Are eHealth interventions for adults who are scheduled for or have undergone bariatric surgery as effective as usual care? A systematic review

Abstract

This systematic review aimed to evaluate the effect of eHealth-delivered interventions for adults who undergo bariatric surgery on postoperative weight loss, weight loss maintenance, eating psychopathology, quality of life, depression screening, and self-efficacy. Six electronic databases were searched, with 14 studies (across 17 reports) included, involving 1633 participants. With substantial heterogeneity, qualitative descriptions have been provided. Interventions were delivered via an online program or internet modules (n 5 2), telephone (n 5 2), text messages (n 5 2), videoconferencing (n 5 3), mobile application (n 5 1), and audiovisual media (n 5 1). Three studies included a combination, including internet modules and telephone (n 5 1), wireless fidelity scales, emails, and telephone (n 5 1), and a combination of online treatment, weekly emails, and access to a private Facebook group (n 5 1). All the eHealth interventions, except for one, implemented behavior change techniques, including self-monitoring, problem solving, social support, goal setting, and shaping knowledge. Both eHealth intervention and control groups lost weight across the included studies, and eHealth was found to be as effective as or more effective than the control for weight loss. Two studies measured weight loss maintenance; both eHealth and control groups regained weight in the longer term. The interventions showed significant improvement on assessment measures for eating psychopathology. In conclusion, when bariatric surgery patients have limited or no access to healthcare teams or require additional support, eHealth may be a suitable option. Future studies implementing eHealth interventions would benefit from reporting intervention components as per the behavior change techniques taxonomy and further consideration of delivering eHealth in a stepped care approach would be beneficial.

Behaviour change theories and techniques used to inform nutrition interventions for adults undergoing bariatric surgery: A systematic review

“…The most commonly reported behaviour change techniques identified were ‘1.2 Problem solving’, ‘3.1 Social support (unspecified)’, ‘1.1 Goal setting (behaviour)’ and ‘2.3 Self‐monitoring of behaviour’. Results are consistent with other reviews exploring diet and physical activity interventions, 16,40 weight loss and weight maintenance eHealth interventions 47 and eHealth interventions for adults undergoing bariatric surgery 48 . However, knowing the common behaviour change techniques does not help to determine which techniques to select.…”

“…Objective and subjective coding of techniques was a novel approach; previous reviews have only coded objectively with the limitation that techniques may be underreported 40,48 . This was required due to the complex and interacting components of interventions and to gain a robust insight regarding all techniques applied in the body of literature.…”

“…Results are consistent with other reviews exploring diet and physical activity interventions, 16 , 40 weight loss and weight maintenance eHealth interventions 47 and eHealth interventions for adults undergoing bariatric surgery. 48 However, knowing the common behaviour change techniques does not help to determine which techniques to select. Johnston et al have hypothesised links between behaviour change techniques and mechanisms of action and subsequently created an online interactive tool.…”

“…Objective and subjective coding of techniques was a novel approach; previous reviews have only coded objectively with the limitation that techniques may be underreported. 40 , 48 This was required due to the complex and interacting components of interventions and to gain a robust insight regarding all techniques applied in the body of literature. The authors recommend researchers place their efforts on reporting intervention components as per the behaviour change technique taxonomy to assist in strengthening intervention replication and implementation.…”

Predicting Acceptance of e–Mental Health Interventions in Patients With Obesity by Using an Extended Unified Theory of Acceptance Model: Cross-sectional Study

“…A recent study revealed that patients who had undergone bariatric surgery were very positive about eHealth interventions in their follow-up care [23]. Particularly after bariatric surgery, eHealth interventions can be effective in postoperative weight maintenance and in the reduction of eating disorder symptoms [24]. Although the proven user acceptance for e-mental health interventions [25] and the reasonable assumption that patients with obesity affected by mental health disorders would benefit from easily accessible and effective e-mental health interventions to support their mental well-being, the current opportunities are still in their infancy.…”