Abstract
BackgroundBinge-eating disorder (BED) and major depressive disorder (MDD) following bariatric surgery are significant predictors for less post-operative weight loss and/or weight regain, however, cognitive-behavioral therapy (CBT) addressing these disorders following surgery has not been investigated so far.ObjectiveThis study examined feasibility of a short-term CBT based on evidence-based manuals for BED and MDD that were adapted to patients following bariatric surgery, and investigated its effectiveness in improving weight loss outcome, psychopathology, and psychosocial functioning.Materials and MethodsIn an uncontrolled proof-of-concept study, the CBT manual was piloted in N = 7 patients who had undergone roux-en-Y gastric bypass surgery at least 6 months before. Weight loss, eating disorder psychopathology, depressive symptoms, and self-esteem were assessed using clinical interviews and self-report questionnaires at pre-treatment, post-treatment, and in a 3-month follow-up.ResultsA significant reduction of body weight was found as well as medium to large effects in the improvement of eating disorder psychopathology, depressive symptoms, and self-esteem from pre-treatment to post-treatment were found. Most of those changes remained stable during the 3-month follow-up period. Study retention was 71.4%.ConclusionsFeasibility and effectiveness of CBT were documented for patients with BED or MDD following bariatric surgery. Adaptations of the study procedure for proof-of-efficacy in randomized-controlled studies are discussed.
Highlights
Bariatric surgery is the only efficacious treatment for patients with severe obesity, resulting in substantial long-term weight loss up to 20 to 35% of initial body weight and decreased morbidity and mortality [1,2,3,4]
Post-operative loss of control (LOC) eating leads to a ≥ 8 lesser BMI loss and weight regain in the long-term [16, 17] and post-operative major depressive disorder (MDD) was associated with ≥ 10% lesser percentage of weight loss in the third year following surgery [15]
In addition to insufficient weight loss outcome, patients with post-operative LOC or MDD suffer from increased eating disorder and general psychopathology, and impairments in quality of life [16, 17]
Summary
Bariatric surgery is the only efficacious treatment for patients with severe obesity (body mass index, BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with comorbidity), resulting in substantial long-term weight loss up to 20 to 35% of initial body weight and decreased morbidity and mortality [1,2,3,4]. Significant predictors for less post-operative weight loss and/ or weight regain have been identified with post-operative eating disturbances or disorders [9,10,11,12,13], e.g. binge-eating disorder (BED) or loss of control (LOC) eating as well as major depressive disorder (MDD) in up to 27% [14] and 17% [15] of the patients, respectively. Post-operative LOC eating leads to a ≥ 8 lesser BMI loss and weight regain in the long-term [16, 17] and post-operative MDD was associated with ≥ 10% lesser percentage of weight loss in the third year following surgery [15]. Binge-eating disorder (BED) and major depressive disorder (MDD) following bariatric surgery are significant predictors for less post-operative weight loss and/or weight regain, cognitive-behavioral therapy (CBT) addressing these disorders following surgery has not been investigated so far
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