Attrition and family participation in obesity treatment programs: clinicians' perceptions.

OBJECTIVE: The majority of participants drop out of pediatric obesity treatment programs; however, clinicians have little knowledge of how to address this problem. The objective of this study was to explore obesity treatment clinicians' perceptions of contributors to attrition, as well as methods to maintain family participation.
METHODS: Semistructured interviews were conducted with 29 pediatric obesity clinicians representing primary care (PC), community based (CB), and tertiary care (TC) treatment programs in North Carolina. Interviews were recorded, transcribed verbatim, and coded with a multistage inductive approach. Grounded theory was used to analyze responses.
RESULTS: Eleven themes emerged from analysis, including: the influence of program elements, family characteristics, and the variety of approaches used to address retention. Only TC programs reported attempts to address attrition. Patients' past experiences with obesity treatment, desire for immediate outcomes, and relationships with clinicians were perceived as important factors related to attrition. Other important themes were: families' understanding of obesity treatment, importance of realistic expectations, and families' value of treatment. Important differences and similarities among programs were identified. All clinicians reported families came to treatment through physician referral, not self referral.
CONCLUSIONS: Clinicians perceive attrition to be a significant problem in pediatric obesity treatment. As a result of clinical interviews, several potential avenues to address attrition were identified, including: the need for clinicians to develop relationships with families, assist in building appropriate expectations, and address families' value of treatment. Findings of this study can inform larger investigations of attrition, and guide exploration of family impressions of and experiences in treatment.