An Acceptance-Based Intervention to Minimize Weight Regain after Bariatric Surgery

Abstract

Bariatric surgery is regarded as the most effective obesity treatment to date; however, tens of thousands of patients each year experience sub-optimal weight losses and/or significant regain. Poor outcomes have been associated with decreased compliance to the recommended postoperative diet, which is quite restrictive in nature. This decreased compliance may be due in part to a lack of psychological skills necessary to continuously engage in healthy eating behaviors over the long-term, especially as the effects of the surgery (on appetite, hunger, and desire for food) decreases. As a result, significant weight regain can occur, which can result in poorer health outcomes and, in more extreme cases, secondary surgical procedures. The current study aimed to develop an acceptance-based intervention to stop weight regain in bariatric surgery patients and to establish its feasibility, acceptability, and preliminary effectiveness. A group of postoperative patients (n = 153) were surveyed to assess their current status as well as interest and preferences for postoperative programs to promote long term success. An open trial was then conducted of a newly-developed, 10-week, acceptance-based behavioral weight control intervention modified for bariatric surgery patients. The intervention emphasized skills thought to be integral to successful weight control postsurgery, i.e., a commitment to engaging in behaviors (e.g., healthy eating, physical activity) that are in accordance with one’s values (e.g., living a healthy life) despite difficulty doing so (e.g., due to the return of food cravings, hunger). Eleven bariatric surgery patients who had regained at least 10% of their lost weight since their lowest postoperative weight were recruited and enrolled in groups to evaluate this program. The intervention was shown to be feasible and acceptable, with 72% retention (100% retention in those who attended more than 1 session) and high mean rating (4.25 out of 5.00) of program satisfaction among completers. In addition, weight regain was stopped, and even reversed, with a mean weight loss of 3.58 ± 3.02% throughout the 10-week intervention. There were also significant improvements in acceptance-based and eatingrelated process variables. Overall, these pilot data provide initial support for the feasibility and acceptability of an acceptance-based intervention for the post-bariatric surgery population. In addition, preliminary effectiveness in stopping and reversing weight regain was demonstrated.%%%%Ph.D., Clinical Psychology – Drexel University, 2013