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Sockalingam S, Leung SE, Agic B, Ma C, Hawa R, Wnuk S, Dash S, Jackson T, Akbar N, Forhan M, Cassin SE. Telephone-based cognitive behavioural therapy for patients with postoperative bariatric surgery to manage COVID-19 pandemic-related mental health issues and distress (TELE-BARICARE): a protocol for a randomised controlled trial. BMJ Open 2022; 12:e067393. [PMID: 36109026 PMCID: PMC9478430 DOI: 10.1136/bmjopen-2022-067393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Bariatric surgery is currently the most effective treatment for obesity, and is performed yearly in over 8000 patients in Canada. Over 50% of those who live with obesity also have a history of mental health disorder. The COVID-19 pandemic has made it difficult for people living with obesity to manage their weight even after undergoing bariatric surgery, which combined with pandemic-related increases in mental health distress, has the potential to adversely impact obesity outcomes such as weight loss and quality of life. Reviews of virtual mental health interventions during COVID-19 have not identified any interventions that specifically address psychological distress or disordered eating in patients with obesity, including those who have had bariatric surgery. METHODS AND ANALYSIS A randomised controlled trial will be conducted with 140 patients across four Ontario Bariatric Centres of Excellence to examine the efficacy of a telephone-based cognitive behavioural therapy intervention versus a control intervention (online COVID-19 self-help resources) in postoperative bariatric patients experiencing disordered eating and/or psychological distress. Patients will be randomised 1:1 to either group. Changes in the Binge Eating Scale and the Patient Health Questionnaire 9-Item Scale will be examined between groups across time (primary outcomes). Qualitative exit interviews will be conducted, and data will be used to inform future adaptations of the intervention to meet patients' diverse needs during and post-pandemic. ETHICS AND DISSEMINATION This study has received ethics approvals from the following: Clinical Trials Ontario (3957) and the University Health Network Research Ethics Committee (22-5145), the Board of Record. All participants will provide written informed consent prior to enrolling in the study. Results will be made available to patients with bariatric surgery, the funders, the supporting organisations and other researchers via publication in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05258578.
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Affiliation(s)
- Sanjeev Sockalingam
- Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Eve Leung
- Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- IMHPR, Centre for Addiction and Mental Health - Russell Street Site, Toronto, Ontario, Canada
| | - Clement Ma
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Raed Hawa
- Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Susan Wnuk
- Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Satya Dash
- Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Timothy Jackson
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Nadine Akbar
- Department of Research, Humber River Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluatior, University of Toronto, Toronto, Ontario, Canada
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie E Cassin
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
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Barenbaum SR, Zhao AS, Saunders KH, Aronne LJ, Shukla AP. Management of Weight Regain Following Bariatric Surgery: Behavioral Intervention and Pharmacotherapy. Expert Rev Endocrinol Metab 2022; 17:405-414. [PMID: 35912876 DOI: 10.1080/17446651.2022.2101993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Bariatric surgery is the most effective intervention currently available for significant and durable weight loss, but weight regain after surgery is not uncommon. This paper focuses on updates in behavioral interventions and pharmacotherapy to combat weight regain after bariatric surgery. AREAS COVERED This paper critically reviews both prospective and retrospective studies assessing pharmacotherapy in post-bariatric surgical patients published within the past 5 years. It also evaluates updates in behavioral therapies and delivery of the therapies in this patient population. EXPERT OPINION Weight regain after bariatric surgery is common. Patients who experience weight regain should be evaluated and treated by a multidisciplinary team. Antiobesity pharmacotherapy should be considered for those who qualify as an adjunct to lifestyle modifications, along with behavioral interventions such as cognitive behavioral therapy.
