Conservative treatment of obesity in an academic obesity unit. Long-term outcome and drop-out

Objective: The aim of this study was to explore the outcome and the problems of drop-out in the treatment of obese outpatients at an academic obesity unit. Design: A twoyear clinical treatment evaluation. Subjects: A total of 117 obese subjects, 83 women and 34 men, mean aged 50 (23–70) years, with an average body mass index (BMI) of 39.0 kg/m2 (28.8–64.7). Intervention: All treatment was based on group therapy and included behaviour modification and nutrition counselling. A team of nurses, dieticians, a physiotherapist, a psychotherapist and a physician supervised the treatment. Two programmes were used. Group 1 initially received a low-calorie diet (LCD) for seven weeks combined with the behaviour treatment programme. Group 2 was treated with the behaviour treatment programme only. All subjects were offered complementary treatment according to their medical needs. Results: There was a continuous drop-out of subjects during the two-year treatment period with an overall drop-out rate of 53%. Anthropometric characteristics, medical history or reasons for drop-out had no impact on the drop-out rate. In completers the weight reduction after two years was 9.2 [±10.8 standard deviation (S.D.) kg. In non-completers the weight reduction of the last observed weight measurement was 4.7 (±7.9 S.D.) kg. After year two, the weight reduction in Group 1 was 8.8 (±12.2 S.D.) kg, and in Group 2 was 9.7 (±8.0 S.D.) kg. Conclusion: This study has showed the difficulties of long-term clinical treatment of obese outpatients, even in a specialised obesity clinic. The findings demonstrate that educated and experienced staff together with an extended package of treatment options is not enough to keep patients in treatment for two years. However though the drop-out rate was high, two thirds of the included subjects reduced their weight, which is a satisfactory result in a clinical setting. The drop-out rate and the reasons for dropping out could give a clue in which direction the diagnostics and analysis of the subject’s individual needs in health care should be directed.