Background Research suggests multi-component family-based lifestyle programmes are efficacious in treating paediatric obesity. However, success relies heavily on family attendance and retention. While attendance offers the support to make long-lasting, positive, lifestyle changes, in addition to the opportunity to identify underlying health issues, the majority of families referred to treatment decline. Moreover, for those who do attend, benefits are often compromised by high programme attrition. While non-attendance directly impacts on the children and their families, it also negatively impacts the health service due to missed appointments and loss of productivity. This systematic review aimed to investigate the factors influencing attendance at community-based lifestyle programmes among families of overweight or obese children. Within this overall review question we specifically sought to explore the barriers and facilitators related to both initial and continued attendance.

Methods A narrative synthesis approach was used to allow for the inclusion of a range of research designs. Quantitative, qualitative and mixed-methods studies were included. Articles published in English were included if they (1) were original research studies, (2) included children aged 4–12 years, (3) had a primary focus on paediatric weight management that (4) incorporated lifestyle (i.e. diet, physical activity and behavioural) components, and (5) reported on the factors influencing attendance at family-based programmes that were delivered in the community setting. The electronic databases, PubMed, CINAHL, EMBASE and PsychINFO were searched from inception to March 2015 and the reference lists of all relevant studies were hand searched for additional articles.

Results Thirteen studies were included. Children enrolled primarily to have fun and make friends. However, the stigma associated with attending these programmes discouraged others. For parents, the main factors influencing enrolment included the concern for their child’s psychological health, the desire to reduce any adverse social experiences their child may be experiencing and to increase their child’s self-esteem. Denial of the issue amongst parents presented a barrier to enrolment and many parents refused to accept their child was carrying excess weight. Logistical factors such as time, transport, conflicting schedules and changing family circumstances influenced families’ decisions to drop out of treatment while group support and good trainer–participant relationships were viewed as crucial to continued attendance.

Conclusion Efforts are urgently required to optimise the effectiveness of childhood obesity treatment in the community setting. This study provides practical recommendations to guide future policy makers, programme delivery teams and researchers in developing strategies to boost recruitment and minimise attrition.