Attrition and Retention in Multidisciplinary Weight Management Interventions for Adults with Obesity: A Systematic Review

Background High rates of attrition undermine the success of weight management interventions (WMIs), but a comprehensive understanding of the factors that increase dropout risk remains absent. This is partly explained by heterogeneity of intervention design, and the absence of a universal definition of attrition. This systematic review aimed to identify the factors related to- and predictive of attrition and retention in multidisciplinary WMIs for adults with obesity. Methods The systematic literature search, conducted in Cochrane, Medline, PsycInfo, and Scopus, aimed to identify original research articles published between February 2008 and December 2019. Articles investigating attrition or retention in multidisciplinary WMIs were eligible for inclusion if interventions were for adults (≥18) with obesity identified by body mass index ≥30kg/M2 and lasted ≥6 months. Multidisciplinary was defined as ≥2 interventionist disciplines or professions, for the purpose of this review. Data was synthesised narratively. Results The literature search resulted in seventeen studies which satisfied the inclusion criteria. Attrition rates ranged from 10% at 3-months to 81% at 3-years. The sociodemographic factors associated with reduced risk of attrition included older age, living in less deprived areas, higher levels of education, and female gender. Poor mental health, low social support, high weight loss goals and poor or unsatisfactory results may increase the likelihood of participant dropout, but evidence was limited and inconclusive because of different methodologies, and only a small number of studies investigating some of the variables. Conclusions The scope for targeted retention strategies is limited because few variables were consistently associated with attrition. Until a comprehensive understanding of attrition emerges, WMIs should seek to reduce social inequities in the benefit of WMI provision. Future research should consider factors reported qualitatively, such as intervention expectations and satisfaction, social support, patient-clinician relationships, and logistical barriers. Adopting a universal definition of attrition and de-homogenising participant dropouts would advance future research. As qualitative evidence is limited, exploring participant experiences of WMIs would help understand how attrition rates can be reduced, and in-turn improve WMI effectiveness.

Correction to: A novel approach to increasing community capacity for weight management a volunteer-delivered programme (ActWELL) initiated within breast screening clinics: a randomised controlled trial

An amendment to this paper has been published and can be accessed via the original article.

PATHWEIGH, pragmatic weight management in adult patients in primary care in Colorado, USA: study protocol for a stepped wedge cluster randomized trial

Background Despite the overwhelming prevalence and health implications of obesity, it is rarely adequately addressed in a health care setting. PATHWEIGH is a pragmatic approach to weight management that uses tools built into the electronic medical record to overcome barriers and guide care. Implementation strategies are employed to facilitate adoption and use of the PATHWEIGH tools and processes. The current study will compare the effectiveness of PATHWEIGH versus standard of care (SOC) on patient weight loss in primary care and explore factors for its successful implementation. Methods A stepped wedge cluster randomized trial design will be used within an effectiveness-implementation hybrid study. Adult patient weight loss and weight loss maintenance will be compared in PATHWEIGH versus SOC in 57 family and internal medicine clinics in a large health system in Colorado, USA. Effectiveness will be evaluated using generalized linear mixed models to determine statistical differences in weight loss and weight loss maintenance at 6, 12, and 18 months. Patient-, provider-, and clinic-level predictors will be identified using mediator and moderator analyses. Conceptually guided by the Practical, Robust, Implementation and Sustainability Model (PRISM), a mixed methods approach including quantitative (practice surveys, use tracking) and qualitative (interviews, observations) data collection will be used to determine factors impeding and facilitating adoption, implementation, and maintenance of PATHWEIGH and evaluate specified implementation strategies. A cost analysis of the practice and system costs and resources required by PATHWEIGH relative to the reimbursement collected will be performed. Discussion The effectiveness and implementation of PATHWEIGH, and their interrelatedness, for patient weight loss are collectively the focus of the current trial. Findings from this study are expected to serve as a blueprint for available and effective weight management in primary care medical practice. Trial registration ClinicalTrials.govNCT04678752. Registered on December 21, 2020.

Effects of a Single Dose of BURN-XT™ on Resting Metabolic Rate, Substrate Oxidation, and Various Indices of Affect

