Abstract
Regular follow-up and the frequency of outpatient clinic visits are crucial factors in the management of obesity. This study aimed to assess the impact of the number and frequency of visits on weight loss outcomes in patients attending the obesity outpatient clinic. This was a 5-year retrospective observational study involving 1531 individuals aged 18 and older who had at least 2 visits to the Obesity Outpatient Clinic. Baseline, minimum, and final weight data blood lipid profiles, HOMA-IR, and body composition measurements (Tanita) were analyzed. Patients with chronic conditions affecting body mass index (e.g., heart or kidney disease, psychiatric eating disorders, pregnancy), as well as those with only 1 visit or incomplete records, were excluded. To reduce bias, only patients with regular follow-up for at least 3 months and a total follow-up period of 1 year or more were included. receiver operating characteristic analysis was used to identify cutoff values for the number of visits associated with ≥5% weight loss. The relationship between the number and frequency of visits and weight loss success was evaluated using receiver operating characteristic analysis. The mean baseline body mass index was 35.74 ± 6.66 kg/m². Of the patients, 16.26% did not lose any weight, 43.31% lost between 0% and 5%, 25.41% lost between 5% and 10%, 9.34% lost between 10% to 15%, and 5.68% lost more than 15% of their initial weight. A significant effect of the number and frequency of visits on weight loss success was observed. The threshold for the total number of visits was found to be 5.5 (AUC = 0.757, sensitivity = 55%, specificity = 82%), and for the annual frequency of visits, it was 1.46 (AUC = 0.721, sensitivity = 72%, specificity = 59%). These values were identified as the most accurate predictors of weight loss. A positive relationship was observed between the number of visits and weight loss; it was seen that the success rate increased as the frequency of visits increased. Frequent visits play a pivotal role in enhancing weight loss during obesity treatment. Regular follow-up may also be beneficial in maintaining the weight lost.
Keywords: frequency of admission, obesity, patient follow-up, weight loss
1. Introduction
Obesity is emerging as a significant health issue worldwide.[1] It is associated with several chronic diseases such as cardiovascular diseases, diabetes, and hypertension, and the prevalence of these diseases is increasing over time the most important factors in obesity treatment is the regular follow-up of patients and ensuring their adherence to treatment. The literature emphasizes the positive effect of regular monitoring and visit frequency on weight loss.[2–4] However number of studies regarding the effects of visit frequency and number on weight loss.
In the treatment of overweight and obesity, selecting the correct targets is crucial. In individuals without additional risk factors, the goal should be to stop further weight gain, whereas for overweight and obese individuals with risk factors, weight loss should be achieved. It is also important to set realistic goals during treatment; for example, achieving a completely normal weight in an obese individual is not a realistic target.[5,6] Instead, according to the recommendations of the Turkish Society of Endocrinology and Metabolism (TEMD), a weight loss of at least 3% to 5% should be targeted to achieve significant improvements in risk factors, and this level should be maintained over time. In patients receiving medical treatment, a weight loss of 5% or more after 3 months of follow-up is considered successful. A weight loss of <5% is considered unsuccessful, 5% to 10% is successful, 10% to 15% is very successful, and over 15% is considered an excellent response. If the weight loss is below 5%, the treatment approach should be reevaluated.[7,8]
The long-term success of obesity treatment is not only related to diet and exercise but also to individuals’ adherence to the treatment process.[2,4] The regularity of visits can enhance treatment adherence and motivation, which in turn supports weight loss.[9] The aim of this study is to investigate how the number and frequency of visits affect the success of weight loss in obesity treatment.
2. Methodology
This study is a retrospective observational study that includes obese patients followed for 5 years at the Faculty of Medicine Family Medicine Obesity Outpatient Clinic. In this obesity outpatient clinic, each patient is assessed through laboratory tests and and body composition was measured using bioelectrical impedance analysis with Tanita® MC-780MA (Tokyo, Japan). All patients receive individualized dietary counseling from a dietitian, and, when appropriate, tailored physical activity recommendations. Medical treatment is initiated if indicated by clinical findings.
