[30]
|
N 426
F 277
M 149
Age 45.4±12.2
BMI 40.0±6.6
Netherlands
|
Evaluation of a commercial obesity treatment centre
|
Not clearly stated
|
Lifestyle modification including physical activity, psychological counselling based on CBT & nutrition advice. Delivery using a combination of group & individual sessions
|
At 18 months, 58%
|
No definition given
|
Univariate: Dropouts scored higher on the three-factor eating questionnaire hunger scale (p=0.011). Completers were older (p<0.001) & reported lower baseline energy intake (p=0.021)
|
Sex, weight, BMI, waist circumference, fat mass, blood pressure, macronutrient & fibre intakes, TFEQ: restraint & disinhibition, SF-36: PCS & MCS, cholesterol, plasma glucose, HbA1C
|
[39]
|
N 82
F 67
M 15
Age 46.9±11.7
BMI 39.4±6.9
Italy
|
Observational in a University Hospital Clinical Nutrition Unit
|
Excluded BMI<30 & >62, severe or chronic medical conditions, psychiatric disorders, substance abuse within 6 months &/or current use of psychotropic medication
|
Personalised hypocaloric diet with nutrition counselling every 4 weeks for 12 months. Follow-up appointments with a Physician & dietitian addressed weight monitoring & topics such as nutrition education
|
6 months, 56.1%
|
Attrition: participants who missed ≥2 consecutive appointments
|
Univariate: Predictors of attrition: alexithymia (OR 9.96 95%CI 1.52-36.1, p=0.003) irritable mood (OR 6.1 95%CI 1.21-29.5, p=0.02) DCPR>1 (OR 4.72 95%CI 1.72-14.5, p=0.004) higher SCL-90-R-GSI scores (OR 8.87 95%CI0.11-0.53, p=0.002) & higher EAT-26-dieting scores (OR 3.73 95%CI 0.01-0.17, p=0.05). Multivariate: alexithymia predicted attrition (OR 6.88 95%CI 1.24-38.0, p=0.002)
|
Age, gender, education, BMI, weight (kg), medical comorbidities, DCPR diagnoses: demoralisation, illness denial, MINI diagnoses:
depressive disorders, anxiety disorders, EAT-26:
total score, total score (≥20), food preoccupation, oral control
|
[36]
|
N 3250
F 2331
M 919
Age 49.8±13.5
BMI 42.0±7.1
Scotland, UK
|
Observational cross-sectional study in an NHS specialist weight management service
|
Age ≥18 with BMI≥30 with obesity-related co-morbidities or BMI≥30 alone
|
Phase 1: 16-week group lifestyle intervention. Phase 2: 3, 1-hour sessions delivered monthly. Phase 3: 12, 1-hour weight maintenance sessions monthly. Interventions can include dietitians, clinical psychologists & physiotherapists
|
Up to 19 months. At 16 weeks, 30.7%
|
Completion: Attend ≥4 of 9 sessions in phase 1
|
Multivariate: men less likely to complete (OR 0.89 95%CI 0.80-0.99, P=0.036), odds of completion increased with age, ≥25 (p<0.001), affluence (p<0.001), BMI (p<0.001). Odds of completion greater in practices with patient list size of 4000-8000 vs <4000 (OR 1.21 95%CI 1.06-1.39, p=0.006), & decreased in practices with a higher % from deprived areas; >40% vs <15% (OR 0.74 95%CI 0.63-0.87, p<0.001)
|
Training practice, patient list >8000, distance to the service, quality & outcome framework points, practice population with 15-40% of its patients from the most deprived areas, practice referral rate
|
[40]
|
N 98
F 62
M 36
Age 44.8±14.2
BMI 35.2±4.8
Italy
|
Retrospective observational study in an academic, clinical nutrition outpatient service
|
Adult, BMI≥30. Excluded pregnant women, individuals with major physical illnesses & psychiatric disorders
|
6-months dietary behavioural programme with individualised diet plans provided by a dietitian. Monthly follow-up appointments conducted by a physician specialised in clinical nutrition to address obstacles hindering weight loss & physical activity
