No Weight Benefits With Phone-Based CBT a Year After Bariatric Surgery

Telephone-based cognitive behavioral therapy (CBT) 1 year after bariatric surgery did not improve weight outcomes, but did improve psychological outcomes, a randomized clinical trial showed.

Patients who participated in the seven weekly sessions of CBT lost a mean 1.44% of their total body weight compared with 1.11% among controls who received standard postoperative bariatric care, which was not significantly different, reported Sanjeev Sockalingam, MD, MHPE, of the Centre for Addiction and Mental Health in Toronto, and colleagues.

At 3 months — approximately 18 months after bariatric surgery — total weight loss still was not significantly different between the groups (1.08% vs 0.86%), the authors noted in JAMA Network Open.

However, the CBT group did have improvements in disordered eating and psychological distress, with significant differences compared with control patients at all time points for mean Binge Eating Scale and Emotional Eating Scale scores (P<0.001 for both), and Patient Health Questionnaire 9-item scale (measuring depression) and Generalized Anxiety Disorders 7-item Scale scores (P<0.001 for both).

“Disordered eating and psychological distress are well-documented risk factors associated with weight regain after bariatric surgery,” Sockalingam’s group explained.

They noted that about 84% of patients randomized to participate in phone-based CBT completed the 7-session course. “Given the high attrition rates related to follow-up after bariatric surgery and the expansion of virtual psychosocial interventions for patients who underwent bariatric surgery, the high acceptability of treatment and retention of patients in this telephone-delivered psychological intervention is noteworthy,” they wrote.

While the intervention didn’t appear to have an impact on weight loss immediately after or in the few months following, Sockalingam and colleagues said there’s still a chance that the improvement in disordered-eating behaviors may reduce the possibility of weight regain in the future.

“[P]atients at 1 year after surgery in this RCT [randomized control trial] may still be too early in their postbariatric surgery journey to experience significant risks of weight regain, and future studies could examine the effects of [telephone-based] CBT delivered beyond the first 2 years after surgery,” they noted.

“These findings support the Canadian Adult Obesity Clinical Practice Guidelines, which shift the focus of obesity care to health and quality of life outcomes rather than weight loss alone,” the authors concluded.

For this study, a total of 306 patients who were 1 year out from their bariatric procedure — either Roux-en-Y gastric bypass (81%) or sleeve gastrectomy (19%) — were included. Participants were recruited from one of three Canadian hospital-based bariatric surgery programs. The majority of patients were women (83.3%), as is expected with a bariatric surgery cohort; average age was 47.5 and 76.5% were white.

All participants had a presurgical body mass index (BMI) of 40 or more, or 35 or more with at least one weight-related comorbidity.

The 1-hour CBT sessions were conducted once weekly for 6 weeks, with a 1-hour booster session given 1 month later. Sessions were led by psychology doctoral students under clinical supervision of a registered clinical psychologist.

Among the 152 patients who participated in CBT and the 154 who did not, the group by time interaction for percentage total weight loss was not significant (P=0.15).

“Future studies should examine the efficacy of this intervention in other contexts with different models of care,” Sockalingam and colleagues wrote.

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