A total of 1531 patients aged 18 years and older, with a body mass index (BMI) ≥25 kg/m² and who visited the outpatient clinic at least twice for obesity treatment, were included in the study. Patients with chronic diseases that could affect BMI, such as chronic heart disease, chronic kidney disease, psychiatric eating disorders, pregnant individuals, and those with only 1 visit were excluded.
Data were retrospectively collected from patient records. The initial, minimum, and final weights, BMI, blood lipid levels, HOMA-IR, and body composition data measured with Tanita® were collected.
From the 1531 patients who visited the obesity clinic between 2018 and 2022, those with visits lasting 1 year or more were analyzed, with a focus on patients who had at least 3 months of regular visits. The cutoff values for the total number of visits and annual visits of patients who lost 5% or more of their body weight were determined, and ROC analysis was conducted to assess the impact of these 2 parameters on weight loss.
Approval was obtained from Düzce University Non-Interventional Health Research Ethics Committee for the research (Decision No: 2023/181, Approval Date: 20.11.2023).
3. Statistical analysis
Descriptive statistics for numerical data were presented as means and standard deviations. For data that did not conform to a normal distribution, the median and interquartile range (IQR) were used. Categorical data were presented as frequencies and percentages. The Kolmogorov-Smirnov Z test and histograms were used to examine the distribution of numerical data. For comparisons between 2 groups, Student t-test and Mann–Whitney U test were used. For dependent groups, Wilcoxon test and paired samples t-test were used. Chi-square test was used for the analysis of categorical data. Receiver operating characteristic (ROC) curves were also generated. Area under the curve and cutoff values were determined for each measurement and sensitivity, specificity and positive likelihood ratio (LR+) were calculated. ROC analysis is traditionally used for diagnostic purposes, but in this study, it was used to investigate meaningful thresholds in visit frequency. The results should be interpreted with caution, and no causal inferences can be made. A P-value of <.05 was considered statistically significant. SPSS 23.0 software (Chicago) was used for the analyses.
4. Results
A total of 1531 patients were included in the study. Of the participants, 84.20% (n = 1306) were female, and 15.80% (n = 245) were male. Regarding marital status, 79.24% (n = 1229) were married, 17.28% (n = 268) were single, and 3.48% (n = 54) were widowed or divorced. The majority of the participants, 60.09% (n = 932), were housewives. Only 23.79% (n = 369) of the patients had a bachelor’s or graduate-level education. It was observed that 60.74% (n = 930) of the patients had at least 1 chronic illness. Among the chronic diseases associated with obesity, hypertension was the most common, observed in 17.92% (n = 278) of the patients (Table 1).
Table 1.
Sociodemographic data of patients.
| Sociodemographic | Number | Percentage | |
|---|---|---|---|
| Gender | Male | 245 | 15.80 |
| Female | 1306 | 84.20 | |
| Marital status | Married | 1229 | 79.24 |
| Single | 268 | 17.28 | |
| Widowed/divorced | 54 | 3.48 | |
| Education level | Illiterate | 35 | 2.26 |
| Literate | 26 | 1.68 | |
| Primary education | 752 | 48.48 | |
| Secondary education | 369 | 23.79 | |
| Bachelor’s/master’s degree | 369 | 23.79 | |
| Occupation | Housewife | 932 | 60.09 |
| Student | 132 | 8.51 | |
| Laborer | 110 | 7.09 | |
| Public servant | 81 | 5.22 | |
| Private sector | 73 | 4.71 | |
| Education sector | 57 | 3.68 | |
| Retired | 44 | 2.84 | |
| Unemployed | 27 | 1.74 | |
| Tradesperson | 25 | 1.61 | |
| Architect/Engineer | 19 | 1.23 | |
| Healthcare sector | 18 | 1.16 | |
| Food industry | 16 | 1.03 | |
| Security sector | 11 | 0.71 | |
| Farmer | 6 | 0.39 | |
| Chronic disease | Yes | 930 | 60.74 |
| No | 601 | 39.26 | |
The average age of all patients included in the study was 39.28 ± 12.6 years. The mean baseline BMI was 35.74 ± 6.66 kg/m², and the mean final BMI was 34.61 ± 6.41 kg/m². The average total weight loss was 5.27 ± 5.27 kg (n = 1164).
