title: Expectations for Treatment in Pediatric Weight Management and Relationship to Attrition.
abstract: Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition.
  
  
  
  A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months.
  
  
  
  From January to August 2013, 405 parents/guardians were recruited and reported about their children (203 adolescents, 202 children <12 years). Of the 203 adolescents, 160 also self-reported. Attrition rate was 42.2% at 3 months. For adolescents, greater interest in family support/behavior skills was associated with decreased odds of attrition at 3 months [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.98, p = 0.04]. The more discordant the parent/adolescent dyad responses in this category, the higher the odds of attrition at 3 months (OR 1.36, 95% CI 1.04-1.78, p = 0.02). Weight loss was an important weight management goal for both adolescents and parents. For adolescents with this goal, the median weight-loss goal was 50 pounds. Attrition was associated with adolescent weight-loss goals above the desired median (50% above the median vs. 28% below the median, p = 0.02).
  
  
  
  Assessing initial expectations may help tailor treatment to meet families' needs, especially through focus on family-based change and realistic goal setting.
  
  
  
  Clinicaltrials.gov NCT01753063.
authors.affiliation: 1 Division of Endocrinology, Boston Children's Hospital , Boston, MA.
authors.forename: Erinn T
authors.initials: ET
authors.lastname: Rhodes
authors.affiliation: 2 Children's Hospital Colorado , Aurora, CO.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Boles
authors.affiliation: 3 Clinical Research Center , Boston Children's Hospital, Boston, MA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Chin
authors.affiliation: 4 Children's Hospital of Illinois , Peoria, IL.
authors.forename: Amy
authors.initials: A
authors.lastname: Christison
authors.affiliation: 5 Mt. Washington Pediatric Hospital , Baltimore, MD.
authors.forename: Elizabeth Getzoff
authors.initials: EG
authors.lastname: Testa
authors.affiliation: 6 Oregon Health and Science University , Portland, OR.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Guion
authors.affiliation: 7 Children's Hospital and Medical Center , Omaha, NE.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Hawkins
authors.affiliation: 3 Clinical Research Center , Boston Children's Hospital, Boston, MA.
authors.forename: Carter R
authors.initials: CR
authors.lastname: Petty
authors.affiliation: 8 Pediatric Comprehensive Weight Management Center, University of Michigan Health System , Ann Arbor, MI.
authors.forename: Bethany
authors.initials: B
authors.lastname: Sallinen Gaffka
authors.affiliation: 9 Connecticut Children's Medical Center , Hartford, CT.
authors.forename: Melissa
authors.initials: M
authors.lastname: Santos
authors.affiliation: 10 University of Virginia , Charlottesville, VA.
authors.forename: Laura
authors.initials: L
authors.lastname: Shaffer
authors.affiliation: 11 Helen DeVos Children's Hospital , Grand Rapids, MI.
authors.forename: Jared
authors.initials: J
authors.lastname: Tucker
authors.affiliation: 12 Pediatrics and Center for Children's Healthy Lifestyles & Nutrition , Children's Mercy Hospital, Kansas City, MO.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hampl
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003142:Communication; D005260:Female; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D011368:Professional-Family Relations; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D061217:Weight Reduction Programs
keywords: attrition; family-based health; obesity; pediatrics; weight management