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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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Tewksbury C, Isom KA. Behavioral Interventions After Bariatric Surgery. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2022; 20:366-375. [PMID: 35789675 PMCID: PMC9244319 DOI: 10.1007/s11938-022-00388-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review Bariatric surgery is the most effective and durable treatment for severe obesity. Postoperative behavioral weight management approaches are available for optimizing weight change for both short- and long-term outcomes. Recent Findings Varying settings such as groups and telemedicine along with techniques such as cognitive behavioral therapy have been assessed in the post-bariatric surgery population. The assessment and application of these programs have been limited due to methodological, financial, and attrition-related constraints. Summary This review aims to summarize the current evidence for different postoperative behavioral interventions on postoperative outcomes, specifically highlighting weight loss. Future opportunities for study include mechanisms for overcoming some of the barriers to implementing these programs in clinical, non-research settings.
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Affiliation(s)
- Colleen Tewksbury
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Silverstein Building, 4th Floor, Philadelphia, PA 19104 USA
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Van Zyl N, Andrews L, Williamson H, Meyrick J. The effectiveness of psychosocial interventions to support psychological well-being in post-operative bariatric patients: A systematic review of evidence. Obes Res Clin Pract 2020; 14:404-420. [PMID: 32631804 DOI: 10.1016/j.orcp.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/12/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bariatric surgery is considered an effective obesity management intervention for individuals with a BMI greater than 40, or 35 with co-morbidities. However, research documents that psychological difficulties prevalent amongst individuals seeking surgery may persist post-operatively. This systematic review aims to assess the evidence to show which psychosocial interventions support psychological well-being post-operatively. METHODS The review is registered with Prospero (CRD42018100280), complying with PRISMA guidelines. The research protocol included grey literature and database searches of psychosocial interventions for post-operative bariatric patients, between November 2017 and September 2019. The primary outcome was psychological well-being; secondary outcomes included weight loss maintenance and quality of life (QoL). The primary reviewer screened titles and extracted data. Study quality was assessed independently by two reviewers, using the Effective Public Health Practice Project criteria. Due to heterogeneity across studies, narrative synthesis was considered suitable for data analysis. RESULTS Ten studies met inclusion criteria. Psychosocial intervention content was delivered in a variety of ways (e.g., clinic, internet-based). Overall, participants (N = 382, Mage = 46.4) receiving psychosocial interventions post bariatric surgery, demonstrated improvements in psychological well-being and weight loss maintenance, compared to baseline measures and/or controls. The strength of evidence is currently limited by the small number of studies found and study quality, limiting the power to detect clinically meaningful changes; findings should therefore be considered preliminary. CONCLUSION Preliminary findings suggest that interdisciplinary interventions including acceptance-based approaches, psychoeducation, nutrition and lifestyle modification, delivered 1-year post-operative, are promising. Further scientific enquiry is warranted with well-designed studies and long-term follow-ups.
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Affiliation(s)
- Natascha Van Zyl
- Institute for Optimum Nutrition, Paradise Road, Richmond, TW9 1SQ, UK.
| | - Lee Andrews
- Abertillery Group Practice, The Bridge Centre, Foundry Bridge, Abertillery, NP13 1BQ.
| | - Heidi Williamson
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
| | - Jane Meyrick
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
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Cheroutre C, Guerrien A, Rousseau A. Contributing of Cognitive-Behavioral Therapy in the Context of Bariatric Surgery: a Review of the Literature. Obes Surg 2020; 30:3154-3166. [DOI: 10.1007/s11695-020-04627-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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David LA, Sijercic I, Cassin SE. Preoperative and post-operative psychosocial interventions for bariatric surgery patients: A systematic review. Obes Rev 2020; 21:e12926. [PMID: 31970925 DOI: 10.1111/obr.12926] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 12/12/2022]
Abstract
Psychosocial interventions are increasingly being utilized to help patients prepare for, and adjust to changes following, bariatric surgery in order to optimize psychosocial adjustment and weight loss. The current systematic review examined the impact of preoperative and post-operative psychosocial interventions with a behavioural and/or cognitive focus on weight, dietary behaviours, eating pathology, lifestyle behaviours, and psychological functioning. A PsycINFO and Medline search of publications was conducted in March 2019. Two authors assessed retrieved titles and abstracts to determine topic relevance and rated the quality of included studies using a validated checklist. Forty-four articles (representing 36 studies) met the study inclusion criteria. The current evidence is strongest for the impact of psychosocial interventions, particularly cognitive behavioural therapy, on eating behaviours (eg, binge eating and emotional eating) and psychological functioning (eg, quality of life, depression, and anxiety). The evidence for the impact of psychosocial interventions on weight loss, dietary behaviours (eg, dietary intake), and lifestyle behaviours (eg, physical activity) is relatively weak and mixed. Psychosocial interventions can improve eating pathology and psychosocial functioning among bariatric patients, and the optimal time to initiate treatment appears to be early in the post-operative period before significant problematic eating behaviours and weight regain occur.
