Telephone-Based Cognitive Behavioral Therapy for Post-Operative Bariatric Surgery Patients: Preliminary Results from a Randomized Controlled Trial

Background: Though surgical interventions are effective in treating patients with severe obesity, approximately 50% will experience weight regain within the first 1.5 to 2 years (Noria, 2023). Pilot studies examining telephone-based cognitive behavioural therapy (Tele-CBT) for bariatric surgery patients have shown high levels of treatment satisfaction and improvements in eating pathology and psychological distress (Cassin, 2016; Sockalingam, 2019). This large multisite randomized controlled trial aimed to examine whether Tele-CBT delivered at 1-year post-surgery is efficacious in optimizing weight loss and improving physical and psychosocial functioning up to 3-years post-surgery.

Methods: Participants were recruited from the University Health Network Bariatric Surgery Program, the Humber River Hospital Bariatric Surgery Program and The Ottawa Hospital Weight Management Clinic between February 2018 and December 2021. This study was approved by the University Health Network Research Ethics Board in Toronto, Canada. Participants were randomized 1:1 to receive Tele-CBT or standard bariatric care. As part of this preliminary analysis, outcomes of weight, measured as percent total weight loss (%TWL), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Emotional Eating Scale (EES), and Binge Eating Scale (BES) were measured at baseline, immediately post-intervention, and 3-months post-intervention. Linear mixed models were used to test the effect of intervention group, time, and group-by-time interaction for each outcome.

Results: 306 patients were included in the intention-to-treat analysis. Mean (SD) age of participants was 47.55 (9.98) years and 83.6% were female. The group by time interaction for %TWL was not significant (p = 0.151). There were significant decreases in mean GAD-7 (p 0.001), PHQ-9 (p < 0.001), EES-Total (p < 0.001), and BES (p < 0.001) scores for the Tele-CBT group immediately post-intervention and 3-month follow-up when compared to baseline and the control group.

Discussion: Although Tele-CBT did not significantly improve weight loss outcomes 1.5-year post-surgery in comparison to standard bariatric surgery aftercare, it did significantly improve disordered eating and psychological distress. Post-operative disordered eating behaviors, such as loss of control over eating, are associated with attenuated weight loss outcomes and weight regain after bariatric surgery. The results of this multisite RCT provide further support for the efficacy of this intervention in treating disordered eating post-bariatric surgery, which could potentially improve weight loss and mitigate weight regain long term.

Conclusion: The largest RCT examining CBT outcomes in bariatric surgery patients to-date demonstrated that Tele-CBT delivered 1-year following bariatric surgery is effective for improving psychological distress and disordered eating, but not short-term weight outcomes.

References:

1. Noria SF, Shelby RD, Atkins KD, Ngyuen NT, Gadde KM. Weight Regain After Bariatric Surgery: Scope of the Problem, Scauses, Prevention, and Treatment. Curr Diab Rep. Mar 2023;23(3):31-42.

2. Cassin SE, Sockalingam S, Du C, Wnuk S, Hawa R, Parikh SV. A pilot randomized controlled trial of telephone-based cognitive behavioural therapy for preoperative bariatric surgery patients. Behav Res Ther. May 2016;80:17-22.
3. Sockalingam S, Leung SE, Hawa R, et al. Telephone-based cognitive behavioural therapy for female patients 1-year post-bariatric surgery: A pilot study. Obes Res Clin Pract. Sep-Oct 2019;13(5):499-504.