PMCID: PMC5369386 DOI: 10.1089/chi.2016.0215
BACKGROUND: 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.
PATIENTS AND METHODS: 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.
RESULTS: From January to August 2013, 405 parents/guardians were recruited and reported about their children (203 adolescents, 202 childrenyears). 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).
CONCLUSIONS: Assessing initial expectations may help tailor treatment to meet families' needs, especially through focus on family-based change and realistic goal setting.
CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov NCT01753063.
Adolescent; Body Mass Index; Child; Child, Preschool; Communication; Female; Health Behavior; Health Education; Health Knowledge, Attitudes, Practice; Humans; Male; Parents; Patient Compliance; Pediatric Obesity; Professional-Family Relations; Prospective Studies; United States; Weight Reduction Programs
attrition; family-based health; obesity; pediatrics; weight management; children; teenagers
Rhodes, E. T., Boles, R. E., Chin, K., Christison, A., Testa, E. G., Guion, K., Hawkins, M. J., Petty, C. R., Sallinen Gaffka, B., Santos, M., Shaffer, L., Tucker, J., Hampl, S. Expectations for Treatment in Pediatric Weight Management and Relationship to Attrition. Child Obes 13, 120-127 (2017).