Attrition and the management of pediatric obesity: an integrative review

A key challenge in managing pediatric obesity is the high degree of program attrition, which can reduce therapeutic benefits and contribute to inefficient health services delivery. Our aim was to document and characterize predictors of, and reasons for, attrition in pediatric obesity management. We searched literature published until January 2014 in five databases (CINAHL, EMBASE, MEDLINE, PsycINFO, and Scopus). Articles were included if they were English, included participants 0-18 years of age, focused on pediatric obesity management, incorporated lifestyle and behavioral changes without pharmacotherapy, provided attrition data, and reported information about predictors of, and/or reasons for, attrition from family-based interventions provided in research or clinical settings. Twenty-three articles (n=20 quantitative; n=2 qualitative; n=1 mixed methods) met our inclusion criteria. Clarity of study aims, objectives, methods, and data analysis were appraised using Bowling's checklist. Attrition varied according to definition (minimum to maximum, 4-83%; median, 37%). There were few consistent predictors of attrition between studies, although dropout was higher among US-based families receiving public health insurance. Older children were also more likely to discontinue care, but sex and baseline weight status did not predict attrition. The most commonly reported reasons for attrition were logistical barriers and programs not meeting families' needs. Developing and evaluating strategies designed to minimize the risk of attrition, especially among families who receive public health insurance and older boys and girls, are needed to optimize the effectiveness of pediatric obesity management.