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Affiliation(s)
- Lauren A David
- Department of Psychology, Ryerson University, Toronto, Canada.,Eating Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Iris Sijercic
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Mental Health, University Health Network, Toronto, Canada
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Medina-Garzón M. Effectiveness of a Nursing Intervention to Diminish Preoperative Anxiety in Patients Programmed for Knee Replacement Surgery: Preventive Controlled and Randomized Clinical Trial. INVESTIGACION Y EDUCACION EN ENFERMERIA 2019; 37:e07. [PMID: 31487444 PMCID: PMC7871492 DOI: 10.17533/udea.iee.v37n2e07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/04/2019] [Indexed: 05/02/2023]
Abstract
OBJECTIVES This work was conducted to determine the effectiveness of a nursing intervention, based on the motivational interview, to diminish preoperative anxiety in patients programmed for knee replacement surgery. METHODS Preventive type controlled and randomized clinical trial, on a sample of 56 patients programmed for knee replacement surgery in a clinic in Girardot (Colombia). Random assignment was made: an intervention group (n=28) and a control group (n=28). The six-question Amsterdam Preoperative Anxiety and Information Scale was applied before and after the intervention. The scale has a total score ranging from 5 to 30; the higher the score, the greater the preoperative anxiety. The nursing intervention was conducted in three sessions of motivational interview each lasting 40 min, during the six weeks prior to the surgical procedure; the control group received conventional management of education in the health institution. RESULTS The mean score of preoperative anxiety was equal in the pre-intervention evaluation in both groups (19.76 in the experimental versus 22.02 in the control =22.02; p<0.226), while during the post-intervention, the anxiety score was lower in the intervention group compared with the control group (15.56 and 20.30, respectively; p <0.013). CONCLUSIONS Nursing intervention based on the motivational interview was effective in diminishing preoperative anxiety in patients programmed for knee replacement surgery.
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Abstract
PURPOSE OF REVIEW Bariatric surgery is the most effective treatment for morbid obesity. However, 20-30% of patients undergoing bariatric surgery experience premature weight stabilization or weight regain postoperatively. We report on the recent literature of predictors of weight loss and the efficacy of cognitive behavioral therapy (CBT) in bariatric patients. RECENT FINDINGS Preoperative disordered eating behaviors do not appear to be significantly predictive of postoperative weight loss. Postoperative disordered eating behaviors, eating disorders, and depressive symptoms have been found to be associated with less optimal weight loss results. Recent studies show that CBT can contribute in reducing disordered eating behaviors and depressive symptoms. Some studies also show that pre and postoperative CBT interventions can promote weight loss. New applications of CBT such as by telephone, internet, or virtual reality might contribute to more accessible and low-cost treatments for the large group of bariatric patients worldwide. SUMMARY CBT seems to be effective in reducing risk factors for weight regain after bariatric surgery, such as disordered eating behavior and depression. Controlled studies with long-term follow-up and larger sample sizes are needed to investigate the long-term effect of CBT interventions on weight loss results and psychological well-being.
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Emotion regulation and mental well-being before and six months after bariatric surgery. Eat Weight Disord 2017; 22:353-360. [PMID: 28390005 PMCID: PMC5440497 DOI: 10.1007/s40519-017-0379-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/01/2017] [Indexed: 02/08/2023] Open
Abstract
PURPOSE According to the current state of research, mental health improves due to bariatric surgery. However, improvements in weight and psychosocial aspects often show a gradual decline with time. As emotion regulation (ER) appears to be a key variable in the successful outcome of weight loss treatments, the present study aimed at investigating ER-strategies applied by bariatric surgery candidates pre- and post-surgery and examining interactions between ER, depressive symptoms, health-related quality of life (HrQoL), and post-surgical weight loss. METHODS Prior to and 6 months after bariatric surgery, 45 patients (76% women) completed self-report questionnaires assessing depressive symptoms (Beck Depression Inventory-II), HrQoL (Short Form-36 Health Survey), and ER-strategies (Emotion Regulation Inventory for Negative Emotions). RESULTS Six months post-surgery, the patients reported significant improvements in depressive symptomatology, HrQoL, and satisfaction with ER compared to pre-surgery. Groups differing in their course of ER-satisfaction also differed in psychosocial dimensions pre- to post-surgery, increased satisfaction being related to less impairment and enhanced communication of negative emotions as a form of an adaptive regulation. Patients with higher weight loss applied the strategy of controlled expression more frequently post-surgery than pre-surgery and compared to patients with lower weight loss. CONCLUSIONS Postoperative weight loss leads to improvements in ER-satisfaction and mental well-being. As satisfaction with ER seems to be associated with less impaired mental well-being among bariatric surgery candidates, presumably even more positive psychosocial outcomes could be obtained post-surgery by implementing trainings explicitly encouraging the use of adaptive ER-strategies.