|
At 1 month, 21.4%, at 6 months 57%
|
No definition given
|
Univariate: Dropout associated with younger age at first diet attempt (p=0.005), higher body fat % (p=0.015), lower diastolic blood pressure (p=0.022), & higher SCL-90 anger-hostility scale score (p=0.022). Completion associated with higher weight loss at 1-month (-3.1±2.1% vs -1.8±1.8%, p<0.01) & 6 months (-7.3±4.1% vs -1.7±2.4%, p<0.001). Multivariate: body fat % (OR 0.84 95%CI 0.72-0.98, p=0.030) & SCL-90 anger-hostility scores (OR4.61 95%CI 1.26-16.85, p=0.021), age at first dieting attempt (OR 0.89 95%CI 0.81-0.98, p=0.016) & lower early weight loss % (OR 0.57 95%CI 0.34-0.95, p=0.029) predicted dropout
|
Age, sex, weight, height, BMI, systolic blood pressure, waist circumference, hip circumference, waist-hip ratio, highest adult weight, lowest adult weight, weight loss goal (in kg), weight loss goal (%), SCL:
somatisation, obsessivity-compulsivity, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation, psychoticism, GSI, BES, BDI
|
[41]
|
N 92
F 80
M 12
Age 41.8±12.7
BMI 38.5±6.3
Italy
|
Observational in a University Hospital
|
BMI ≥30 age ≥18-65, excluded individuals with cognitive impairment, with severe & unstable illness or pregnant
|
Individual sessions every 2 weeks targeting decreased caloric intake combined with behavioural counselling to improve lifestyle, delivered by a dietitian & diabetologists
|
6 months, 32.6%
|
Attrition: individuals lost to follow-up within 6 months of the first evaluation appointment
|
Univariate: Completers scored higher for harm-avoidance using TCI (p=0.03). Non-completion associated with presence of any Axis I disorder (p=0.003) & anxiety disorder (p=0.02). Multivariate: completion was predicted by high reward-dependence scores (B=-148; OR 0.863 95% CI 0.751-0.991, p=0.037) & absence of any mental disorder (B=-2.011; OR 0.134 95%CI 0.034-0.529, p=0.004)
|
BMI, age, sex, age at onset of obesity, TCI: (novelty seeking, reward dependence, persistence, self-directedness, co-cooperativeness, self-transcendence), eating disorder, mood disorder, somatoform disorder, impulse-control disorder
|
[31]
|
N 247
F 173
M 75
Age 40.8±11.8
BMI 41.4±5.6
Sweden
|
Observational in a specialist obesity clinic at a University Hospital
|
Not stated
|
Phase 1: lectures on lifestyle behaviours. Phase 2: group treatment based on lifestyle changes. Some groups were assigned to a 5-week liquid calorie diet based on staff’s clinical judgement. Intervention team included a doctor, nurses, dietitians & a physiotherapist
|
Follow up unclear (37-45 weeks based on timeframes given), 63%
|
No definition given
|
Univariate: Completers were associated with a higher level of education (university level) (p<0.001), being born in Sweden (p=0.016) & in occupation or studying (p=0.025). Completers were associated with a history of greater weight cycling (p=0.001), & less body dissatisfaction (p=0.046)
|
Age, sex, Initial BMI, % weight loss after screening, % weight loss after 5 lectures, overweight in parent, obesity onset before adulthood, weighing at least monthly, high motivation for weight reduction, high motivation for habit change, mental distress, binge eating, eating disorder, night eating, weight locus of control
|
[37]
|
N 634
F 634
Age 48±10.6
BMI 37.8±6.6
Italy
|
Observational across 8 Italian Health Service accredited medical centres specialised in obesity treatment
|
Female with BMI≥30, age between ≥18-65 & not in active treatment at time of enrolment
|
