Predictors of dropout and bariatric surgery in Icelandic morbidly obese female patients

Background Little is known on how morbidly obese individuals who participate in different treatments differ in relation to anthropometrical measurements and psychological characteristics. In the present study we investigated attrition and treatment choice, i.e., bariatric surgery and conservative treatment, of morbidly obese subjects. Methods Data was collected during screening from 292 morbidly obese women who participated in a weight loss program at an Icelandic rehabilitation center. Information were available on body composition, fasting blood samples, psychological characteristics, medication use, drop-out and whether patients underwent bariatric surgery after the weight loss program at the rehabilitation center. Inclusion criteria were age between 18 and 65 years and BMI > 35 kg/m², exclusion criteria were alcohol- or drug addiction. Results Of the 292 women who finished screening, 113 (39%) dropped out, 100 (34%) finished the weight loss program and 79 (27%) finished the weight loss program and consecutively underwent surgery. According to multivariate models individuals with BMI ≥50 kg/m² were 4.5 times more likely (P = 0.003) to undergo bariatric surgery than individuals with BMI <40 kg/m². Individuals with severe depression were 2.4 times more likely (P = 0.01) to drop out than individuals with no depression. Serum glucose (+36% for an increase by 1 mmol/L, P = 0.036) and use of psychotropic medication (+73%, P = 0.05) were also associated with higher odds of dropout. Conclusion A large proportion of morbidly obese individuals dropped out of a weight loss program at an Icelandic rehabilitation center and severe depression symptoms more than doubles this risk.