title: Parents and pediatric weight management attrition: experiences and recommendations.
abstract: BACKGROUND
  One of the most frequently cited challenges faced by pediatric weight management programs/clinics is attrition, with many studies reporting rates greater than 50%. Few studies have evaluated parental perspectives on recommendations for weight-management treatment enhancement. The aim of this study was to elicit perspectives on areas for improvement, discussions with staff about discontinuation, and potentially modifiable aspects of attrition from parents who prematurely discontinued stage 3 pediatric weight management treatment.
  
  
  METHODS
  This study was performed as a semistructured interview as part of a telephone survey assessing reasons for attrition.
  
  
  RESULTS
  Interviews were performed with 147 parents of children who attended programs/clinics at 13 children's hospitals participating in the National Association of Children's Hospitals and Related Institutions (now Children's Hospital Association) FOCUS on a Fitter Future II collaborative. The majority of parents (65%) denied talking to staff about their decisions to stop coming. When describing what could have been done to retain families, parents most frequently discussed changing logistics (e.g., hours and locations). Parents described changes in logistics and components (i.e., nutrition education, exercise, and behavior education/support) when asked what would work best for their family for pediatric weight management.
  
  
  CONCLUSIONS
  Parental responses appeared to express frustration about flexibility with appointment times and treatment locations. The most frequently desired components were those traditionally offered by stage 3 pediatric weight management programs/clinics, and this may suggest a need for treatment delivery of these components to be more individualized. Additional discussion with families about their desire to discontinue treatment may provide a timely opportunity to address this need.
authors.affiliation: 1 Pediatric Comprehensive Weight Management Center, Department of Pediatrics, Division of Child Behavioral Health, University of Michigan C.S. Mott Children's and Von Voigtlander Women's Hospital , Ann Arbor, MI.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Sallinen Gaffka
authors.forename: Maura
authors.initials: M
authors.lastname: Frank
authors.forename: Sarah
authors.initials: S
authors.lastname: Hampl
authors.forename: Melissa
authors.initials: M
authors.lastname: Santos
authors.forename: Erinn T
authors.initials: ET
authors.lastname: Rhodes
mesh_terms: D015992:Body Mass Index; D002648:Child; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009042:Motivation; D010290:Parents; D010349:Patient Compliance / Q000706:statistics & numerical data*; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D011368:Professional-Family Relations; D014481:United States / Q000453:epidemiology; D061217:Weight Reduction Programs