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Affiliation(s)
- Sarah R Barenbaum
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Alice S Zhao
- Weill Cornell Medical College, New York, NY, USA
| | - Katherine H Saunders
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Alpana P Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
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Abstract
PURPOSE OF REVIEW The COVID-19 pandemic is associated with increased levels of stress, anxiety and depression in the population. These are associated with unhealthy eating patterns and sedentary behaviour. In turn, this may increase risk of obesity or aggravate it. This narrative review discusses the link between adverse mental health states and weight related behaviours. We present emerging evidence for this phenomenon during the COVID-19 pandemic in individuals with and without pre-existing obesity. RECENT FINDINGS A sizeable proportion of the population exhibits deterioration in mental health during the pandemic and those affected often report unhealthy weight-related behaviours such as "junk food" consumption and physical inactivity. Women, individuals with obesity, and those with pre-existing mental health conditions seem to be particularly at risk for overeating in response to stress (i.e. emotional eating). A number of psychological interventions including cognitive behavioural therapy and self-compassion may be effective in improving mental health and emotional eating patterns among the general population and particularly in individuals living with obesity. There is a need to complement efforts to improve mental health in the general population during the COVID-19 pandemic with targeted action to improve physical activity levels and healthy eating particularly among groups at-risk. This may be achieved by reducing disruptions to specialist and primary healthcare services and facilitating access to psychological interventions that address stress-related eating behaviours. Additional studies that examine such interventions, especially those that are delivered remotely, are urgently needed.
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Affiliation(s)
- Osnat C Melamed
- Centre for Addiction and Mental Health, 100 Stokes St, Toronto, Ontario, M6J 1H4, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Peter Selby
- Centre for Addiction and Mental Health, 100 Stokes St, Toronto, Ontario, M6J 1H4, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Sockalingam S, Leung SE, Ma C, Hawa R, Wnuk S, Dash S, Jackson T, Cassin SE. The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial. Obes Surg 2022; 32:1884-1894. [PMID: 35218006 PMCID: PMC8880302 DOI: 10.1007/s11695-022-05981-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
Background Patients undergoing bariatric surgery have high rates of psychiatric comorbidity, which may increase their vulnerability to COVID-19-related mental health distress. Exacerbation of mental health distress and disordered eating could have significant negative effects on long-term weight management and quality of life for these patients if untreated. Objective To determine the efficacy of a telephone-based cognitive behavioral therapy (Tele-CBT) intervention in improving depressive, anxiety, and disordered eating symptoms during COVID-19. Methods Participants were recruited as part of a larger randomized controlled trial study (clinicaltrials.gov ID: NCT03315247) between March 2020 and March 2021 and randomized 1:1 to receive Tele-CBT or standard bariatric care. Outcomes of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Emotional Eating Scale (EES), and Binge Eating Scale (BES) were measured at baseline, immediately post-intervention, and 3 months post-intervention. Linear mixed models were used to test the effect of intervention group, time, and group-by-time interaction for each outcome. Results Eighty-one patients were included in the intention-to-treat analysis. Mean (SD) age of participants was 47.68 (9.36) years and 80.2% were female. There were significant group-by-time interactions for all outcomes and significant differences between groups across time. There were significant decreases in mean GAD-7 (p = 0.001), PHQ-9 (p < 0.001), EES-Total (p = 0.001), EES-Anger (p = 0.003), EES-Anxiety (p < 0.001), EES-Depression (p < 0.001), and BES (p = 0.002) scores for the Tele-CBT group at post-intervention and follow-up when compared to baseline and the control group. Conclusion Tele-CBT is a feasible and effective treatment for improving psychological distress and disordered eating among post-operative bariatric surgery patients during the COVID-19 pandemic. Graphical abstract ![]()
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Affiliation(s)
- Sanjeev Sockalingam
- Bariatric Surgery Program, University Health Network, Toronto, ON, M5T 2S8, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada. .,Centre for Addiction and Mental Health, ON, M6J 1H4, Toronto, Canada. .,Centre for Mental Health, University Health Network, Toronto, ON, M5G 2C4, Canada.
