Tele-CBT Improves Psychological Distress After Bariatric Surgery

Sanjeev Sockalingam, MD, MHPE

Credit: American Society for Metabolic and Bariatric Surgery

New research provided valuable insight into the potential benefits of telephone-based cognitive behavioral therapy (tele-CBT) as a post-bariatric surgery intervention. While tele-CBT did not lead to significant changes in short-term weight outcomes, it was effective in improving disordered eating behaviors and reducing psychological distress.¹

Bariatric surgery has been an effective intervention for individuals struggling with obesity, leading to significant weight loss and improvement in various obesity-related medical comorbidities. However, the study acknowledged that weight regain after bariatric surgery remains a concern, necessitating the development of psychosocial interventions to support long-term success and overall mental health.

Sanjeev Sockalingam, MD, MHPE, Bariatric Surgery Program, University Health Network, and a team of investigators conducted the randomized clinical trial to investigate the effectiveness of a tele-CBT intervention in improving weight loss, disordered eating, and psychological distress among individuals one year after undergoing bariatric surgery.

The multisite trial involved 306 adult participants who had undergone bariatric surgery 1 year prior to the study. The participants were recruited between February 2018 - December 2021 from 3 hospital-based bariatric surgery programs.

To be eligible, participants needed to be fluent in English and have access to both a telephone and the internet. Those with active suicidal ideation or poorly controlled severe psychiatric illness were excluded from the study.

The tele-CBT intervention consisted of 6 weekly 1-hour sessions, with an additional booster session 1 month later. The control group received standard postoperative bariatric care. Primary outcome measures included postoperative percentage total weight loss, while secondary outcomes were assessed through the Binge Eating Scale (BES), Emotional Eating Scale (EES), Patient Health Questionnaire-9 item scale (PHQ-9), and Generalized Anxiety Disorder-7 item scale (GAD-7).

Data were collected at baseline (1 year after surgery), after the intervention (approximately 15 months after surgery), and at the 3-month follow-up (approximately 18 months after surgery).

Investigators did not find a significant difference in weight outcomes between the tele-CBT group and the control group. However, the results showed promising outcomes in terms of disordered eating and psychological distress.

Individuals who received tele-CBT reported significant reductions in binge eating, emotional eating, depression, and anxiety symptoms compared with the control group.

Specifically, the group that underwent tele-CBT displayed significant interactions for mean BES, EES total, PHQ-9, and GAD-7 scores across all times compared with the control group.

Investigators noted tele-CBT could play a crucial role in supporting individuals' mental health and overall well-being following bariatric surgery. Further research continues to explore the impact of these psychosocial improvements on long-term weight outcomes as part of an ongoing longitudinal multisite randomized clinical trial.

As obesity rates continue to rise, the integration of effective psychosocial interventions like tele-CBT becomes increasingly essential to enhance the success and sustainability of bariatric surgery outcomes, the study stated.

Investigators acknowledged the relatively small sample size and focus on short-term outcomes were possible limitations of the study. Future investigations with larger and more diverse populations, as well as longer follow-up periods, were recommended to fully understand the potential benefits of tele-CBT in the context of bariatric surgery.

Overall the findings of this study highlighted the promising role of tele-CBT in improving mental health and eating behaviors for individuals who have undergone bariatric surgery. As investigators continue to delve deeper into the subject, tele-CBT has potential to become a crucial component of post-bariatric surgery care, ultimately contributing to better long-term outcomes and improved quality of life for those affected by obesity.

References:

1. Sockalingam S, Leung SE, Ma C, et al. Efficacy of Telephone-Based Cognitive Behavioral Therapy for Weight Loss, Disordered Eating, and Psychological Distress After Bariatric Surgery: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(8):e2327099. doi:10.1001/jamanetworkopen.2023.27099