Lifestyle modification programmes across 8 centres, based on CBT (individual or group), prescription of diet & exercise, medical input & pharmacotherapy
|
At 12 months, 32.3%
|
Attrition: losing contact with the centre
|
Univariate: Dropouts were younger (p=0.001), had a higher rate of active employment & lower rate of retired participants (p<0.001), scored higher for novelty-seeking (p=0.038) & lower for self-directedness (p=0.041). Univariate logistic regression: younger age predicted dropout (OR 0.96 95%CI 0.94-0.97, p<0.0001) as did higher TCI novelty-seeking scores (OR 1.007 95%CI 1.0-1.013, P=0.038) & lower self-directedness scores (OR 0.994 95&CI 0.988-1.9, p=0.042), but not after adjusting for confounders
|
BMI, binge eating scale score, night eating questionnaire score, TCI: (harm avoidance, persistence, reward-dependence, co-cooperativeness, self-transcendence)
|
[42]
|
Same as above
|
Same as above
|
Same as above
|
Same as above
|
Same as above
|
Same as above
|
Univariate: Dropouts weighed more at baseline (p=0.022). Dropout associated with amount of weight loss needed to reach weight loss goals, dream (p=0.004) happy (p<0.001) acceptable (p<0.001) & disappointing (p<0.001). Multivariate: odds of dropout increased with higher baseline weight (kg) (OR 1.1 for 10kg 95%CI 1.01-1.21, p=0.023), & weight loss needed to reach targets; for every 1% increase in weight loss needed to achieve acceptable- (OR 1.05 95%CI 1.02-1.08, p<0.001) and disappointing (OR 1.07 95%CI 1.04-1.10, p<0.001) targets
|
Dream- and happy weight loss goals
|
[17]
|
N 124
F 92
M 32
Age 47.5±12.4
BMI 41.6±7.3
Croatia
|
Randomised single-blinded design
|
BMI≥30 age≥18-69. Excluded newly diagnosed T2DM, CVD, hypertension, recent change in antihypertensive & oral antidiabetic therapy, use of insulin therapy & weight-control drugs alcohol abuse, pregnant or breastfeeding
|
Patients allocated to either a Mediterranean diet or standard hypocaloric diet. Group therapy during a 5-day intensive educational intervention, followed by 5, 2-hour follow up visits at 7 days, 1, 3, 6 & 12 months. Intervention team included dietitians, pharmacists, nurses, endocrinologist & physiotherapist
|
12 months, 32.3%
|
No definition given
|
Univariate: Completion associated with female sex (p=0.04), lower baseline BMI (p=0.008), lower baseline weight (kg) (p=0.001), lower baseline waist circumference (p=0.005) & higher levels of education (university level) (p=0.04). Multivariate: Dropout predicted by higher baseline bodyweight (OR 0.974 95%CI 0.954-0.994, p=0.01), completion predicted by higher education level (OR 3.261 95%CI 1.223-8.695, p=0.018)
|
Age, employment status, marital status, number of children, age at onset of obesity (before or after 20), parental obesity, metabolic syndrome, number of prescribed drugs, thyroid problems, depression, smoking, type of diet (mediterranean v standard)
|
[10]
|
N 229
F 170
M 59
Age 18-64
BMI 37.7±6.6
Canada
|
Observational in a community-based weight management initiative
|
BMI≥30
|
Phase 1: 12-week group programme with an exercise therapist, dietitian, & psychologist delivered CBT. Phase 2: 12 weeks of exercise sessions to help with maintenance. Participants asked to attend with a family member or friend with BMI≥30 for support
|
24 weeks, 20.1%
|
No definition given
|