| | - Samantha E Leung
- Bariatric Surgery Program, University Health Network, Toronto, ON, M5T 2S8, Canada
| | - Clement Ma
- Centre for Addiction and Mental Health, ON, M6J 1H4, Toronto, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Raed Hawa
- Bariatric Surgery Program, University Health Network, Toronto, ON, M5T 2S8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Centre for Mental Health, University Health Network, Toronto, ON, M5G 2C4, Canada
| | - Susan Wnuk
- Bariatric Surgery Program, University Health Network, Toronto, ON, M5T 2S8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Centre for Mental Health, University Health Network, Toronto, ON, M5G 2C4, Canada
| | - Satya Dash
- Bariatric Surgery Program, University Health Network, Toronto, ON, M5T 2S8, Canada.,Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada
| | - Timothy Jackson
- Bariatric Surgery Program, University Health Network, Toronto, ON, M5T 2S8, Canada.,Division of General Surgery, University Health Network, University of Toronto, Toronto, ON, M5T 2S8, Canada
| | - Stephanie E Cassin
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.,Centre for Mental Health, University Health Network, Toronto, ON, M5G 2C4, Canada.,Department of Psychology, Ryerson University, Toronto, ON, M5B 2K3, Canada
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Santiago VA, Cassin SE, Wnuk S, Du C, Hawa R, Parikh SV, Sockalingam S. "If you're offered help, take it": A qualitative study examining bariatric patients' experience of telephone-based cognitive behavioural therapy. Clin Obes 2021; 11:e12431. [PMID: 33251753 DOI: 10.1111/cob.12431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022]
Abstract
The increased recognition of patients' mental health needs after bariatric surgery has resulted in the emergence of accessible psychosocial interventions; however, there is a dearth of literature on patient experience and satisfaction with these interventions. We explored patients' perceptions and experiences of telephone-based cognitive behavioural therapy (Tele-CBT) in this qualitative study. Ten participants from the Toronto Western Hospital Bariatric Surgery Program in Toronto, Canada who completed the Tele-CBT (ClinicalTrials.gov Identifier: NCT02920112) were individually interviewed from November 2014 to June 2016 until thematic saturation occurred (ie, no more new coding groups emerged). Interviews were transcribed, independently coded, checked for discrepancies, and analysed using grounded theory. Four themes emerged: (1) participants were generally satisfied with Tele-CBT (eg, therapeutic alliance, resources provided, relevance of therapy to their own bariatric journey), (2) participants noticed emotional, cognitive, and behavioural changes following therapy, (3) the optimal time to deliver the Tele-CBT was when weight loss plateaued, generally at one-year post-surgery, and (4) participants found the telephone modality convenient. CBT was generally found to be helpful and the telephone format increased convenience and accessibility. Patients reported learning skills and receiving resources that could help them improve their well-being following bariatric surgery.
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Affiliation(s)
- Vincent A Santiago
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Susan Wnuk
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Chau Du
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Raed Hawa
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Sanjeev Sockalingam
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Villa G, Lanini I, Amass T, Bocciero V, Scirè Calabrisotto C, Chelazzi C, Romagnoli S, De Gaudio AR, Lauro Grotto R. Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review. Perioper Med (Lond) 2020; 9:38. [PMID: 33292558 PMCID: PMC7722323 DOI: 10.1186/s13741-020-00169-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
A maladaptive response to surgical stress might lead to postoperative complications. A multidisciplinary approach aimed at controlling the surgical stress response may reduce procedural complications and improve patients’ quality of life in the short and long term. Several studies suggest that psychological interventions may interact with the pathophysiology of surgical stress response, potentially influencing wound repair, innate and adaptive immunity, inflammation, perception of pain, and patients’ mood. The aim of this systematic review is to summarise the effects of perioperative psychological interventions on surgical pain and/or anxiety in adult patients scheduled for elective general abdominal and/or urologic surgery. We conducted a systematic review of controlled clinical trials and observational studies involving psychological interventions for adult patients scheduled for elective general abdominal and/or urologic surgery. Only studies reporting pain and/or anxiety among outcome measures were included in the systematic review. The following psychological interventions were considered: (1) relaxation techniques, (2) cognitive-behavioural therapies, (3) mindfulness, (4) narrative medicine, (5) hypnosis and (6) coping strategies. We examined 2174 papers. Among these, 9 studies were considered eligible for inclusion in this systematic review (1126 patients cumulatively): 8 are randomised controlled trials and 1 is an observational prospective pre/post study. Psychological characteristics widely influence the pathophysiological mechanisms underlying the neuroendocrine and inflammatory response to surgical stress, potentially interfering with surgical outcomes. Psychological interventions are technically feasible and realistically applicable perioperatively during abdominal and/or urologic surgery; they influence the pathophysiological mechanisms underlying maladaptive surgical stress response and might have positive effects on patients’ surgical outcomes, such as pain and anxiety.
