the full intervention, OR0.5 (0.3-0.9, p = 0.02). Age, BMI, social deprivation and travel distance were among the variables not associated with completion or early dropout.
This study provides further evidence of the importance of support for participants of WMIs and the need for services to consider how support networks can be incorporated. Patients with poorer mental health may be more likely to drop out early and consequently benefit less from WMIs. Future research should qualitatively explore why these factors contribute to attrition to improve WMI effectiveness.
体重管理干预措施（WMIs）的高淘汰率会降低其效果，但人们对此知之甚少。本研究旨在确定国家卫生服务（NHS）WMIs 中完成和早期退出的决定因素。
在这项前瞻性观察研究中，329 名在初始咨询预约时符合资格标准的患者入选：年龄≥18 岁，体重指数（BMI）≥30kg/m 。使用多变量逻辑回归分析确定完成和早期退出的优势比（OR，给出 95%置信区间）。
干预完成率为 39.8%（329 名中的 131 名）。增加完成可能性的变量包括参加支持课程，OR10.6（4.7-23.6，p<0.001）；男性，OR2.5（1.4-4.5，p=0.002）；骨关节炎，OR1.9（1.1-3.3，p=0.014）；以及一个或多个标记为“无法出席”的错过干预预约（通知未出席），OR1.8（1.1-2.9，p=0.032）。患有焦虑和抑郁的参与者早期退出的几率更高，OR2.0（1.0-4.0，p=0.039）。与小组计划参与者相比，接受饮食治疗 1:1 的参与者早期退出的可能性较低，OR0.3（0.2-0.7，p=0.002），但完成完整干预的可能性较低，OR0.5（0.3-0.9，p=0.02）。年龄、BMI、社会贫困和旅行距离是与完成或早期退出无关的变量之一。
本研究进一步证明了 WMIs 参与者支持的重要性，以及服务部门需要考虑如何纳入支持网络。心理健康状况较差的患者可能更有可能早期退出，因此从 WMIs 中获益较少。未来的研究应从定性角度探讨这些因素为何会导致流失率增加，以提高 WMIs 的效果。
