Predictors of Attrition in a Multidisciplinary Adult Weight Management Clinic

Richdeep Gill, MD, Shahzeer Karmali, MD FRCSC, Ghassan Hadi, MD FRCSC, Matthew Hudson, Xinzhe Shi, Daniel W Birch, MD FRCSC. University of Alberta

Background
Worldwide, over 1.7 billion individuals may be classified as overweight and are in need of appropriate medical and surgical treatments. The primary goal of a comprehensive weight management program is to produce sustainable weight loss. However, for a weight management program to be effective, the patient must first complete the program. In this study, we analyze attrition rates and predictors of attrition within a publicly funded, multidisciplinary adult weight management program.

Methods
A retrospective chart review was conducted utilizing a multidisciplinary Adult Weight Management Clinic program database (Weight Wise, Alberta Health Services, Edmonton, Alberta, Canada). Patients received medical or surgical treatment with appropriate clinical follow-up. Patient’s records were accessed for information on demographics and co-morbidities. The patients in the surgical clinics were treated with either laparoscopic gastric band insertion or gastric bypass. Univariate analysis and multivariate analyses on predictors of attrition was completed. Statistical significance was defined as p<0.05.

Results
A total of 1205 patients were treated in the weight management program; 887 were treated in the medical clinic and 318 were treated surgically and followed in a surgical clinic. Overall 516 patients left the program or were lost to follow-up (attrition rate = 42.8%). The attrition rate was 53.9% in the medical clinic and 11.9% at the surgical clinic. Multivariate analyses identified participation in the medical clinic, younger patient age and lower BMI as predictors of attrition.

Conclusion
This study identified lower attrition rates in surgically treated patients as compared to medically treated patients in a multidisciplinary weight management clinic. Further research is needed to understand those variables that lead to improved attrition rates.

Key Words: Attrition, Weight-loss program, bariatric surgery, obesity