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Affiliation(s)
- Gianluca Villa
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy. .,Department of Anaesthesia and intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Iacopo Lanini
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy
| | - Timothy Amass
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, CO, USA
| | - Vittorio Bocciero
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy
| | - Caterina Scirè Calabrisotto
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy
| | - Cosimo Chelazzi
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy.,Department of Anaesthesia and intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy.,Department of Anaesthesia and intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - A Raffaele De Gaudio
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy.,Department of Anaesthesia and intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Rosapia Lauro Grotto
- Department of Health Sciences, Section of Psychology and Psychiatry, University of Florence, Largo Brambilla 3, 50100, Florence, Italy
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Ellis JD, Struble CA, Fodor MC, Cairncross M, Lundahl LH, Ledgerwood DM. Contingency management for individuals with chronic health conditions: A systematic review and meta-analysis of randomized controlled trials. Behav Res Ther 2020; 136:103781. [PMID: 33302054 DOI: 10.1016/j.brat.2020.103781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Contingency management (CM) interventions involve providing reinforcement for engaging in a desired behavior, and have been shown to increase treatment adherence and promote abstinence in the treatment of substance use disorders. This review was conducted to systematically review the literature on the effectiveness of CM when applied to a range of medical conditions outside of substance use disorders. METHOD The authors identified a total of 24 randomized studies examining the effects of CM on four outcomes: weight change, physical activity, medication/device adherence, and viral load that were included in the qualitative summary, and 20 studies included in the meta-analysis. RESULTS CM was associated with positive outcomes for physical activity and medication/device adherence compared to control conditions. Findings with weight loss and viral load were more mixed, and evidence for publication bias was found for both outcomes. The effects of CM tend to dissipate when the contingency is removed. Heterogeneity was observed across most outcomes. LIMITATIONS AND CONCLUSIONS This review provides preliminary support for the use of CM in increasing physical activity and improving adherence to medication for chronic health conditions while reinforcement is ongoing. Future studies should examine potential moderators and identify strategies to maintain these changes over time.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, USA
| | - Cara A Struble
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Marina C Fodor
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Molly Cairncross
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Canada
| | - Leslie H Lundahl
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - David M Ledgerwood
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA.
