The Impact of a Preoperative Cognitive Behavioural Therapy (CBT) on Dysfunctional Eating Behaviours, Affective Symptoms and Body Weight 1 Year after Bariatric Surgery: A Randomised Controlled Trial

Abstract

BackgroundTo examine whether a preoperative cognitive behavioural therapy (CBT) intervention exceeds usual care in the improvements of dysfunctional eating behaviours, mood, affective symptoms and body weight 1 year after bariatric surgery.MethodsThis is a 1-year follow-up of a single centre parallel-group randomised controlled trial (http://clinicaltrials.gov/ct2/show/NCT01403558). A total of 80 (55 females) patients mean (SD) age 44 (10) years were included. The intervention group received 10 weeks of CBT prior to bariatric surgery, and the control group received nutritional support and education. Both groups were assessed at baseline (T0), post CBT intervention/preoperatively (T1), and 1 year postoperatively (T2). Using a mixed modelling statistical approach, we examined if the CBT group improved more across time than the control group.ResultsOur hypothesis was not supported as both groups had comparable improvements in all outcomes except for anxiety symptoms. Body weight declined by 30.2 % (37.3 kg) in the CBT group and by 31.2 % (40.0 kg) in the control group from baseline to follow-up, p = 0.82.There were statistically significant reductions in anxiety and depression symptoms in the CBT group between T0 and T1 and between T1 and T2 for depression only. However, in the control group, the anxiety score did not change significantly. The CBT group showed an earlier onset of improvements in all eating behaviours and affective symptoms than the control group.ConclusionThe 10-week CBT intervention showed beneficial effects preoperatively, but the non-significant group differences postoperatively indicate a genuine effect of surgery.

The association between severity of King’s Obesity Staging Criteria scores and treatment choice in patients with morbid obesity: a retrospective cohort study

“…In accordance with the results of a previous review by Wadden et al, a large proportion (aproximately 40%) of the patients in our cohort reported a lifetime history of symptoms of either anxiety or depression, with no difference between treatment groups [25]. Although mental health and affective symptoms often improve after bariatric surgery, it is questionable whether patients with serious psychological symptoms benefit from bariatric surgery, and should rather as such abstain from surgery [26, 27]. A survey of psycological assessment of bariatric surgery applicants showed that psyhologists differed in their preoperative evaluations, with the respondents recommending either the delay or denying of surgery for between zero and 60% of the candidates.…”

Preoperative and post‐operative psychosocial interventions for bariatric surgery patients: A systematic review

“…Of the studies reviewed, 16 focused on preoperative interventions and 24 on post‐operative interventions . One study offered the intervention either before or after surgery, and three studies examined interventions delivered at time points both before and after surgery …”

“…Of the reviewed articles, 13 studies examined a cognitive‐behavioural intervention, and 13 examined behavioural modification techniques . Many selected studies examined a cognitive, cognitive‐behavioural, or behavioural modification intervention in conjunction with various other approaches, including motivational techniques, mindfulness‐based approaches, acceptance‐based treatments, dialectical behavioural therapy (DBT), virtual reality, dynamic guidance psychotherapy, exercise programmes, and meal delivery programmes …”

Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity

“…Although it is well established that implementing a preoperative psychological assessment is important to prevent psychological complications of bariatric surgery, there are no standard protocols to help health professionals to implement this assessment [13, 14]. A previous study reported that preoperative cognitive behavioral therapy was not effective in the preparation of patients awaiting bariatric surgery [15]. Although one study has reported improved mental health after bariatric surgery, there is no consensus on therapeutic consequences of psychological evaluation [16].…”