Univariate: Non-completion associated with past negative experience as a barrier to exercise (p=0.036), lower level of education (no postsecondary education) (p=0.005), not having a ‘social buddy support contract’ signed (p=0.046) & moderate or severe depressed mood (p=0.029). Multivariate: independent risk factors for non-completion included lower level of education (OR 2.90, CI 1.20-7.03, p=0.018) & not having a signed social support contract (OR 2.91, 95% CI 1.01-8.34, p=0.047)
|
Age, sex, marital status, employment status, ≥1 comorbidities
|
[11]
|
N 1838
F 1340
M 498
Age 49.1±13.5
BMI 43.26
Scotland, UK
|
Prospective cohort in an NHS adult weight management service
|
Age ≥18, BMI≥30 with obesity-related co-morbidities or BMI≥35 alone
|
Phase 1: 16-week group lifestyle intervention. Phase 2: 3, 1-hour sessions delivered monthly. Phase 3: 12, 1-hour weight maintenance sessions monthly. Interventions can include dietitians, clinical psychologists & physiotherapists
|
12 months 57.7%
|
Completion: attended ≥4/9 sessions in phase 1, ≥2/3 in phase 2, ≥6/12 phase 3
|
Univariate: using HADS-A scale, fewer patients with anxiety completed at 6-months (p=0.001), fewer patients with severe anxiety completed at 3-months (p=0.008), at 6-months (p<0.001) & 12 months (p<0.001). Using HADS-D scale, fewer patients with depression completed at 6-months (p=0.011) & 12 months (p=0.024). Fewer patients with severe depression completed at 12-months (p=0.028). Following stratification by age & HADS scores, at 12-months attrition lower with increasing age in non-cases- (p=0.001) & non-severe cases of anxiety or depression (p=0.001)
|
Anxiety & completion at 3 & 12 months, depression & completion at 3 months, severe depression & completion at 3 & 6 months, anxiety stratified by sex, depression stratified by sex, deprivation stratified by anxiety, deprivation stratified by depression
|
[38]
|
N 2156
F 1591
M 565
Age
F 44.6
M 47.5
BMI ≥30+
Scotland, UK
|
Evaluation of an NHS weight management clinic
|
Age≥18, BMI≥30 with co-morbidities or BMI≥35. Excluded pregnant women, being unable to attend outpatient clinic, in early stages of smoking cessation & current poorly controlled psychiatric illness
|
Phase 1: 16-week group lifestyle intervention. Phase 2: 3, 1-hour sessions delivered monthly. Phase 3: 12, 1-hour weight maintenance sessions monthly. Interventions can include dietitians, clinical psychologists & physiotherapists
|
Up to 19 months. Attrition assessed at end of phase 1 – 16 weeks, 62.5%
|
Completion: attending ≥4 or 9 sessions in phase 1
|
Univariate: in entire cohort, completion associated with older age (≥40) (p<0.01), higher BMI (p=0.02), COPD (p=0.03) and living in less deprived areas (p=0.01)
Multivariate: In entire cohort odds of completion increased with older age (≥40) (p<0.01), higher BMI (p=0.02) & living in less deprived areas (p<0.01). COPD associated with decreased odds of completion (OR 0.56 95%CI 0.37-0.86, P=0.01). In females, odds of completion increased with older age (p<0.01), higher BMI (p=0.05) & decreased with COPD (OR 0.53 95% CI 0.31-0.89, p=0.02) & stroke (OR 0.38 95% CI 0.19-0.76, p=0.01). Male patients from less deprived areas more likely to complete (p<0.01)
|
In entire cohort, sex, heart disease, hypertension, stroke, osteoarthritis, hypothyroidism, diabetes mellitus, anxiety, depression, prescribed drug use. In male-only analysis: age, BMI, comorbidities, prescribed drug use. In female-only analysis:
heart disease, osteoarthritis, hypertension, hypothyroidism, diabetes mellitus, anxiety, depression, prescribed drug use, deprivation
|
[34]
|
N 270
F 140
M 130
Age 49±8
BMI 41±5
USA
|
Observational in a University weight management programme
|
Not clearly stated
|
