Adolescents' and parents' perspectives on attrition from pediatric obesity therapeutic patient education programs: A qualitative study

BACKGROUND: Pediatric obesity represents a major public health challenge and while Therapeutic Patient Education programs constitute standard treatment, they face significant attrition rates. AIM: To analyze reasons for attrition reported by adolescents enrolled in Therapeutic Patient Education programs for pediatric obesity in France and their parents. METHOD: This study used a qualitative phenomenological approach to explore the lived experiences of adolescents and their parents regarding attrition from pediatric therapeutic education programs for obesity in five French centers. Participants had initiated but discontinued a program. Data were collected through focus groups conducted separately with adolescents and their parents. Inductive thematic analysis following Braun and Clarke's framework was performed, followed by abductive theoretical conceptualization integrating Bronfenbrenner's (ecosystemic), Prochaska's (transtheoretical model of change) and Calgary (family assessment) models. RESULTS: Ten focus groups were conducted between October 2024 and July 2025: five groups with 25 adolescents aged 12 years and older and five parallel groups with their parents (n = 28). Analysis identified five themes among adolescents (21 subthemes and 622 quotations) and six among parents (25 subthemes, 935 quotations): program related barriers, psychological dimensions, psychosocial factors and stigmatization, family dynamics, adolescence-specific factors and organizational constraints (parents only). Over 60% of attrition factors concentrated at micro and mesosystemic levels, reflecting predominantly relational dynamics. Our findings confirm the role of therapeutic alliance quality, weight-based stigma, psychological distress and organizational constraints as an attrition factor documented in existing literature. Beyond these confirmations, the study reveals three major contributions: 1-systematic motivational asynchrony between adolescent and parents leading to attrition; 2- parental exhaustion as a progressive process of eroding investment capacity facing organizational constraints, family tensions and adolescent resistance; 3-adolescent boredom as a marker of developmental inadequacy of standardized program formats failing to recognize autonomy quest. CONCLUSION: Attrition from pediatric obesity Therapeutic Patient Education programs is not an individual failure but results from desynchronized systemic dynamics. These findings challenge the paradigm of uniform family-based interventions and advocate for individualized pathways accounting for each family member's stage of motivational change. REGISTRATION: ClinicalTrials.gov Identifier: NCT06488235. Ethics Committee of the Angers University Hospital (number 2024-046). First recruitment: 22/10/2024.