Behavioral weight management interventions in metabolic and bariatric surgery: A systematic review and meta‐analysis investigating optimal delivery timing

Abstract

Summary Metabolic and bariatric surgery (MBS) yields unprecedented clinical outcomes, though variability is high in weight change and health benefits. Behavioral weight management (BWM) interventions may optimize MBS outcomes. However, there is a lack of an evidence base to inform their use in practice, particularly regarding optimal delivery timing. This paper evaluated the efficacy of BWM conducted pre‐ versus post‐ versus pre‐ and post‐MBS. The review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement and included pre‐ and/or post‐operative BWM interventions in adults reporting anthropometric and/or body composition data. Thirty‐six studies (2,919 participants) were included. Post‐operative BWM yielded greater decreases in weight (standardized mean difference [SMD] = −0.41; 95% confidence interval [CI]: −0.766 to −0.049, p < 0.05; I2 = 93.5%) and body mass index (SMD = −0.60; 95% CI: −0.913 to −0.289, p < 0.001; I2 = 87.8%) relative to comparators. There was no effect of BWM delivered pre‐ or joint pre‐ and post‐operatively. The risk of selection and performance bias was generally high. Delivering BWM after MBS appears to confer the most benefits on weight, though there was high variability in study characteristics and risk of bias across trials. This provides insight into the type of support that should be considered post‐operatively.

Additional preconditioning program for bariatric surgery: Any benefits? A large cohort study

“…Recently, a meta-analysis was published on the optimal delivery time of behavioural weight-management interventions. 29 Although results were in line with ours, stating that an APP had no statistical significant effect on WL, they found that included studies had high risk of bias and that studies on nonweight-related outcomes are needed, on which we contributed by analysing protein intake and the number of no-shows.…”

Three‐ and five‐year follow‐up results of a randomized controlled trial on the effects of cognitive behavioral therapy before bariatric surgery

“…Recent research suggests that the most optimal timing for intervention is postoperative (Cassin et al, 2020;David et al, 2020;Julien et al, 2021;Nijamkin et al, 2012Nijamkin et al, , 2013. For instance, Nijamkin et al Whether postoperative intervention should be indicated only for patients experiencing weight and mental problems, or should be indicated for all patients, is another issue that needs to be researched.…”

Coconstruction of adjunct behavioral interventions to bariatric surgery: The INTER-Change program.

“…This step is critical to integrating previously accumulated knowledge on adjunct behavioral interventions in patients undergoing BS. The first part of this step focused on the timing of the interventions relative to surgery (Julien et al, 2021). Other sections of the living systematic review include evaluating the quality of trials using the NPI-CONSORT statement (Boutron et al, 2017) and the TIDieR checklist (Hoffmann et al, 2014) and deconstructing the interventions into their active components by applying Michie's Behaviour Change Technique Taxonomy (Michie et al, 2013).…”