title: Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment.
abstract: The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r(2)  = 0.094, P < 0.001 and r(2)  = 0.175, P < 0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5 kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P = 0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non-cases at 3, 6 and 12 months of follow-up (P < 0.01). Despite a less favourable case-mix of risk-factors for poor weight loss, patients who scored caseness for severe anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes.
authors: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors: R C
authors: RC
authors: McLean
authors: West of Scotland Cancer Surveillance Unit, 1 Lilybank Gardens, Glasgow, UK.
authors: D S
authors: DS
authors: Morrison
authors: Glasgow and Clyde Weight Management Service, NHS Greater Glasgow and Clyde, Glasgow, UK.
authors: R
authors: R
authors: Shearer
authors: Glasgow and Clyde Weight Management Service, NHS Greater Glasgow and Clyde, Glasgow, UK.
authors: S
authors: S
authors: Boyle
authors: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors: J
authors: J
authors: Logue
mesh_terms: D000367:Age Factors; D001007:Anxiety / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology* / Q000628:therapy*; D010352:Patient Dropouts; D011446:Prospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*
keywords: Anxiety; depression; weight loss; weight management