When examining the weight loss status of the 1531 patients included in the study, it was found that 16.26% of the patients did not lose any weight (n = 249), 43.31% lost between 0% and 5% of their initial weight (n = 663), 25.41% lost between 5% and 10% (n = 389), 9.34% lost between 10% and 15% (n = 143), and 5.68% lost more than 15% (n = 87).
Regarding the highest amount of weight lost, it was found that men lost significantly more weight than women (P = .005). Additionally, the total weight loss was significantly higher in men compared to women (P <.001). When evaluating annual visit frequencies, women were found to visit the clinic significantly more often than men (P = .025).
In Table 2, the changes in initial and final weight, BMI, waist circumference, BEI-F, HOMA-IR, and ALT values over time are presented. A significant decrease was observed in weight (P <.001), BMI (P <.001), waist circumference (P = .025), BEI-F (P <.001), and ALT (P <.001). However, HOMA-IR did not show a significant change (P = .123).
Table 2.
Changes in initial and final weight, BMI, waist circumference, BEI-F, HOMA-IR, and ALT values.
| n | First application median (IQR) | Last application median (IQR) | P | |
|---|---|---|---|---|
| Weight | 1531 | 92.20 (20.90) | 89.10 (21.60) | <.001 * |
| BMI | 1531 | 34.48 (8.50) | 33.35 (8.24) | <.001 * |
| Waist circumference | 524 | 105.51 ± 13.44 | 104.41 ± 13.67 | .025 ** |
| Tanita BEİ-F | 684 | 41.00 (9.40) | 39.70 (9.40) | <.001 * |
| HOMA-IR | 734 | 2.69 (2.24) | 2.64 (2.28) | .123* |
| ALT | 778 | 18.20 (13.60) | 17.40 (12.50) | <.001 * |
Bold values indicate a significant difference.
ALT = alanine aminotransferase, BMI = body mass index, BEI-F = regional fat distribution, HOMA-IR = homeostatic model assessment of insulin resistance, IQR = interquartile range.
Wilcoxon.
Paired samples test.
A total of 552 patients, who had been followed for at least 1 year at the obesity outpatient clinic, were analyzed using ROC analysis. The median total number of visits was 2.67 (IQR: 2.18), and the median annual visit frequency was 1.44 (IQR: 3.74). A significant effect of the number and frequency of visits on weight loss success was observed (P <.001). The threshold value for the total number of visits was found to be 5.5 (AUC = 0.757, sensitivity = 55%, specificity = 82%), and for the annual visit frequency, it was 1.46 (AUC = 0.721, sensitivity = 72%, specificity = 59%). These values were identified as the best predictors of weight loss (Table 3, Fig. 1).
Table 3.
Evaluation of the total number and frequency of visits in relation to weight loss success.
| Parameters | cutoff value | AUC (P) 95% CI | Sensitivity (%) | Specificity (%) | LR+ |
|---|---|---|---|---|---|
| Total number of visits | 5.5 | 0.757 (<.001)* 717–797 | 55 | 82 | 2.96 |
| Number of visits per year | 1.46 | 0.721 (<.001)* 679–764 | 72 | 59 | 1.78 |
Bold values indicate a significant difference.
AUC = area under the curve, CI = confidence interval, LR+ = positive likelihood ratio, ROC = receiver operating characteristic.
ROC curve test.
Figure 1.
ROC curve analyses of total visit count and visit frequency parameters. ROC = receiver operating characteristic.
5. Discussion
In this study, it was found that the number and frequency of visits had a significant effect on weight loss success in individuals attending the obesity outpatient clinic. The total number of visits and the annual visit frequency were identified as key parameters in predicting weight loss success. These findings are consistent with similar studies in the literature. Although similar studies have been previously conducted, this study contributes to the literature by including a large real-life clinical sample, applying objective cutoff values via ROC analysis, and highlighting the structured multidisciplinary approach in a primary care setting.
