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The Impact of a Preoperative Cognitive Behavioural Therapy (CBT) on Dysfunctional Eating Behaviours, Affective Symptoms and Body Weight 1 Year after Bariatric Surgery: A Randomised Controlled Trial.

ABSTRACT: To examine whether a preoperative cognitive behavioural therapy (CBT) intervention exceeds usual care in the improvements of dysfunctional eating behaviours, mood, affective symptoms and body weight 1 year after bariatric surgery.This is a 1-year follow-up of a single centre parallel-group randomised controlled trial ( http://clinicaltrials.gov/ct2/show/NCT01403558). A total of 80 (55 females) patients mean (SD) age 44 (10) years were included. The intervention group received 10 weeks of CBT prior to bariatric surgery, and the control group received nutritional support and education. Both groups were assessed at baseline (T0), post CBT intervention/preoperatively (T1), and 1 year postoperatively (T2). Using a mixed modelling statistical approach, we examined if the CBT group improved more across time than the control group.Our hypothesis was not supported as both groups had comparable improvements in all outcomes except for anxiety symptoms. Body weight declined by 30.2 % (37.3 kg) in the CBT group and by 31.2 % (40.0 kg) in the control group from baseline to follow-up, p?=?0.82. There were statistically significant reductions in anxiety and depression symptoms in the CBT group between T0 and T1 and between T1 and T2 for depression only. However, in the control group, the anxiety score did not change significantly. The CBT group showed an earlier onset of improvements in all eating behaviours and affective symptoms than the control group.The 10-week CBT intervention showed beneficial effects preoperatively, but the non-significant group differences postoperatively indicate a genuine effect of surgery.

SUBMITTER: Gade H

PROVIDER: S-EPMC4595536 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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The Impact of a Preoperative Cognitive Behavioural Therapy (CBT) on Dysfunctional Eating Behaviours, Affective Symptoms and Body Weight 1 Year after Bariatric Surgery: A Randomised Controlled Trial.

Gade Hege H Friborg Oddgeir O Rosenvinge Jan H JH Småstuen Milada Cvancarova MC Hjelmesæth Jøran J

Obesity surgery 20151101 11

<h4>Background</h4>To examine whether a preoperative cognitive behavioural therapy (CBT) intervention exceeds usual care in the improvements of dysfunctional eating behaviours, mood, affective symptoms and body weight 1 year after bariatric surgery.<h4>Methods</h4>This is a 1-year follow-up of a single centre parallel-group randomised controlled trial ( http://clinicaltrials.gov/ct2/show/NCT01403558). A total of 80 (55 females) patients mean (SD) age 44 (10) years were included. The intervention ...[more]

PMID: 25893651

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Project description:BackgroundDepression and binge eating disorder (BED) are prevalent among bariatric surgery candidates. Depression subtypes may be differentially related to obesity, such that the atypical subtype predicts poorer outcomes. However, no research has examined depression subtypes, BED, and weight loss in bariatric candidates.ObjectiveTo examine whether presurgical atypical depressive symptoms, compared with no depressive and melancholic depressive symptoms, were associated with higher rates of presurgical BED, binge eating severity, and poorer postsurgical weight loss trajectories among bariatric candidates.SettingAn outpatient Midwest bariatric clinic.MethodsParticipants were 345 adults (aged 46.27 ± 12.78 yr, 76% female; body mass index = 49.84 ± 8.51 kg/m2) who received a presurgical evaluation. Depression subtypes (melancholic, atypical, and no depressive symptoms) were categorized using the Beck Depression Inventory-II. BED diagnosis and severity were evaluated using the Eating Disorder Diagnostic Scale and Binge Eating Scale, respectively. Weight loss trajectories were calculated as percent total weight loss postsurgery.ResultsUsing no depression as the referent, participants reporting melancholic symptoms (odds ratio = 7.60, P < .001 confidence interval95 [2.59-22.28]) and atypical symptoms (odds ratio = 10.11, P < .01 confidence interval95 [2.69-37.94]) were more likely to meet criteria for BED. Patients with atypical depressive symptoms exhibited the highest binge eating severity scores (mean = 23.03). Depression subtypes did not predict percent total weight loss trajectories within 18-months postbariatric surgery.ConclusionsPatients reporting preoperative atypical depressive symptoms were more likely to meet criteria for co-morbid BED diagnosis and have greater binge eating severity but did not have poorer weight loss within 18 months postsurgery. Future studies with longer-term follow-up and corresponding measures of postsurgical depression and binge eating pathology are warranted.

Project description:Importance:Perception of weight loss requirements before bariatric surgery varies among patients, physicians, and health insurance payers. Current clinical guidelines do not require preoperative weight loss because of a lack of scientific support regarding its benefits. Objective:To examine the association of preoperative body mass index (BMI) and weight loss with 30-day mortality after bariatric surgery. Design, Setting, and Participants:This cohort study used data from 480 075 patients who underwent bariatric surgery from 2015 to 2017 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which covers more than 90% of all bariatric surgery programs in the United States and Canada. Clinical and demographic data were collected at all participating institutions using a standardized protocol. Data analysis was performed from December 2018 to November 2019. Exposures:Preoperative BMI and weight loss. Main Outcomes and Measures:30-day mortality after bariatric surgery. Results:Of the 480 075 patients (mean [SD] age 45.1 [12.0] years; 383 265 [79.8%] women), 511 deaths (0.1%) occurred within 30 days of bariatric surgery. Compared with patients with a preoperative BMI of 35.0 to 39.9, the multivariable-adjusted odds ratios for 30-day mortality for patients with preoperative BMI of 40.0 to 44.9, 45.0 to 49.9, 50.0 to 54.9, and 55.0 and greater were 1.37 (95% CI, 1.02-1.83), 2.19 (95% CI, 1.64-2.92), 2.61 (95% CI, 1.90-3.58), and 5.03 (95% CI, 3.78-6.68), respectively (P for trend < .001). Moreover, compared with no preoperative weight loss, the multivariable-adjusted odds ratios for 30-day mortality for patients with weight loss of more than 0% to less than 5.0%, 5.0% to 9.9%, and 10.0% and greater were 0.76 (95% CI, 0.60-0.96), 0.69 (95% CI, 0.53-0.90), and 0.58 (95% CI, 0.41-0.82), respectively (P for trend = .003). Conclusions and Relevance:In this study, even moderate weight loss (ie, >0% to <5%) before bariatric surgery was associated with a lower risk of 30-day mortality. These findings may help inform future updates of clinical guidelines regarding bariatric surgery.

Dataset Information

The Impact of a Preoperative Cognitive Behavioural Therapy (CBT) on Dysfunctional Eating Behaviours, Affective Symptoms and Body Weight 1 Year after Bariatric Surgery: A Randomised Controlled Trial.

Publications

The Impact of a Preoperative Cognitive Behavioural Therapy (CBT) on Dysfunctional Eating Behaviours, Affective Symptoms and Body Weight 1 Year after Bariatric Surgery: A Randomised Controlled Trial.

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