Introduction: Many consumers use dietary supplements in the hopes of increasing energy and burning more calories, which if sustained over time may help accelerate weight loss. The purpose of this clinical trial was to investigate the effects of an over-the-counter thermogenic supplement called Burn-XT™ (BXT) on metabolic rate, substrate oxidation, and various psychometric indices of affect that impact weight management. Methods: Using a double-blind, placebo-controlled, cross-over design, 16 women and 10 men (29.3 ± 7.3 yr, 169.4 ± 8.6 cm, 75.5 ± 14.3 kg) underwent two testing sessions: placebo (PL) and BXT. Seated metabolic rate and substrate oxidation, vital signs, and anchored visual analogue scale (VAS) assessments of energy, mood, motivation, focus, fatigue, concentration, and appetite were made before supplementation and hourly for three hours post-ingestion. Two-factor (2x4) factorial ANOVAs and paired sample t-tests (corrected for multiple comparisons) were used for analyses. Results: Significant increases in metabolic rate (oxygen consumption) were noted at 60 minutes in BXT (+11.9 mL O2/min) vs. PL (-2.5 mL O2/min), p = 0.004, d = -0.74. Only BXT increased metabolic rate compared to baseline at 60 minutes (+11.9 mL O2/min, p = 0.021, d = -0.53) and 120 minutes (+12.1 mL O2/min, p = 0.019, d = -0.54). The AUC for resting energy expenditure increased more in BXT vs. PL (p = 0.007, d = -0.57). VAS detected significant improvements in energy, mood, focus, and concentration for BXT vs. PL at 120 and 180 minutes (all p < 0.05, d = -0.58 to -0.68). In all cases, within-group changes from baseline for these VAS parameters were significant (all p < 0.05, d = -0.76 to -1.38) in BXT but not in PL. No within or between group differences in appetite, substrate oxidation, or heart rate were noted. Small (~3-4 mm Hg), but statistically significant (p < 0.05, d = -0.51 to -0.69) increases in diastolic blood pressure were noted in BXT at 60, 120, and 180 min vs. PL; and in systolic blood pressure at 60 min vs. PL. In all cases, values remained within normal clinical hemodynamic ranges. Conclusions: A single dose of BXT safely increased metabolic rate, energy, mood, focus, and concentration. Given that these factors are known to favorably impact weight management, future studies should determine whether daily supplementation with BXT reduces body weight and improves body composition.

Onset of Weight Gain and Health Concerns for Men: Findings from the TAP Programme

With shown reticence by men to engage with dietary interventions for weight loss, investigations that provide detail on men’s perceptions for the causes of weight gain and subsequent concerns over health and image are important. Such discoveries have potential to make a valuable contribution to male gendered programme design aimed at tackling weight gain and promoting good health. Connecting to men to health using their hobbies and interests, this study deployed semi-structured interviews of eight male participants (age > 35 years) enrolled on The Alpha Programme (TAP). TAP is a 12-week football and weight management intervention delivered in local community venues. Results captured men’s lived experiences and feelings of being overweight, their attempts at dietary modification, health and causes of weight gain. Results signify externalized attribution for weight gain, entrenched habitual intake practices, despondency related to weight stigmatization, self-objectification and low self-worth. Moreover, this study outlines the processes for capturing this information using a male friendly approach and setting. Outcomes have potential for shaping bespoke men’s weight management and health improvement interventions in the future.

Sustainability of weight loss from a family-centered pediatric weight management program integrated in primary care

Background A 6-month pediatric weight loss program showed modest success, but the sustainability of this success after 12 months was unclear. The present study aims tomeasure the medium-term effectiveness of family-based weight management in pediatric primary care to reduce body weight in children living with obesity. Methods In a retrospective cohort study, children ages 3 to 17 years with obesity in Kaiser Permanente Orange County, California, who enrolled in a weight management program between April 2014 and December 2018 (FB-WMG, n = 341) were compared to children referred but not enrolled (Ref-CG, n = 317) and controls matched by sex, age, zip code and BMI (Area-CG, n = 801). The relative distance from the median BMI-for-age at months 0, 6, and 12 were expressed as difference-in-differences (DID) using multivariable linear regressions with robust standard error. Results The baseline BMI-for-age was 98.6 (SD 1.08) percentile in FB-WMG, 98.2 (SD 1.22) percentile in Ref-CG, and 98.6 (1.13 in Area-CG). FB-WMG had a median of 3 visits (P25 1 visit, P75 5 visits) in the first 6 months. Despite a more considerable decrease in the relative distance to the median BMI-for-age in FB-WMG children with 3+ visits after 6 months, the success obtained was not sustained at 12 months (DID FB-WMG vs Area-CG -0.34, 95% CI − 3.00 to 2.33%, FB-WMG vs Ref-CG -0.39, 95% CI − 3.14 to 2.35%). At 12 months, there was no statistical significant difference between the three groups (FB-WWG, Ref-CG, Area-CG). Conclusions The initial success in weight management was not sustained in the absence of continued support for healthy lifestyle changes. Based on current evidence, continued support is necessary to maintain and promote success beyond a brief 6 month intervention. Long-term pediatric weight management programs are needed to promote continuing progress.

Formulating a novel fermented soy milk functional meal replacement among overweight individuals: a preliminary weight loss clinical trial

Meal replacement is an optimising strategy in designing structured diets for weight management. In this study, a novel fermented soy-whey based beverage was fortified with dietary bioactive ingredients containing probiotic strains (Lactobacillus bulgaricus and Streptococcus thermophilus). The aim of this study was to evaluate its efficacy on the body weight loss of participants pre-and post-meal replacement. A total of 20 participants underwent the weight loss program. Over the 14-day trial, women volunteers had a body weight loss of 6.70% of their initial body weight, and men had a comparable body weight reduction of 6.18%. In comparison to the blood glucose baseline level of 3.5420 mmol/L, the meal replacement decreased the level of blood glucose by nearly 50%, reaching 1.7785 mmol/L. Total cholesterol level was reduced by the beverage with a 15.7% reduction. The functional drink also decreased the triglycerides and low-density lipoprotein significantly (p<0.001). A significantly higher level of high-density lipoprotein was obtained at Day 14 (1.73 mmol/L) compared with Day 0 (1.23 mmol/L). The meal replacement was able to provide satiety within the average of 180.7 minutes post-meal. This study supports the soy-based functional milk is of benefit for weight management, glucose homeostasis and blood cholesterol-lowering effect.