Continuous care in the treatment of obesity: an observational multicentre study.
OBJECTIVE
To investigate weight loss and reasons for attrition in obese patients on long-term continuous care.


METHODS
Observational study with 36 months of follow-up. Setting. Fifteen Italian obesity centres applying a continuous care model of medical treatment.


METHODS
One thousand treatment-seeking obese subjects (785 females, median age 45.1 years, median BMI 37.4 kg m(-2)). Weight loss expectations were systematically recorded at baseline.


METHODS
An initial intensive treatment period (3-6 months) was followed by a less intensive continuous care (a follow-up control every 2-4 months). Main outcome measures. Attrition, reasons for treatment interruption and BMI change. Data were recorded by telephone interview in dropouts.


RESULTS
Only 157 patients (15.7%) were in continuous treatment at 36 months. The main reasons of attrition were logistics, unsatisfactory results and lack of motivation. The only basal predictor for continuous care was lower Expected One-Year BMI Loss (P = 0.016). The probability of dropout increased systematically for any 5% expected BMI loss (Hazard ratio, 1.05; 96% confidence interval, 1.01-1.09). The mean percentage weight loss was greater in continuers (5.2% vs. 3.0% in dropouts; P = 0.016). However, the dropouts satisfied with the results or confident to lose additional weight without professional help reported a mean weight loss of 9.6% and 6.5% respectively.


CONCLUSIONS
Continuous care produces long-term weight loss only in a subgroup of obese patients seeking treatment in medical centres. The finding that subgroups of dropouts report long-term weight loss has implication for the treatment of obesity.
Dalle Grave
R
R
Villa Garda Hospital, Garda, Verona, Italy.
Melchionda
N
N
Calugi
S
S
Centis
E
E
Tufano
A
A
Fatati
G
G
Fusco
M A
MA
Marchesini
G
G
D000328:Adult; D000704:Analysis of Variance; D019440:Anti-Obesity Agents / Q000627:therapeutic use; D001067:Appetite Depressants / Q000627:therapeutic use; D001521:Behavior Therapy; D002908:Chronic Disease; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance; D012189:Retrospective Studies; D016896:Treatment Outcome
D019440:Anti-Obesity Agents; D001067:Appetite Depressants