Cognitive behavior therapy improves mental health, quality of life after bariatric surgery
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Key takeaways:
- Improvements in disordered eating and psychological distress were reported in those who received cognitive behavior therapy after bariatric surgery.
- Cognitive behavior therapy did not affect weight loss.
Although telephone-based cognitive behavioral therapy did not change short-term weight outcomes in patients 1 year after bariatric surgery, it did improve disordered eating and psychological distress, researchers reported.
“Despite advances in pharmacotherapy and behavioral treatments for obesity and related comorbidities, bariatric surgery remains the most effective treatment for severe obesity,” Sanjeev Sockalingam, MD, MHPE, of the bariatric surgery program at University Health Network in Toronto, and colleagues wrote in JAMA Network Open. “However, 11% to 22% of patients experienced suboptimal weight loss within the first 2 years after surgery, and 10% or greater weight regain was reported by 23% and 72% of patients at 1 year and 5 years after surgery, respectively.”
They continued: “Given that weight regain has been associated with recurrence of medical comorbidities and deterioration in quality of life, developing efficacious psychosocial interventions that target risk factors and prevent or reverse weight regain is imperative.”
In a multicenter, randomized clinical trial, Sockalingam and colleagues enrolled 306 adults (mean age, 47.55 years; 83.3% women; mean weight, 93.78 kg) 1 year after bariatric surgery to undergo telephone-based cognitive behavioral therapy (n = 152) or standard postoperative care (n = 154).
Patients in the therapy group received six weekly 1-hour CBT sessions with a seventh session 1 month later. Interventions included goal-setting, identifying and planning for difficult eating scenarios, and scheduling healthy meals and snacks.
The primary outcome was postoperative percentage total weight loss; secondary outcomes were disordered eating, assessed by the Binge Eating Scale (BES) and Emotional Eating Scale (EES), and psychological distress, assessed using the Patient Health Questionnaire-9 item scale (PHQ-9) and Generalized Anxiety Disorder-7 item scale (GAD-7).
Researchers evaluated outcomes at baseline, after the intervention (15 months after surgery) and at a 3-month follow-up (18 months after surgery).
According to results, participants in the tele-CBT group achieved a mean weight loss of 1.44% after the intervention and 1.08% at the 3-month mark, while controls achieved a mean weight loss of 1.11% and 0.86%, respectively. The group-by-time interaction for percentage total weight loss was not significant, researchers reported.
However, tele-CBT did improve secondary outcomes of disordered eating and psychological distress, with significant improvements reported in the therapy group vs. controls after intervention and at follow-up in mean BES (5.33 vs. 9.37; 6.48 vs. 9.11), total EES (37.71 vs. 44.29; 39.39 vs. 45.34) PHQ-9 (2.22 vs. 4.31; 2.67 vs. 4.66) and GAD-7 (1.84 vs. 3.34; 2.02 vs. 3.46).
“Although tele-CBT did not affect short-term weight outcomes, the intervention demonstrated significant reductions in eating psychopathology, depressive symptoms and anxiety symptoms after bariatric surgery in the largest randomized controlled trial to date, to our knowledge,” Sockalingam and colleagues concluded. “These findings support the Canadian Adult Obesity Clinical Practice Guidelines, which shift the focus of obesity care to health and quality of life outcomes rather than weight loss alone.”
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