November 03, 2016
2 min read

Negative family functioning affects attrition in pediatric weight management programs

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NEW ORLEANS — Drop-out from treatment of pediatric weight management programs is more likely among families with disengaged or rigid functioning and stressful life events, according to a presenter here.

“We know that pediatric weight management programs have high rates of attrition, sometimes upwards of 75%. What complicates this is that treatment necessitates family involvement,” Joseph A. Skelton, MD, associate professor of pediatrics at the Center on Diabetes, Obesity and Metabolism, Epidemiology & Prevention at Wake Forest Baptist Health, said during the presentation. “Given the importance of family in treatment, there has been very little research looking at family factors, and then dropout from treatment, as well as the role stress plays in a family’s ability to participate in treatment.”

Skelton and colleagues evaluated 87 parent-child dyads (mean child age, 11.9 years) enrolled in a single weight management program to determine the associations between family functioning and dropout from the program from the intake period through six follow-up visits.

“Our hypothesis was that unbalanced family functioning is associated with attrition, or another to look at it is greater imbalance would predict higher levels of attrition,” Skelton said.

The Family Adaptability and Cohesion Scale IV was used to identify two indices of family functioning: disengaged/somewhat rigid and connected/structured. The Family Inventory of Life Events and Changes and the Hassles and Uplifts Scale were used to measure stress. The number of attended sessions after intake was used to define attrition (0 to 6 sessions).

Treatment was not completed by 63% of participants, and 30% dropped out after intake and two sessions; mean number of sessions attended after intake was 3.64.

Thirty-eight percent of the variance in attrition were predicted by family factors. Fewer program sessions were attended by families with negative life events and higher levels of a disengaged/somewhat rigid pattern of family functioning. More sessions were attended by families who experienced more daily hassles during the past year.

“Families characterized as somewhat disengaged and rigid and families with more stressful life events in the past year were more likely to drop out of treatment,” Skelton said. “Experiencing daily hassles predicted better attendance, and our hypothesis was that these families have more motivation or willingness, or maybe they were just in ‘better shape’ to participate in a rigorous treatment program. This may indicate new areas that we can focus on, because you can theoretically actually modify families’ functioning, which could improve adherence to treatment and hopefully improve outcomes.” – by Amber Cox


Skelton JA, et al. ORAL T-OR-2032. Presented at: ObesityWeek 2016; Oct. 31-Nov. 4, 2016; New Orleans.

Disclosure: Skelton reports no relevant financial disclosures.