Post‐operative behavioural management in bariatric surgery: a systematic review and meta‐analysis of randomized controlled trials

Abstract

Recent research has provided evidence that bariatric surgery maximizes long-term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight loss outcome and weight regain over time. Post-operative behavioural management may facilitate long-term weight control in bariatric surgery population. The objective of this systematic review and meta-analysis was to determine the effects of post-operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta-analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post-operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery.

Obese patients lose weight independently of nutritional follow-up after bariatric surgery

“…It has been argued that patient's follow-up by interdisciplinary specialized group is important after surgery to monitor weight changes, medical comorbidities and long-term surgical adverse events, such as multiple nutrient deficits. 2,13,14 Nevertheless, most major RYGBP series have shown a 60-50% postoperative follow-up rate at 1 year, which drops off dramatically with time. 15 These estimates are similar to the overall adherence prevalence of 51% (95%CI: 44.5-57.5%) during the 18-month follow-up period of our study.…”

A Pilot Study on Telephone Cognitive Behavioral Therapy for Patients Six-Months Post-Bariatric Surgery

“…Stewart and Avenell included eight pre-surgery and post-surgery behavioral intervention studies in their meta-analysis and concluded that patients receiving behavioral interventions resulted in greater weight change when added to bariatric surgery in comparison to surgery alone [3]. This review also suggested that post-operative interventions had greater evidence than pre-surgery interventions for improving weight loss outcomes [3], which is further reinforced by a meta-analysis of five randomized controlled trials demonstrating greater weight loss with post-operative behavioral lifestyle interventions compared to surgery alone [2]. However, these reviews cautioned interpretation of their results and called for greater research in this area.…”

“…Systematic reviews and meta-analyses of pre-and post-bariatric surgery individual and group psychotherapeutic interventions, have shown greater weight loss in comparison to control groups, with a moderate effect size (pooled effect size correlation = 0.18) for weight loss after bariatric surgery [1,2]. Stewart and Avenell included eight pre-surgery and post-surgery behavioral intervention studies in their meta-analysis and concluded that patients receiving behavioral interventions resulted in greater weight change when added to bariatric surgery in comparison to surgery alone [3].…”

Cognitive Behavior Therapy Procedure Prior To Bariatric Surgery

“…Among other factors, dysfunctional eating behaviors such as emotional eating, binge eating and loss of control over eating, have been indicated as negative psychological factors for treatment outcome [3,4]. As such, behavioral life style interventions seem important to achieve optimal weight loss results [5].…”

“…In this protocol patients receive 10 sessions of CBT focused on nutritional and activity management (session 1-4), cognitive restructuring and self-control (session [5][6][7][8] and relapse prevention strategies and preparation for the period after surgery (session 9-10). See Table 1 for an overview of the interventions in the 10 sessions.…”