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Outcomes from an orientation model to reduce attrition in paediatric weight management.

ABSTRACT: We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was programme attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modelling. Patients in the Orientation Group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (adjusted Hazard ratio, aHR 1.23; 95% confidence interval, CI: 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, P = 0.004). An increase in body mass index z-score of 1 unit resulted in a nearly fivefold increased odds of attrition (aHR 5.24; 95% CI: 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the programme.

SUBMITTER: Zenlea IS

PROVIDER: S-EPMC5023470 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Outcomes from an orientation model to reduce attrition in paediatric weight management.

Zenlea I S IS Milliren C C Herel S S Thomaseo Burton E E Askins N N Ludwig D S DS Rhodes E T ET

Clinical obesity 20160804 5

We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of re ...[more]

PMID: 27487780

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Project description:Objectives: To investigate the impact of the Cambridge Intensive Weight Management Programme (IWMP) on weight change, eligibility for bariatric surgery, HbA1c, and blood pressure. Design: Prospective non-randomized intervention. Setting: The IWMP is a multi-disciplinary weight loss intervention for severely obese patients to avoid or optimize their physiological state thus enabling bariatric surgery. It uses dietary interventions, pharmacotherapy, and physical activity along with behavior change counseling. Participants: Severely obese patients (Body Mass Index, BMI≥40 kg/m2). Interventions: IWMP is a prospective intervention conducted in a National Health Service Tier 3 obesity service. It includes 3 phases of 8 weeks each: weight loss, weight stabilization, and weight maintenance. In each phase, patients adhered to a prescribed dietary regime and attended regular clinic visits. Data included in this analysis are from those who enrolled in IWMP between 2009 and 2013. Primary and secondary measures: The primary outcome was weight change between baseline and completion of the programme. Secondary outcomes included changes in blood pressure, HbA1c and eligibility for bariatric surgery pre-assessment. Changes in outcomes were compared by age, sex, smoking status, and employment. Results: Of n = 222 eligible patients, complete data were available for n = 141 patients (63.5%). At baseline, the mean (SD) BMI was 49.7 (9.2) kg/m2 for women, and 47.9 (7.2) kg/m2 for men. Mean (SD) weight change for women was -18.64 (8.36) kg and -22.46 (10.98) kg for men. N = 97 (69%) of patients achieved ≥10% weight loss. Individuals aged ≤ 50 years lost significantly more weight than those aged >50 years [mean (SD) weight loss: 22.18 (10.9) kg vs. 18.32 (7.92) kg, p = 0.020]. Changes in weight were non-significant by smoking status or employment. Median (IQR) change in systolic and diastolic blood pressure was -6 (-14.6) mmHg and 0 (-8.6) mmHg (non-significant), respectively. There was ~50% reduction in the need for bariatric surgery. Conclusions: For the majority of the patients, IWMP is promoting weight loss and allowing for avoidance of, or optimization before, bariatric surgery.

Project description:BackgroundYoghurt is part of the diet of many people worldwide and is commonly recognised as a 'health food'. Epidemiological studies suggest that yoghurt may be useful as part of weight management programs. In the absence of comprehensive systematic reviews, this systematic review investigated the effect of yoghurt consumption by apparently healthy adults on weight-related outcomes.MethodsAn extensive literature search was undertaken, as part of a wider scoping review, to identify yoghurt studies. A total of 13?631 records were assessed for their relevance to weight-related outcomes.ResultsTwenty-two publications were eligible according to the review protocol. Cohort studies (n=6) and cross-sectional studies (n=7) all showed a correlation between yoghurt and lower or improved body weight/composition. Six randomised controlled trials (RCTs) and one controlled trial had various limitations, including small size and short duration. One RCT showed significant effects of yoghurt on weight loss, but was confounded by differences in calcium intake. One trial showed nonsignificant weight gain and the remaining five trials showed nonsignificant weight losses that were greater in yoghurt consumers.ConclusionsYoghurt consumption is associated with lower body mass index, lower body weight/weight gain, smaller waist circumference and lower body fat in epidemiological studies. RCTs suggest weight reduction effects, but do not permit determination of a cause-effect relationship. Well-controlled, adequately powered trials in research and community settings appear likely to identify a modest but beneficial effect of yoghurt consumption for prevention of weight gain and management of obesity. The ready availability of yoghurt (a nutrient-dense food) and its ease of introduction to most diets suggests that educating the public to eat yoghurt as part of a balanced and healthy diet may potentially contribute to improved public health. Future carefully designed RCTs could provide proof of principle and large community-based studies could determine the practical impact of yoghurt on body weight/composition.

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Outcomes from an orientation model to reduce attrition in paediatric weight management.

Publications

Outcomes from an orientation model to reduce attrition in paediatric weight management.

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