Abstract
BackgroundThe purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service (BRS) on patient weight loss following bariatric surgery at 1 year.MethodsA single-site open-randomised parallel group control trial based at St. Richard’s Hospital in Chichester in the UK. Patients (n = 162) were recruited immediately prior to Roux-en-Y gastric bypass and randomly allocated to receive either treatment as usual (n = 80) or the BRS (n = 82). The BRS involved three 50-min one-to-one sessions with a health psychologist and provided information, support and mentoring pre and post surgery addressing psychological issues such as dietary control, self esteem, coping and emotional eating. Weight loss was assessed at 1 year. The key outcome variable was BMI and change in BMI.ResultsFollow-up weight was available for 145 patients. Intention-to-treat analysis (n = 162) using last measured weights showed that mean change in BMI by 1 year post surgery was −16.49. There was no significant difference between the two groups (control group = −16.37, 95 % CI = 15.15–17.57; intervention = −16.6, 95 % CI = 15.42–17.81; η p 2 = 0.001). Similarly, explanatory analysis (n = 145) showed a mean change in BMI of −17.17. The difference between the two groups was not significant (control group = −16.9, 95 % CI = 15.78–18.18; intervention = −17.35, 95 % CI = 18.5–16.16; η p 2 = 0.001).ConclusionsPsychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by 1 year. It is argued that psychological support should be targeted to patients who start to demonstrate weight regain at a later stage.Trial registration: ClinicalTrials.gov NCT01264120.
Highlights
Weight loss and other associated health outcomes are greater following weight loss surgery (WLS) than those achieved by either medication or behavioural interventions [1,2,3,4,5], such results are not consistent for all patients and a large minority of patients either do not show the desired loss of excess weight or regain weight by follow-up [4, 6,7,8]
The results indicated that whilst successful surgery was associated with a reduction in hunger and preoccupation with food and a sense of being more in control of food intake, less successful surgery was associated with feeling unprepared for the changes required after surgery, reporting being unsupported in the time following surgery and a sense that psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected
The results showed that at 12 months follow-up, the health psychology-led bariatric rehabilitation service had no impact on weight loss in terms of BMI and change in BMI, with patients showing a mean change in BMI of −16.49 regardless of group
Summary
Weight loss and other associated health outcomes are greater following weight loss surgery (WLS) than those achieved by either medication or behavioural interventions [1,2,3,4,5], such results are not consistent for all patients and a large minority of patients either do not show the desired loss of excess weight or regain weight by follow-up [4, 6,7,8]. The results indicated that whilst successful surgery was associated with a reduction in hunger and preoccupation with food and a sense of being more in control of food intake, less successful surgery was associated with feeling unprepared for the changes required after surgery, reporting being unsupported in the time following surgery and a sense that psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected This highlights key areas that need to be addressed to improve patient outcomes following surgery. It confirms the conclusions made by OBES SURG (2015) 25:500–505 several research teams [15,16,17] who have argued that WLS patients require multidisciplinary care including psychological input pre and post surgery It reflects recent studies which have offered either lifestyle interventions or counselling pre or post surgery to improve outcomes [18, 19]. The difference between the two groups was not significant
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