Background:
There is a growing evidence base supporting intensive lifestyle and medical treatment for severe obesity, although dropout rates reported in these studies are high. Our aim was to identify predictors of non-completion of an intensive multidisciplinary treatment for severe obesity, called the Metabolic Rehabilitation Programme (MRP), in a public hospital clinic.
Methods:
We extracted data from medical records for 219 eligible obese patients with a body mass index (BMI) of 35 or greater referred to the MRP from 2014 through 2015. Non-completion status (case definition) was coded for patients who started but failed to complete at least 12 months of the MRP. Baseline predictors tested: age, gender, BMI, waist circumference, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications.
Results:
78/219 (35.6%) failed to complete at least 12 months of MRP. Significant between-group differences (non-completers vs completers) included: age (47.1 vs 54.5 years); residential distance from clinic (21.8 vs 17.1 km); type 2 diabetes (56.4% vs 69.3%); and OSA (42.9% vs. 56.7%); current CPAP (11.7% vs 28.4%). Using multivariable logistic regressions, the probability of non-completion was: inversely associated with age (p=0.001), residential distance (p=0.084), and OSA (p=0.051) in Model 1; and inversely associated with age (p=0.001), residential distance (p=0.064), and CPAP (p=0.004) in Model 2. Using receiver operating characteristics (ROC) and area under the curve, Model 2 performed slightly better than Model 1 (69.5% vs 66.4%).
Conclusions:
Younger patients with fewer complex care needs living further away from the clinic were more likely dropout of this intensive obesity service than their colleagues. Clinicians should be aware of these risk factors when managing patients with severe obesity, whereas policy makers may consider strategies for increasing access to specialist obesity clinics/services.