In our study, it was observed that women visited the clinic more frequently than men, while men had a higher weight loss rate. This suggests that women may be more motivated to participate in the program, but hormonal and metabolic differences may influence weight loss success. Literature has also indicated that women have higher participation rates in obesity treatments; however, men are generally more successful in weight loss due to their metabolic advantages.[10,11] These findings suggest significant differences in weight loss behaviors between men and women, highlighting the need for gender-specific weight loss strategies. Additionally, socio-economic factors, such as education level and occupation, are known to influence treatment adherence. Interestingly, while men lost more weight on average, women attended more follow-up visits. This gender-related discrepancy may reflect behavioral, hormonal, or metabolic differences and warrants further exploration.
Obesity is often accompanied by systemic and metabolic disorders, which can either occur together or as complications. In our study, the most common obesity-related disease observed was hypertension. Similar studies have also found hypertension to be the most frequent comorbidity in obese patients.[12–15]
Our findings show a significant reduction in BMI, waist circumference, and body fat percentage during obesity treatment. However, no significant change was observed in HOMA-IR values. This suggests that longer-term interventions may be necessary to improve insulin resistance. Literature reports more significant improvements in insulin sensitivity with bariatric surgery or pharmacological treatments.[16] Our results imply that the biochemical improvements resulting from weight loss achieved through lifestyle changes may be more limited.
This study demonstrates the positive impact of more frequent and regular visits on weight loss. Numerous studies in the literature emphasize that regular clinical visits and patient follow-up enhance obesity treatment success. The Obesity Society Guidelines recommend intensive lifestyle interventions (at least 2 sessions per month for the first 6 months) and regular follow-up sessions to increase weight loss. These intensive interventions are associated with significant weight loss compared to less frequent visits. Furthermore, individual counseling during this process has been shown to increase the likelihood of weight loss and maintenance.[7,17]
In a study conducted after bariatric surgery, it was emphasized that regular clinical visits are essential for maintaining weight loss. A strong relationship was found between visit frequency and long-term weight loss success. Furthermore, Wing and Phelan study highlighted the critical role of regular monitoring and supportive healthcare services in maintaining long-term weight loss.[3,18] Similarly, obesity treatment guidelines emphasize the need for frequent and close follow-up. According to the TEMD (Turkish Society of Endocrinology and Metabolism) guidelines, frequent visits (every 15 days for the first 2 months and once a month for the next 3 months) are necessary for effective obesity treatment. The weight loss of 5% or more should be achieved and maintained for a meaningful clinical improvement in obesity-related risk factors.[8,19,20] While a ≥5% weight loss is often used as a clinical benchmark, it is important to recognize that smaller reductions may still yield metabolic and behavioral health benefits, such as improved diet quality, hydration, or physical activity levels.
In our study, it was observed that regular and frequent visits to the obesity outpatient clinic increased weight loss success. The 2013 guidelines from the American College of Cardiology and the American Heart Association recommend intensive lifestyle interventions with at least 14 sessions over 6 months to enhance weight loss, with strong evidence supporting this recommendation. High-intensity interventions are reported to lead to a 5% and 10% weight loss, whereas low-intensity interventions have no significant effect.[17,21] In general, high-intensity exercise includes monthly counseling sessions, behavior modification strategies, and personalized physical activity plans.[9]
The 2018 consensus report by the American Diabetes Association and the European Association for the Study of Diabetes (EASD) also found that dietary changes and frequent counseling sessions lead to effective weight loss. These studies demonstrate that the intensity of behavioral interventions directly influences weight loss success.[22] For example, a 2019 review by Tronieri et al highlighted that high-intensity behavioral counseling led to greater weight loss compared to other interventions.[23]
Additionally, a systematic review by the U.S. Preventive Services Task Force showed that individuals receiving 12 to 26 behavioral therapy sessions per year experienced a 6% weight loss, while fewer sessions resulted in only a 2.8% loss.[24] Our findings align with these results, demonstrating that increased visit frequency enhances weight loss.
