The association between ethnicity, socioeconomic status and compliance to pediatric weight-management interventions - A systematic review.
High dropout rates and low compliance to pediatric weight-management programs have been reported. Socioeconomic status (SES) and ethnicity have been suggested as potentially important determinants of dropout and non-compliance. This review aims to assess the association between SES, ethnicity and study- and intervention dropout and non-compliance among participants in pediatric weight-management programs.



PubMed, Embase, MEDLINE, Scopus, Cochrane, Web-of-Science and Google Scholar were searched for eligible studies up to March 2014. Included were randomised controlled trials (RCT), controlled clinical trials and cohort studies evaluating pediatric weight-management programs. Studies had to report dropout or non-compliance to the study or intervention with regard to ethnicity or SES. Associations between SES and ethnicity and dropout and non-compliance were analysed descriptively.



Fourteen RCTs and 16 cohort studies were included, studying 7264 children and adolescents, aged 2-20 years. Twenty-four studies presented data on dropout or non-compliance regarding ethnicity and 26 studies presented data regarding SES. Black participants showed higher dropout rates in weight-management interventions (range 65-67%) than White participants (range 22-27%), and low family income was associated with lower compliance to weight-management interventions.



Black ethnicity and low family income seemed to be associated with higher dropout and lower compliance to pediatric weight-management interventions. Future qualitative studies may be needed to assess underlying reasons for increased dropout and non-compliance in these sub-populations.
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: k.ligthart@erasmusmc.nl.
Kelly A M
KAM
Ligthart
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Leanne
L
Buitendijk
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Bart W
BW
Koes
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Marienke
M
van Middelkoop
D000293:Adolescent; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016239:MEDLINE; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000208:ethnology* / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000208:ethnology / Q000706:statistics & numerical data; D063766:Pediatric Obesity / Q000208:ethnology* / Q000628:therapy*; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012923:Social Class; D061217:Weight Reduction Programs / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
Compliance; Dropout; Ethnicity; Overweight; Socioeconomic status