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Benefits of Tele-CBT for post-bariatric surgery patients

Telephone cognitive behavioural therapy (Tele-CBT) intervention is helpful in reducing symptoms of depression, anxiety, binge eating and emotional eating, according to researchers from the University Health Network (UHN), Centre for Addiction and Mental Health (CAMH) and Toronto Metropolitan University (TMU), Canada. Although the study - thought to be the largest randomised controlled trial examining psychosocial interventions to support patients after bariatric surgery – showed a reduction in these symptoms the tele-CBT and control groups did not significantly differ in percentage weight loss at 1.5 years after surgery.

Sanjeev Sockalingam

“This is the largest CBT/psychological intervention trial for patients after bariatric surgery, which is an evidence-based obesity treatment,” said Dr Sanjeev Sockalingam, the paper’s senior author, Psychosocial Director of the UHN Bariatric Centre of Excellence, Senior Scientist at the CAMH, and Scientific Director at Obesity Canada. “This study also supports the effectiveness of CBT delivered by telephone and is timely, given the growth of virtual care during the pandemic.”

To determine the efficacy of a telephone-based tele-CBT intervention at one year after bariatric surgery in improving weight loss, disordered eating and psychological distress. In total, 306 patients (152 patients in the tele-CBT group and 154 patients in the control group) were recruited into the study with the tele-CBT intervention group receiving six weekly one-hour sessions and a seventh booster session one month later. The control group received standard postoperative bariatric care. The primary and secondary outcome measures were assessed at baseline (one year after surgery), after the intervention (approximately 15 months after surgery), and at three-month follow-up (approximately 18 months after surgery). The primary outcome was postoperative percentage total weight loss. Secondary outcomes were disordered eating (Binge Eating Scale [BES] and Emotional Eating Scale [EES]) and psychological distress (Patient Health Questionnaire-9 item scale [PHQ-9] and Generalized Anxiety Disorder-7 item scale [GAD-7]).

They reported percentage total weight loss was not significant (p=0.15). However, there were significant interactions for mean BES (p<0.001), EES total (p<0.001), PHQ-9 (p<0.001) and GAD-7 (p<0.001) scores between the tele-CBT group and control group across all times.

These results provide more conclusive data and build on smaller studies, also done by this research team, that showed short term improvements in disordered eating, depression, and anxiety in patients after bariatric surgery. The current study also looked at whether the Tele-CBT intervention helped to improve weight loss outcomes, although no differences were found between patients’ weights in the two groups.

Nonetheless, this research shows that CBT and psychological interventions are an important part of psychological aftercare in obesity treatment. Results from this research provide data to support the widespread use of CBT to support patients with difficulties after bariatric surgery.

The research team is continuing to update their findings as data collection for this study is still in progress. The researchers will be following these patients up to three-years post-surgery to determine whether the improvements in mood and disordered eating are maintained over time, and whether they lead to better weight outcomes long term.

This research is important and clearly demonstrates the positive impact of CBT delivered by telephone is both remarkable and timely, especially in the context of virtual care expansion. This research further supports the Canadian Adult Obesity Clinical Practice Guidelines in identifying CBT and psychological interventions as an evidence-based treatment option for individuals living with obesity.

The outcomes were reported in the paper, ‘entitled Efficacy of Telephone-Based Cognitive Behavioural Therapy for Weight Loss, Disordered Eating and Psychological Distress After Bariatric Surgery: A Randomized Clinical Trial’, published in JAMA Network Open. To access this paper, please click here


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