A 2014 study by Wadden et al showed that lifestyle interventions led to a weight loss of 0.3 to 6.6 kg over 6 months, with weight loss decreasing in longer follow-up periods. Other studies, including those by Christian and Wharton, also showed that multidisciplinary, high-intensity programs were associated with greater weight loss. Frequent follow-ups were emphasized as contributing to the sustainability of weight loss.[25] These findings support the results of our study, suggesting that encouraging frequent and regular visits in obesity treatment can increase weight loss and help maintain healthy habits in the long term.
The ROC analysis results indicated that the threshold values for total visit count and annual visit frequency provide important clinical insights for patient management. Specifically, patients with more than 5.5 visits had higher weight loss success. These results underscore the importance of structured follow-up protocols that encourage patients to engage more in the treatment process. These findings support the integration of structured follow-up programs in primary care settings and suggest that patient retention strategies may significantly influence weight management outcomes.
As a retrospective design, our study may be subject to selection bias. However, to minimize this, only patients with regular follow-up for at least 3 months and a total duration of 1 year or more were included.
One of the main limitations of this study is its retrospective design. Another limitation is the homogeneity of the sample, as the majority of participants were housewives, which may have introduced bias in the generalizability of the findings. Additionally, other factors such as diet, physical activity, and lifestyle changes were not assessed in detail. Future prospective and randomized controlled studies could more clearly identify the effects of visit frequency and other variables on weight loss. One of the other limitations of this study is the absence of multivariate statistical modeling. A multivariate statistical model was not applied due to limitations in the retrospective data, including incomplete records on key variables such as comorbidities, medication use, and adherence. To avoid potential bias, we relied on univariate and ROC analyses. This limitation should be considered when interpreting the results.
6. Conclusion
In the treatment of obesity, regular visits have been found to enhance weight loss and help in the long-term maintenance of the lost weight. Increasing the frequency of visits during obesity treatment and follow-up is expected to positively impact treatment success. Future prospective studies in this area may provide further insight into the most effective visit frequency for obesity treatment.
Author contributions
Conceptualization: Oguz Savas, Abdulkadir Kaya.
Data curation: Oguz Savas, Abdulkadir Kaya.
Formal analysis: Oguz Savas, Abdulkadir Kaya.
Funding acquisition: Oguz Savas, Abdulkadir Kaya.
Investigation: Oguz Savas, Abdulkadir Kaya.
Methodology: Oguz Savas, Abdulkadir Kaya.
Project administration: Oguz Savas, Abdulkadir Kaya.
Resources: Oguz Savas, Abdulkadir Kaya.
Software: Oguz Savas, Abdulkadir Kaya.
Supervision: Oguz Savas, Abdulkadir Kaya.
Validation: Oguz Savas, Abdulkadir Kaya.
Visualization: Oguz Savas, Abdulkadir Kaya.
Writing – original draft: Oguz Savas, Abdulkadir Kaya.
Writing – review & editing: Oguz Savas, Abdulkadir Kaya.
Abbreviations:
- ADA
- American Diabetes Association
- ALT
- alanine aminotransferase
- AUC
- area under the curve
- BEI-F
- regional fat distribution
- BMI
- body mass index
- EASD
- European Association for the Study of Diabetes
- HOMA-IR
- homeostatic model assessment of insulin resistance
- IQR
- interquartile range
- LR+
- positive likelihood ratio
- ROC
- receiver operating characteristic
- SD
- standard deviation
- TEMD
- Turkish Society of Endocrinology and Metabolism
This research involving human subjects complied with all relevant national regulations and institutional policies and was conducted in accordance with the tenets of the Helsinki Declaration. This study was approved by University Faculty of Medicine Ethics Committee (Decision No: 2023/181, Approval Date: 20.11.2023).
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Savas O, Kaya A. The impact of the number and frequency of visits on weight loss success in patients attending the obesity outpatient clinic. Medicine 2026;105:2(e47120).
This study is the PhD thesis of the first author.
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