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Tackling psychosocial maladjustment in Parkinson's disease patients following subthalamic deep-brain stimulation: A randomised clinical trial. PLoS One 2017; 12:e0174512. [PMID: 28399152 PMCID: PMC5388322 DOI: 10.1371/journal.pone.0174512] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 03/08/2017] [Indexed: 01/10/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for the motor and non-motor signs of Parkinson’s disease (PD), however, psychological disorders and social maladjustment have been reported in about one third of patients after STN-DBS. We propose here a perioperative psychoeducation programme to limit such social and familial disruption. Methods Nineteen PD patients and carers were included in a randomised single blind study. Social adjustment scale (SAS) scores from patients and carers that received the psychoeducation programme (n = 9) were compared, both 1 and 2 years after surgery, with patients and carers with usual care (n = 10). Depression, anxiety, cognitive status, apathy, coping, parkinsonian disability, quality-of-life, carers’ anxiety and burden were also analysed. Results Seventeen patients completed the study, 2 were excluded from the final analysis because of adverse events. At 1 year, 2/7 patients with psychoeducation and 8/10 with usual care had an aggravation in at least one domain of the SAS (p = .058). At 2 years, only 1 patient with psychoeducation suffered persistent aggravated social adjustment as compared to 8 patients with usual care (p = .015). At 1 year, anxiety, depression and instrumental coping ratings improved more in the psychoeducation than in the usual care group (p = .038, p = .050 and p = .050, respectively). No significant differences were found between groups for quality of life, cognitive status, apathy or motor disability. Conclusions Our results suggest that a perioperative psychoeducation programme prevents social maladjustment in PD patients following STN-DBS and improves anxiety and depression compared to usual care. These preliminary data need to be confirmed in larger studies.
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Zientek F, Winter K, Müller A, Rullmann M, Luthardt J, Becker GA, Bresch A, Patt M, Sabri O, Hilbert A, Hesse S. Effortful control as a dimension of temperament is negatively associated with prefrontal serotonin transporter availability in obese and non-obese individuals. Eur J Neurosci 2016; 44:2460-2466. [PMID: 27519298 DOI: 10.1111/ejn.13362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/26/2016] [Accepted: 08/02/2016] [Indexed: 11/25/2022]
Abstract
There is evidence that temperamental factors are associated with obesity; however, the biological mechanism of such association remains elusive. We aimed to investigate a possible association between serotonin transmission and regulative temperament in obese and non-obese individuals by using positron emission tomography (PET) imaging of serotonin transporters (SERT) and the Adult Temperament Questionnaire. Twenty-nine obese individuals with body mass index (BMI) ≥ 35 kg/m2 and 13 non-obese controls (BMI < 30 kg/m2 ) underwent PET with [11 C]-labeled DASB (highly selective for SERT) and self-completed the Effortful Control (EC) scale of the Adult Temperament Questionnaire-Short Form (ATQ). With the help of this questionnaire, we aimed to assess the capacity of self-regulation. Overall, for obese and non-obese individuals together, VOI-based (volume of interest) analysis showed significant negative correlations between SERT BPND and ATQ-EC AC (Activation Control) subscale in several brain regions (all r ≤ -0.47). Obese and non-obese individuals separated showed equally strong positive, but non-significant correlations. The analysis did not reveal any significant correlations of SERT availability and ATQ-EC IC (Inhibitory Control) or ATQ-EC AtC (Attentional Control) subscale within and between the two groups. The results indicate that regulative temperament - particularly the capacity to mitigate negatively toned impulses and to resist inappropriate avoidance behavior - might be associated with the prefrontal serotonergic system.
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Affiliation(s)
- Franziska Zientek
- Integrated Treatment and Research Centre (IFB) Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany. .,Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany.
| | - Karsten Winter
- Translational Centre for Regenerative Medicine (TRM), University of Leipzig, Leipzig, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Michael Rullmann
- Integrated Treatment and Research Centre (IFB) Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Julia Luthardt
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Georg-Alexander Becker
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Anke Bresch
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Marianne Patt
- Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Osama Sabri
- Integrated Treatment and Research Centre (IFB) Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Anja Hilbert
- Integrated Treatment and Research Centre (IFB) Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany.,Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Swen Hesse
- Integrated Treatment and Research Centre (IFB) Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
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