Overweight and obesity are serious health concerns due to the high prevalence worldwide. The increased risk of other health issues, financial burden to health services and the increasing prevalence demonstrates the importance of continuing to establish and improve weight loss interventions.
As a nutritionist, I am interest to find out more about why people drop out of weight loss programmes, and to take these considerations in when taking on clients, especially clients who are looking to lose a lot of weight, or individuals who have already tried multiple weight loss diets prior to coming to me.
Not all weight loss programmes work for everyone, and it is very common for individuals to drop out of programmes. Dropping out of a weight loss programme prior to the end dare or the end goal is a common problem in individuals who are on weight loss programmes. According to the research, the rates of individuals who drop out of weight loss programmes ranges from 10-80% [1-4]. Therefore, it is a major problem that needs to be reduced. And the issue with dropping out, is that those individuals won't have achieved their main outcome goals for the programme, and it may impact their future enrolment to weight loss programmes, and perhaps give up on trying to lose weight.
There are studies that have looked at factors that may be associated with reasons behind dropping out [2]. In the UK, the main population of individuals who are at highest risk of dropping out is women aged between 18-49 years. And according to the statistics, more than half (54%) of women within this age category are either overweight or obese. Being overweight or obese specifically in women have particular consequences, as it is associated with alterations in the reproductive cycle with a reduction in fertility, as well as increased risk of cardiovascular disease and type 2 diabetes[5]. According to the statistics, there is an increased risk of infertility by 78% in obese women, and by 27% in overweight women of this population compared to women of same age group who are of normal weight.
As well, being obese during pregnancy is associated with short- and long-term health risks to the mother, such as hypertension, pre-eclampsia and gestational diabetes [6]. Not only does the mother have short and long-term health problems associated with maternal obesity/overweight, infants born from mothers that are overweight/obese has increased risk of long-term health problems such as increased incidence of type 2 diabetes in the offspring.
Weight loss programmes success or drop-out in women with polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women (18-49 years). According to international guidelines, weight management is the first-line treatment for the condition. A study was done to see what factors are associated with successful or drop-out of weight loss programmes in women with PCOS and overweight or obese. The findings of the study was that, despite a high rate of women dropping out, successful weight loss was achieved by 63% of women in the study.
They found that women who were showing depressive symptoms (e.g. poor self-esteem) were more likely to drop-out of the programme, and women who had higher appointment attendance, were at lower risk of dropping out and showed better weight loss success. This study highlights the importance of assessing psychological well-being, so that individuals that show lower psychological well-being can be offered greater psychological support for improving the adoption and sustaining of healthy lifestyle behaviours and weight management.
Weight loss programmes success or drop-out in individuals who are married/in a relationship or has children
Starting and sticking to a weight loss programme, while the other people you live with such as your husband are not can make it difficult to making the programme successful. A study reported that individuals who drop out of weight loss programmes are more likely to be married or in a relationship. They reported that 81% of married participants or ones in a relationship dropped out. Whereas, 67% of single participants dropped out of the programme. They also reported that having children can increase drop out chance.
It is thought that women tend to prioritise the needs of their children and want to accommodate food preference of family members, making it difficult to stick to their own personal dietary goals. So, as a nutritionist, it is important to help overcome this barrier, making it easier to make dietary changes that are suitable for everyone in the household. Other factors that may be useful to consider are:
- The mother's employment status. If she is in a full time job, then we know that she will want quick simple meals, and will not have the time to cook separate meals.
- Is it the mother that does all the cooking, or does she have help. If so, then cooking separate meals to the children is an option.
- How many children, and what are their ages. This is to provide the mother with guidance on recipes to feed everyone and that the meals are suitable for everyone in the household.
Getting your partner involved, whether it is by joining in on your lifestyle change, or by offering the support needed can help stick out a weight loss programme. If they aren't joining in, but want to be supportive, then keep them in the loop with how you are feeling, what you find difficult about the programme and discuss your goals. This is so that your partner is aware of how you are finding it, be able to offer the right support, and are aware of things that the partner may be able to do to reduce temptation and make the difficult parts easier.
