More than 1.7 billion people worldwide may be classified as overweight and need appropriate medical or surgical treatment with the goal of sustainable weight loss. But for weight management programs to be effective, patients must complete them, states a study published in the Canadian Journal of Surgery (CJS) that analyzed drop-out rates and predictors of attrition within a publicly-funded adult weight management program.

Researchers from the Department of Surgery at the University of Alberta and the Centre for the Advancement of Minimally Invasive Surgery at the Royal Alexandria Hospital in Edmonton, Alberta, found that over a six-year period almost half (43%) of the patients of a weight-management clinic funded by Alberta Health Services dropped out of the program before achieving sustainable weight loss.

The program involves 6 months of primary care, including education on strategies for treating obesity, nutritional counselling, smoking cessation, physical activity and mental health assessment to identify untreated conditions, such as depression, that may be barriers to effective weight management. Some participants also undergo bariatric surgery.

In a group of patients who are motivated enough to participate in a program like this, a 43% drop-out rate is surprising. "Identifying the factors that predict attrition may serve as a basis for program improvement and further research," the authors state.

Among the patients included in the study, the drop-out rate was 54% in the group treated by medical management only and 12% in the group treated surgically. These drop-out rates are similar to those reported in other studies. "We speculate that patients willing to undergo the initial bariatric surgical procedure may be more committed to complete the program," the authors explain. They suggest that the substantial early weight loss associated with bariatric surgery may serve as additional motivation to continue in the program.

Younger patients and women were also more likely to drop out of the program.

"Further research is needed to clarify why surgical patients have lower attrition rates and how these factors can be applied to proactively decrease the drop-out rates and increase success," the authors state.