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Youssef A, Keown-Stoneman C, Maunder R, Wnuk S, Wiljer D, Mylopoulos M, Sockalingam S. Differences in physical and mental health-related quality of life outcomes 3 years after bariatric surgery: a group-based trajectory analysis. Surg Obes Relat Dis 2020; 16:1837-1849. [DOI: 10.1016/j.soard.2020.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
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Cassin S, Leung S, Hawa R, Wnuk S, Jackson T, Sockalingam S. Food Addiction Is Associated with Binge Eating and Psychiatric Distress among Post-Operative Bariatric Surgery Patients and May Improve in Response to Cognitive Behavioural Therapy. Nutrients 2020; 12:nu12102905. [PMID: 32977459 PMCID: PMC7598202 DOI: 10.3390/nu12102905] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022] Open
Abstract
The current study examined clinical correlates of food addiction among post-operative bariatric surgery patients, compared the clinical characteristics of patients with versus without food addiction, and examined whether a brief telephone-based cognitive behavioural therapy (Tele-CBT) intervention improves food addiction symptomatology among those with food addiction. Participants (N = 100) completed measures of food addiction, binge eating, depression, and anxiety 1 year following bariatric surgery, were randomized to receive either Tele-CBT or standard bariatric post-operative care, and then, repeated the measure of food addiction at 1.25 and 1.5 years following surgery. Thirteen percent of patients exceeded the cut-off for food addiction at 1 year post-surgery, and this subgroup of patients reported greater binge eating characteristics and psychiatric distress compared to patients without food addiction. Among those with food addiction, Tele-CBT was found to improve food addiction symptomatology immediately following the intervention. These preliminary findings suggest that Tele-CBT may be helpful, at least in the short term, in improving food addiction symptomatology among some patients who do not experience remission of food addiction following bariatric surgery; however, these findings require replication in a larger sample.
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Affiliation(s)
- Stephanie Cassin
- Department of Psychology, Ryerson University, Toronto, ON M5B 2K3, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (R.H.); (S.W.)
- Centre for Mental Health, University Health Network, Toronto, ON M5T 2S8, Canada;
- Correspondence: (S.C.); (S.S.); Tel.: +1-416-979-5000 (ext. 3007) (S.C.); +1-416-535-8501 (ext. 32178) (S.S.)
| | - Samantha Leung
- Centre for Mental Health, University Health Network, Toronto, ON M5T 2S8, Canada;
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada;
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (R.H.); (S.W.)
- Centre for Mental Health, University Health Network, Toronto, ON M5T 2S8, Canada;
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada;
| | - Susan Wnuk
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (R.H.); (S.W.)
- Centre for Mental Health, University Health Network, Toronto, ON M5T 2S8, Canada;
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada;
| | - Timothy Jackson
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada;
- Division of General Surgery, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada; (R.H.); (S.W.)
- Centre for Mental Health, University Health Network, Toronto, ON M5T 2S8, Canada;
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada;
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
- Correspondence: (S.C.); (S.S.); Tel.: +1-416-979-5000 (ext. 3007) (S.C.); +1-416-535-8501 (ext. 32178) (S.S.)
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10
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Quilez-Orden A, Ferreres-Galán V, Osma J. Feasibility and Clinical Usefulness of the Unified Protocol in Online Group Format for Bariatric Surgery Candidates: Study Protocol for a Multiple Baseline Experimental Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176155. [PMID: 32854200 PMCID: PMC7503837 DOI: 10.3390/ijerph17176155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023]
Abstract
Obesity is currently becoming a serious global public health problem due to its high prevalence and continuous increase. This condition is associated with different physical and mental health problems. The presence of emotional disorders (anxiety, depression and related disorders) among candidates for bariatric surgery is very high and predicts worse physical and psychological results. The present study aims to explore the feasibility and clinical usefulness of the Unified Protocol, a transdiagnostic emotion regulation-based intervention, delivered in an online group format to patients with emotional disorder diagnosis or symptoms, who are waiting for bariatric surgery. We will conduct a pilot study with a repeated single-case experimental design (multiple baseline design) in a public mental health service. The sample will consist of 60 participants, who will be randomized to three baseline conditions: 8, 12 or 15 evaluation days before the intervention. Diagnostic criteria, symptomatology and body mass index are the primary outcome measures, and we will include affectivity, personality, quality of life, body image, eating behavior and surgical complications like secondary measures. An analysis of treatment satisfaction will be also performed. Assessment points will include pre-treatment, baseline, treatment, post-treatment, and follow-ups every three months until two years after post-treatment. The results obtained in this study may have important clinical, social and economic implications for public mental health.