Initial intensive energy restriction for 3-6 months with aim of 15% weight loss, followed by behaviour change & physical activity counselling. Appointment with exercise physiologist to develop an activity programme. Entire 2-year programme involves 11 visits with a physician & 26 with a dietitian
|
At 3 months, 10%, at 6 months, 17%, at 12 months, 33%, at 18 months, 45%, at 2 years, 49% - excludes n30 participants who voluntary left
|
Short term completion: attending ≥1 visit at 6 months, 2-year completion: attending ≥1 visit at 2 years
|
Univariate: At 6 months, completers were older (p=0.0033), & had lower BMI’s (p=0.0177). At 2 years completers were older (p=0.0002), white ethnic (p=0.049), had lower BMI’s (p=0.0015), better quality of life (using IWQOL-lite) (p=0.0138) & less present with depressive symptoms (using IDS-SR) (p=0.0331). Multivariate: older age (OR 1.06 95% CI 1.02-1.09, p=0.0013), lower baseline BMI (OR 0.93 95% CI 0.87-0.99, p=0.0139) & having health insurance with a specific provider (96% of participants had insurance with this provider) (OR 5.92 95% ci 1.16-22.68, p=0.0337) predicted retention at 2 years
|
6-month or 2-year retention & sex, education, employment, marital status, distance to intervention site, comorbidities, EQ-5D: (mobility limitations, self-care limitations, usual activities problems, pain, anxiety/depression). 6-month retention & ethnicity, education, employment status, IWQOL-lite, IDS-SR.
|
[4]
|
N 2457
F 71.6%
M 28.4%
Age 48.6±13.8
BMI 45.6±6.8
England, UK
|
Evaluation of an NHS weight management service
|
BMI≥40 or BMI≥35 with ≥1 comorbidities
|
Personalised plan set by a GP lasting up to 2 years, with a dietitian, physiotherapist & occupational therapist, & referrals to local leisure centre classes. 12, weekly group sessions. Reviews every 1-3 months & weekly weight checks optional. Prescription of orlistat or liquid meal replacements available on a self-pay basis
|
Of patients who attended initial consultation (n1929): 19% did not attend one additional appointment, 35% did not attend ≥2 appointments & 61% dropped out <6 months
|
Attrition not clearly defined. Basic level of engagement was attendance at initial consultation & further ≥2 appointments. Longer-term engagement defined as attendance at >6 months
|
Univariate: Attenders >6 months were older (51.7±12.9 vs 47.8±13.9, p<0.001), & more likely to have diabetes (p=0.001), sleep apnoea (p<0.001), hypertension (p=0.009), hyperlipidaemia (p=0.01) & joint pain (p<0.001). Of those who engage in >2 appointments, a higher proportion were from the least deprived quintile (p=0.003), & of those who engaged >6 months, a higher proportion were also from the least deprived quintile (p=0.01). Multivariate: attendance >6 months was associated with increasing age (OR 1.017 95%CI 1.008-1.026, p<0.001), living in less deprived area (OR 1.082 95%CI 1.012-1.157, p=0.02) & presence of sleep apnoea (OR 1.357 95%CI 1.077-1.710, p=0.001)
|
Engagement >6 months: gender, BMI, depression, ischaemic heart disease, engagement >12 months: deprivation
|
[32]
|
N 1109
F 759
M 350
Age 48.3±13.1
BMI 45.3±9.3
Australia
|
Evaluation of a hospital-based weight control clinic
|
Adult with a BMI≥35 or ≥30 with a weight-related comorbidity & have made previous unsuccessful attempts to lose weight or maintain weight loss
|
Initial VLED phase with appointments every 2-4 weeks, followed by a transition period with dietary & lifestyle modification. Long-term weight maintenance phase with appointments every 1-3 months. Treatment staff include endocrinologists & dietitians. Pharmacotherapy used for patients unable to maintain weight loss
