title: Individual, facility, and program factors affecting retention in a national weight management program.
abstract: BACKGROUND
  High attrition is a common problem for weight loss programs and directly affects program effectiveness. Since 2006, the Veterans Health Administration (VHA) has offered obesity treatment to its beneficiaries through the MOVE! Weight Management Program for Veterans (MOVE!). An early evaluation of this program showed that attrition rate was high. The present study examines how individual, facility, and program factors relate to retention for participants in the on-site MOVE! group program.
  
  
  METHODS
  Data for all visits to MOVE! group treatment sessions were extracted from the VHA outpatient database. Participants were classified into three groups by their frequency of visits to the group program during a six month period after enrollment: early dropouts (1 - 3 visits), late dropouts (4 - 5 visits), and completers (6 or more visits). A generalized ordered logit model was used to examine individual, facility, and program factors associated with retention.
  
  
  RESULTS
  More than 60% of participants were early dropouts and 11% were late dropouts. Factors associated with retention were older age, presence of one or more comorbidities, higher body mass index at baseline, lack of co-payment requirement, geographic proximity to VA facility, addition of individual consultation to group treatment, greater program staffing, and regular, on-site physical activity programming. A non-completion rate of 74% for on-site group obesity treatment poses a major challenge to reducing the population prevalence of obesity within the VHA.
  
  
  CONCLUSIONS
  Greater attention to individualized consultation, accessibility to the program, and facility factors including staffing and physical activity resources may improve retention.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Spring
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA. msohn@northwestern.edu.
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.forename: Sara M
authors.initials: SM
authors.lastname: Locatelli
authors.forename: Sattar
authors.initials: S
authors.lastname: Hadi
authors.forename: Leila
authors.initials: L
authors.lastname: Kahwati
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D015992:Body Mass Index; D001835:Body Weight; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D010352:Patient Dropouts; D015995:Prevalence; D015397:Program Evaluation; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D061217:Weight Reduction Programs
references.citation: JAMA. 2001 Mar 7;285(9):1172-7
references.pmid: 11231746
references.citation: Soc Sci Med. 2004 Dec;59(11):2387-99
references.pmid: 15450711
references.citation: J Cardiovasc Nurs. 2006 Jul-Aug;21(4):251-8; quiz 259-60
references.pmid: 16823276
references.citation: J Consult Clin Psychol. 1984 Feb;52(1):139-40
references.pmid: 6699245
references.citation: J Pers Soc Psychol. 1996 Jan;70(1):115-26
references.pmid: 8558405
references.citation: N Engl J Med. 2011 Nov 24;365(21):1959-68
references.pmid: 22085317
references.citation: Arch Intern Med. 1981 Mar;141(4):426-8
references.pmid: 7212881
references.citation: Behav Res Ther. 2009 Aug;47(8):685-91
references.pmid: 19497559
references.citation: Prev Chronic Dis. 2009 Jul;6(3):A98
references.pmid: 19527600
references.citation: Curr Cardiovasc Risk Rep. 2012 Apr;6(2):120-134
references.pmid: 23082235
references.citation: J Fam Pract. 1995 Sep;41(3):231-6
references.pmid: 7650500
references.citation: Am J Prev Med. 2011 Nov;41(5):457-64
references.pmid: 22011415
references.citation: Womens Health Issues. 2003 Mar-Apr;13(2):55-61
references.pmid: 12732441
references.citation: Ann Intern Med. 2003 Dec 2;139(11):930-2
references.pmid: 14644896
references.citation: Obes Res. 2004 Jun;12(6):1011-8
references.pmid: 15229342
references.citation: Ann Intern Med. 2005 Jan 4;142(1):56-66
references.pmid: 15630109
references.citation: Obes Res. 2005 Nov;13(11):1961-9
references.pmid: 16339128
references.citation: JAMA. 2005 Jan 5;293(1):43-53
references.pmid: 15632335
references.citation: Arch Intern Med. 1998 Sep 28;158(17):1855-67
references.pmid: 9759681
references.citation: Transl Behav Med. 2011 Dec;1(4):551-60
references.pmid: 24073079
references.citation: Obes Res. 2003 Jul;11(7):888-94
references.pmid: 12855759
references.citation: JAMA Intern Med. 2013 Jan 28;173(2):105-11
references.pmid: 23229890
references.citation: Med Care. 1998 Jan;36(1):8-27
references.pmid: 9431328