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Affiliation(s)
- Alba Quilez-Orden
- Department of Psychology and Sociology, University of Zaragoza, 44003 Teruel, Spain;
- Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | | | - Jorge Osma
- Department of Psychology and Sociology, University of Zaragoza, 44003 Teruel, Spain;
- Health Research Institute of Aragón, 50009 Zaragoza, Spain
- Correspondence: ; Tel.: +34-97-864-5390
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Rudolph A, Hilbert A. Cognitive-Behavioral Therapy for Postbariatric Surgery Patients With Mental Disorders: A Pilot Study. Front Psychiatry 2020; 11:14. [PMID: 32116836 PMCID: PMC7028699 DOI: 10.3389/fpsyt.2020.00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Binge-eating disorder (BED) and major depressive disorder (MDD) following bariatric surgery are significant predictors for less post-operative weight loss and/or weight regain, however, cognitive-behavioral therapy (CBT) addressing these disorders following surgery has not been investigated so far. OBJECTIVE This study examined feasibility of a short-term CBT based on evidence-based manuals for BED and MDD that were adapted to patients following bariatric surgery, and investigated its effectiveness in improving weight loss outcome, psychopathology, and psychosocial functioning. MATERIALS AND METHODS In an uncontrolled proof-of-concept study, the CBT manual was piloted in N = 7 patients who had undergone roux-en-Y gastric bypass surgery at least 6 months before. Weight loss, eating disorder psychopathology, depressive symptoms, and self-esteem were assessed using clinical interviews and self-report questionnaires at pre-treatment, post-treatment, and in a 3-month follow-up. RESULTS A significant reduction of body weight was found as well as medium to large effects in the improvement of eating disorder psychopathology, depressive symptoms, and self-esteem from pre-treatment to post-treatment were found. Most of those changes remained stable during the 3-month follow-up period. Study retention was 71.4%. CONCLUSIONS Feasibility and effectiveness of CBT were documented for patients with BED or MDD following bariatric surgery. Adaptations of the study procedure for proof-of-efficacy in randomized-controlled studies are discussed.
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Affiliation(s)
- Almut Rudolph
- Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Life Sciences, University of Leipzig, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Departments of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
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Costa-Dookhan KA, Leung SE, Cassin SE, Sockalingam S. Psychosocial Predictors of Response to Telephone-Based Cognitive Behavioural Therapy in Bariatric Surgery Patients. Can J Diabetes 2019; 44:236-240. [PMID: 31447318 DOI: 10.1016/j.jcjd.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Bariatric surgery is an empirically supported treatment for severe obesity; however, it does not directly target underlying behavioural and psychological factors that potentially contribute to obesity. Mounting evidence supports the efficacy of cognitive behavioural therapy (CBT) for improving eating psychopathology and psychological distress among bariatric patients, and telephone-based CBT (Tele-CBT) is a novel delivery method that increases treatment accessibility. METHODS This study aimed to identify demographic and clinical predictors of response to Tele-CBT among 79 patients who received Tele-CBT in 3 previous studies. Listwise deletion was applied, after which 58 patients were included in a multivariate linear regression adjusted for age, sex and education status, to evaluate patient rurality index (urban or nonurban), and baseline binge eating, emotional eating and depression symptoms, as predictors of tele-CBT response. RESULTS The predictors explained 31% of the observed variance [R2=0.312, F(4,57)=3.238, p<0.01]. Patient rurality index (beta=0.341, p<0.01) was the only statistically significant predictor of Tele-CBT response. CONCLUSIONS Given the limited psychosocial resources available in many bariatric surgery programs, the findings suggest that Tele-CBT may be particularly beneficial for patients residing in nonurban communities with limited access to other health-care services.
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Affiliation(s)
- Kenya A Costa-Dookhan
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto Institute of Medical Science, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Samantha E Leung
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Stephanie E Cassin
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto Institute of Medical Science, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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