Attrition Bias in an Observational Study of Very Low-Energy Diet: A Cohort Study.

Abstract

Obesity treatment is plagued by attrition. Estimates of attrition bias are needed. Thus, in this study, percent change from baseline BMI at 1, 2, and 3 years following enrollment in a 2-year weight management program using a very low-energy diet was calculated. Program data were supplemented with information from medical records. Attrition was classified as occurring early (<6 months), late (6-21 months), at program completion (22-28 months), and after program completion (>28 months). Stepwise multivariable regression examined attrition and other covariates. A total of 881 subjects had ≥3 years of follow-up. BMI decreased by a mean (SD) of 11.8 (9.2), 8.6 (9.3), and 5.2 (10.0) kg/m² at 1, 2, and 3 years after enrollment, respectively. At year 1, every 10-kg/m² increase in baseline BMI was associated with a 2% (95% CI: 1%-3%) decrease in BMI. Individuals with early attrition decreased their mean BMI by 13% (11%-15%) less than program completers and by 9% (7%-11%) at 2 years. At 3 years, there was no significant difference in BMI between individuals with early attrition and program completers. However, BMI decreased 5% (3%- 8%) more in individuals who extended participation compared with program completers. Reported outcomes of weight management programs must account for program attrition.