While some studies show that couples are far more likely to be successful when changing lifestyle patterns together, other studies show the opposite. This may be because one partner is likely to influence the other one if they decide to stop the healthy habits.
Does age have an affect on weight loss programmes success or drop-out
According to the research [1], yes, age is a factor to consider. This study found that middle-aged and older participants (50+ years) were less likely to drop out of a weight loss programme and more likely to be successful compared to younger individuals (18-49 years). Possible reasons for this age-related differences in drop out rates could be due to the fact that younger individuals may not be able to attend consultations as frequently as older individuals due to barriers such as lack of time, working, lack of childcare, have less financial stability and may not be able to get time off work [7]. In addition, it is thought hat the younger age group mat be less motivated to improve their health [8].
Having looked at the research, I can see that the main barriers for individuals in the younger age group category is that they have less flexible schedules and have personal responsibilities (e.g. employment, care for children and parents), that make them less likely to focus on self-care. The take home message here is nutritionists need to take into consideration of busy lifestyles for individuals within this age group, and allowing flexible consultation hours that are most suitable for the individual, whether it is early in the morning, or late in the evening after the children have gone to bed.
Key factors to be aware of that may lead to individuals dropping out of weight loss programmes (useful for anyone giving nutrition advice):
Individual who is experiencing depressive symptoms
Individuals who are partnered or have kids
Age: Younger individuals
Other factors that may be reasons for dropping out of a weight loss program:
The method of the programme: lack of contact/engagement with clients
The number of appointments: lack of appointments
High expectations for large weight loss
Previously attempted numerous diets and did not succeed, or have since put the weight back on
Not enough knowledge on nutrition, or lack of cooking skills
To conclude:
It is common for individuals to drop out of weight loss programmes and not achieve their initial goal. From what has been said in this article, we can see that nutritionist and other health care professionals have a crucial role in adapting and providing guidance for individuals who enrol onto a weight loss programme. It is important to take into consideration of possible barriers that may impact the success of the programme, and to understand that everyone's way of living and personal responsibilities, goals, knowledge and understanding and previous experiences and skills are different.
References:
Jiandani, D., Wharton, S., Rotondi, M. A., Ardern, C. I., & Kuk, J. L. (2016). Predictors of early attrition and successful weight loss in patients attending an obesity management program. BMC Obesity, 3(1).
Moroshko, I., Brennan, L., & O'Brien, P. (2011). Predictors of dropout in weight loss interventions: a systematic review of the literature. Obesity Reviews, 12(11), 912-934.
Pirotta, S., Joham, A., Hochberg, L., Moran, L., Lim, S., Hindle, A., & Brennan, L. (2019). Strategies to reduce attrition in weight loss interventions: A systematic review and meta‐analysis. Obesity Reviews, 20(10), 1400-1412.
Teixeira, P. J., Going, S. B., Houtkooper, L. B., Cussler, E. C., Metcalfe, L. L., & Blew, R. M. et al. (2004). Pretreatment predictors of attrition and successful weight management in women. International Journal of Obesity, 28(9), 1124-1133.
Ezzati, M., Lopez, A. D., Rodgers, A., Vander Hoorn, S., Murray, C. J., & Comparative Risk Assessment Collaborating Group. (2002). Selected major risk factors and global and regional burden of disease. The Lancet, 360(9343), 1347-1360.
Sui, Z., Grivell, R. M., & Dodd, J. M. (2012). Antenatal exercise to improve outcomes in overweight or obese women: a systematic review. Acta obstetricia et gynecologica Scandinavica, 91(5), 538-545.
Honas, J. J., Early, J. L., Frederickson, D. D., & O'brien, M. S. (2003). Predictors of attrition in a large clinic‐based weight‐loss program. Obesity research, 11(7), 888-894.
Fabricatore, A. N., Wadden, T. A., Moore, R. H., Butryn, M. L., Heymsfield, S. B., & Nguyen, A. M. (2009). Predictors of attrition and weight loss success: Results from a randomized controlled trial. Behaviour research and therapy, 47(8), 685-691.
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