|
At 1-year, 58.0%, at 3-years, 80.8%
|
Completion: still attending at 3-years
|
Multivariate: 1-year retention (prediction rate 75.9%) predicted by childhood obesity (OR 1.38 95%CI 1.03-1.85, p<0.05) BMI (direction not stated) (OR 1.02 95%CI 1.0-1.03, p<0.05) English 1st language (OR 0.53 95%CI 0.28-0.99, p<0.05) hypertension (OR 1.69 95%CI 1.26-2.26, p<0.001) & CAD (OR 1.82 95%CI 1.13-2.98, p<0.05). 3-year retention (prediction rate 83.7%) predicted by childhood obesity (OR 1.42 95%CI 1.00-2.01, p<0.05), asthma (OR 1.45 95%CI 1.02-2.07, p<0.05) hypertension (OR 1.66 95%CI 1.13-2.45, p<0.01) CAD (OR 1.67 95%CI 1.0-2.77, p<0.05) & non-smoking (OR 0.53 95%CI 0.31-0.87, p<0.05)
|
Sex, age, BMI & 3-year retention, asthma & 1-year retention, smoking & 1-year retention, baseline blood pressure, type 2 diabetes, mental illness, English as 1st language & 3-year retention
|
[35]
|
N 59
F 59
Age
Cases 42.2±10.4
Controls 42.4±14.0
BMI
Cases 36.1±4.4
Controls 35.6±5.1
Italy
|
Nested case-control in an academic obesity outpatient unit
|
BMI≥30 age ≥18 & treatment resistant (≥2 previous diet attempts). Excluded pregnant women, major physical illness & history of psychiatric disorders & treatment
|
Cases received CBT by a psychologist & dietitian, including nutrition education, self-monitoring, physical activity, cognitive restructuring, behaviour chaining, behavioural strategies & relapse prevention. Controls received standard dietary treatment planned by a dietitian & supervised by a physician
|
6 months,
35% of cases & 62% of controls dropped out. 47% combined dropout rate
|
Failing to complete the 6-month program, but no definition of completion provided
|
Multivariate: Following age- and multivariate adjusted analyses, cases (received CBT) were more likely to complete than controls (OR 2.94, 95% CI 1.05-8.97) (OR 2.77, 95% CI 1.02-8.34) respectively. Age at first dieting attempt was an independent predictor of attrition in cases (beta -9.02, t= 5.40, p<0.05). Anger-hostility subscale was an independent predictor of attrition in controls (using SCL-90), (beta 7.86, t=5.40, p<0.05)
|
Age, weight, height, BMI, body fat%, waist circumference, highest or lowest adult weight, age at first diet attempt in controls, number of dieting attempts, SCL-90 scores: (somatization, obsessivity-compulsivity, interpersonal sensitivity, depression, anxiety, anger-hostility in cases, phobic anxiety, paranoid ideation), global severity index scores, BES scores, BDI scores
|
[33]
|
N 461
F 385
M 76
Age 18-55
BMI ≥30
USA
|
Prospective cohort set in a community weight management clinic
|
BMI≥30 age≥18-55
|
Bi-weekly group educational sessions on diet & physical activity with a health educator. Individual sessions with a lifestyle counsellor every 3-months, targeting weight-related behaviours
|
71% - timepoint measured not stated
|
Attrition: participants who do not return following first appointment
|
Univariate: Retention associated with female sex (p=0.053). Participants with children (p=0.036) & black ethnicity (p=0.006) associated with dropout. Multivariate: Women more likely to continue engaging (OR 2.33 95%CI 1.21-4.49, p=0.012). Having children reduced odds of retention (OR 0.60 95%CI 0.38-0.94, p=0.027).
|
Age, stages of change, physical activity, calorie- fruit & vegetable- or fat intake, education, employment, marital status, family structure, smoking, drinking, medication, comorbidities
|