A research team at the Hartford HealthCare Digestive Health Institute (DHI) will launch a new study, funded by a US$2.9-million federal grant, to examine how to support patients who have undergone metabolic bariatric surgery to achieve long-term changes in physical activity for improved weight loss maintenance. The five-year grant, from the National Institute of Diabetes and Digestive and Kidney Diseases, will test an intervention promoting patients’ internal motivation to adopt and maintain changes in physical activity.
The research team, led by Dr Dale Bond, director of research integration at DHI, will also examine whether changes in physical activity help prevent post-surgical weight gain. Bond explained that the intervention will teach patients to build connections between their desire to exercise and their internal values such as being productive, having energy and endurance to play with their kids, being healthier as they age and being a good partner. Patients will also learn how to be more flexible in how they approach and overcome barriers to being active.
“We think this approach could be effective because it ties motivation for exercise to internal values. These are more stable and enduring than external motivators like appearance, desire to look good for an event and exercising because your doctor tells you to,” said Bond.
The study, which begins recruitment in summer 2024, will expand existing research into the impact of lifestyle modifications on sustained weight loss after surgery, added Dr Pavlos Papasavas, director of surgical research at DHI and a study investigator. Previous research, however, focused mainly on rescuing patients who had already regained weight: “We will work with patients whose weight is stabilised or are just starting to put it back on to prevent significant weight regain from occurring. We discovered that having the doctor tell you to exercise doesn’t work in the long-term. They need to tie exercise to things they value in life."
To be eligible to participate, patients must have had bariatric surgery within 10 to 20 months. Any type of procedure except revision will be considered. Before being accepted, the research team will verify if a patient’s weight is stabilized by having them use a cellular scale to capture weight over several weeks.
“Once we determine they’re eligible, they’ll wear a physical activity monitor and complete other assessments and questionnaires,” explained Bond says.
Participants will be randomised into two intervention groups:
Acceptance and commitment therapy-focused group will participate in activities connecting physical activity to personally meaningful areas of life to help patients maintain a physically active lifestyle long term.
Traditional physical activity education group will receive information on topics like the physiology of weight loss and maintenance, how activity can help them keep the weight off, and how to monitor their physical activity to achieve prescribed physical activity goals.
Unlike other therapeutic approaches, the researchers will not try to change or stop the way participants think about exercise but them accept thoughts and feelings in the way of the exercise they’re trying to do and living according to their values.
Both groups will have four two-hour online small group interventions conducted by therapists and receive email and telephone-based support. Assessments will be repeated at intervals over the 18-month study.
If successful, the researchers say this intervention can be added to post-surgical treatment plans for all patients. The virtual nature of the work, they agree, enables them to share with systems worldwide if successful.
“In addition, the physical activity can help patients minimize lean body mass and muscle loss. They don’t only lose fat with metabolic bariatric surgery or medications – 20% of weight loss is from lean body mass,” said Papasavas. “This is an intervention that’s near to the heart for them. They’ve gone through the hard process of surgery and they worry when they experience weight gain. This study may help patients make changes to minimise weight gain after metabolic bariatric surgery.”
The new study is part of the hybrid model the Hartford HealthCare Medical and Surgical Weight Loss Program has created to incorporate academic research into the system’s drive for innovation.
“As national leaders the treatment of obesity, we look to our research to help drive and shape the care of our patients,” said Dr Darren Tishler, director of metabolic and bariatric surgery.
“The obesity research program we have established, along with this new grant, allows us to continue transforming the understanding and care of obesity for all patients,” added Dr Rocco Orlando, Hartford HealthCare’s chief academic and research officer. “Our surgical weight loss program is leading innovations in bariatric surgery by merging and synergizing surgical practice, long-term quality patient care and cutting-edge research. This study and the federal funding supporting it help solidify Hartford HealthCare as a scientific and clinical leader.”