Differences in physical and mental health-related quality of life outcomes 3 years after bariatric surgery: a group-based trajectory analysis

Youssef, Alaa; Keown-Stoneman, Charles D.G.; Maunder, Robert G.; Wnuk, Susan; Wiljer, David; Mylopoulos, Maria; Sockalingam, Sanjeev

doi:10.1016/j.soard.2020.06.014

Cited by 15 publications

(19 citation statements)

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“…Having access to interprofessional bariatric support post‐surgery allowed patients to cultivate their self‐awareness capacity and learn specific coping strategies that helped them self‐manage emotional dysregulation and problematic eating behaviours associated with weight regain. Thus, findings from this study support previous work underscoring the importance of attending to the psychological changes following bariatric surgery 8,11,25,29,40 …”

Section: Discussionsupporting

confidence: 89%

“…Thus, findings from this study support previous work underscoring the importance of attending to the psychological changes following bariatric surgery. 8,11,25,29,40 A major strength of this qualitative study is the iterative data collection and analysis approach to develop a mechanistic understanding of bariatric patients' self-management experiences. Recruiting participants from a diverse sample of bariatric patients with distinct postoperative care experiences allowed for exploring variation in patients'…”

Section: The Impact Of Mental Health Post-surgery On Individuals' Motivation and Capacity For Self-carementioning

confidence: 99%

“…Whilst evidence on the strength of the correlation between mental health and weight regain remains inconclusive, 21,22 mounting evidence supports the association of common psychiatric disorders, mainly depression and eating disorders, post-surgery with a decline in mental HRQoL outcomes and suboptimal weight loss 2-years or more following bariatric surgery. 24,25 Data from a recent Australian population-based wide cohort study demonstrated an increased prevalence of mental health services utilization post-surgery. Specifically, 40% of patients accessed mental health services for their first time after bariatric surgery.…”

Section: Introductionmentioning

confidence: 99%

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Understanding bariatric patients' experiences of self‐management post‐surgery: A qualitative study

et al. 2021

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Summary Although most bariatric patients achieve significant weight loss and improvements in both physical and mental health‐related quality of life (HRQoL) in the short‐term, there is wide variability in weight and long‐term HRQoL outcomes. The role of bariatric patients' self‐management style in explaining variability in long‐term outcomes is unclear. This qualitative study examined bariatric patients' self‐management experiences after bariatric surgery in relation to long‐term outcomes. A qualitative study was conducted using semi‐structured individual interviews with post‐surgery patients (n = 23) at a Canadian bariatric surgery program. A constant comparative approach was used to systematically analyse the data and identify overarching themes. Variation in patients' experiences and follow‐up time were the two primary units of analysis. Patients were predominantly female (n = 19; 82.6%) and had a mean age of 50 ± 8.49 years. The median time post‐surgery was 2 years (range: 6 months–7 years). Three distinct phases described the process of self‐management post‐bariatric surgery: (1) rediscovering self‐esteem and confidence in one's ability to self‐manage (1‐month to 1.5‐years post‐surgery), (2) achieving weight maintenance and addressing emotion dysregulation (1.5–3‐years post‐surgery) and (3) embracing a flexible balanced lifestyle (beyond 3‐years). Bariatric surgery patients experience distinct challenges relative to their post‐surgery time course. Facilitating access to interprofessional bariatric care after surgery allowed patients to acquire the self‐management knowledge and skills necessary to address challenges to following the bariatric guidelines in the long‐term.

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Section: Discussionsupporting

confidence: 89%

Section: The Impact Of Mental Health Post-surgery On Individuals' Motivation and Capacity For Self-carementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Understanding bariatric patients' experiences of self‐management post‐surgery: A qualitative study

et al. 2021

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“…Approximately 55 to 70% of bariatric surgery patients have a lifetime history of psychiatric illness consisting mainly of depressive, anxiety, and binge eating disorders, which could increase patients’ vulnerability to mental health complications during COVID-19 [ 10 – 12 ]. Moreover, patients experiencing disordered eating (e.g., binge eating symptoms) beyond the first year after bariatric surgery are at increased risk of poorer weight loss and mental quality of life outcomes [ 13 – 15 ]. Beyond the second year following bariatric surgery, patients may be at increased risk of developing depression, which has been associated with weight recidivism and impaired quality of life [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, patients experiencing disordered eating (e.g., binge eating symptoms) beyond the first year after bariatric surgery are at increased risk of poorer weight loss and mental quality of life outcomes [ 13 – 15 ]. Beyond the second year following bariatric surgery, patients may be at increased risk of developing depression, which has been associated with weight recidivism and impaired quality of life [ 15 , 16 ]. During COVID-19, post-operative bariatric surgery patients reported challenges with eating behaviors, specifically difficulty following their recommended diet, increased hunger, increased impulse to eat, and increased snacking behavior [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial

Sockalingam

Leung

et al. 2022

OBES SURG

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Background Patients undergoing bariatric surgery have high rates of psychiatric comorbidity, which may increase their vulnerability to COVID-19-related mental health distress. Exacerbation of mental health distress and disordered eating could have significant negative effects on long-term weight management and quality of life for these patients if untreated. Objective To determine the efficacy of a telephone-based cognitive behavioral therapy (Tele-CBT) intervention in improving depressive, anxiety, and disordered eating symptoms during COVID-19. Methods Participants were recruited as part of a larger randomized controlled trial study (clinicaltrials.gov ID: NCT03315247) between March 2020 and March 2021 and randomized 1:1 to receive Tele-CBT or standard bariatric care. Outcomes of 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 Eighty-one patients were included in the intention-to-treat analysis. Mean (SD) age of participants was 47.68 (9.36) years and 80.2% were female. There were significant group-by-time interactions for all outcomes and significant differences between groups across time. There were significant decreases in mean GAD-7 ( p = 0.001), PHQ-9 ( p < 0.001), EES-Total ( p = 0.001), EES-Anger ( p = 0.003), EES-Anxiety ( p < 0.001), EES-Depression ( p < 0.001), and BES ( p = 0.002) scores for the Tele-CBT group at post-intervention and follow-up when compared to baseline and the control group. Conclusion Tele-CBT is a feasible and effective treatment for improving psychological distress and disordered eating among post-operative bariatric surgery patients during the COVID-19 pandemic. Graphical abstract

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Efficacy of Telephone-Based Cognitive Behavioral Therapy for Weight Loss, Disordered Eating, and Psychological Distress After Bariatric Surgery

Sockalingam

Leung

et al. 2023

JAMA Netw Open

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ImportanceWeight regain after bariatric surgery is associated with recurrence of obesity-related medical comorbidities and deterioration in quality of life. Developing efficacious psychosocial interventions that target risk factors, prevent weight regain, and improve mental health is imperative.ObjectiveTo determine the efficacy of a telephone-based cognitive behavioral therapy (tele-CBT) intervention at 1 year after bariatric surgery in improving weight loss, disordered eating, and psychological distress.Design, Setting, and ParticipantsThis multisite randomized clinical trial was conducted at 3 hospital-based bariatric surgery programs, with recruitment between February 2018 and December 2021. Eligibility for participation was assessed among 314 adults at 1 year after bariatric surgery who were fluent in English and had access to a telephone and the internet. Patients with active suicidal ideation or poorly controlled severe psychiatric illness were excluded. Primary and secondary outcome measures were assessed at baseline (1 year after surgery), after the intervention (approximately 15 months after surgery), and at 3-month follow-up (approximately 18 months after surgery). Data were analyzed from January to February 2023.InterventionsThe tele-CBT intervention consisted of 6 weekly 1-hour sessions and a seventh booster session 1 month later. The control group received standard postoperative bariatric care.Main Outcomes and MeasuresThe primary outcome was postoperative percentage total weight loss. Secondary outcomes were disordered eating (Binge Eating Scale [BES] and Emotional Eating Scale [EES]) and psychological distress (Patient Health Questionnaire-9 item scale [PHQ-9] and Generalized Anxiety Disorder-7 item scale [GAD-7]). The hypotheses and data-analytic plan were developed prior to data collection.ResultsAmong 306 patients 1 year after bariatric surgery (255 females [83.3%]; mean [SD] age, 47.55 [9.98] years), there were 152 patients in the tele-CBT group and 154 patients in the control group. The group by time interaction for percentage total weight loss was not significant (F1,160.61 = 2.09; P = .15). However, there were significant interactions for mean BES (F2,527.32 = 18.73; P &lt; .001), EES total (F2,530.67 = 10.83; P &lt; .001), PHQ-9 (F2,529.93 = 17.74; P &lt; .001), and GAD-7 (F2,535.16 = 15.29; P &lt; .001) scores between the tele-CBT group and control group across all times.Conclusions and RelevanceThis study found that tele-CBT delivered at 1 year after surgery resulted in no change in short-term weight outcomes but improved disordered eating and psychological distress. The impact of these psychosocial improvements on longer-term weight outcomes is currently being examined as part of this longitudinal multisite randomized clinical trial.Trial RegistrationClinicalTrials.gov Identifier: NCT03315247

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Differences in physical and mental health-related quality of life outcomes 3 years after bariatric surgery: a group-based trajectory analysis

Cited by 15 publications

References 50 publications

Understanding bariatric patients' experiences of self‐management post‐surgery: A qualitative study

Understanding bariatric patients' experiences of self‐management post‐surgery: A qualitative study

The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial

Efficacy of Telephone-Based Cognitive Behavioral Therapy for Weight Loss, Disordered Eating, and Psychological Distress After Bariatric Surgery

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