Cognitive Behavioral Therapy Versus Usual Care Before Bariatric Surgery: One-Year Follow-Up Results of a Randomized Controlled Trial

Eating Disorders in the Context of Metabolic and Bariatric Surgery: Current Status and Future Directions

PURPOSE OF REVIEW

Eating disorders (EDs) are a relatively uncommon yet salient concern for patients undergoing metabolic and bariatric surgery (MBS). This report aims to advance understanding of the complex relationship between EDs and MBS by highlighting recent empirical evidence and identifying areas for future research.

RECENT FINDINGS

Little-to-no empirical evidence suggests that EDs be considered an absolute contraindication for MBS. However, a small subset of patients experience recurrent or emergent ED symptoms following surgery, invariably resulting in poorer postsurgical outcomes. Plausibly, a confluence of psychosocial and neurobiological mechanisms explains post-MBS ED symptoms. Accurate identification of MBS-related ED concerns is essential, with growing evidence suggesting structured postsurgical treatment may be optimal. Despite recent advances, more research on EDs in the context of MBS is needed, including rigorous mechanistic studies with long-term follow-up that clarify how predisposing factors interact to precipitate postsurgical ED symptoms. More work is also required to inform design and dissemination of targeted ED interventions for patients pursuing MBS.

Assessing the reliability and validity of sleep assessments in patients seeking metabolic and bariatric surgery

BACKGROUND

More than 80% of patients seeking metabolic and bariatric surgery (MBS) report disturbance in sleep function. No studies have assessed the psychometric properties of sleep measures in MBS samples.

OBJECTIVES

This study assessed the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) in a large sample of patients seeking MBS.

SETTING

Two academic medical centers.

METHODS

Measures of sleep (PSQI and ISI) and psychological functioning, including the Quick Inventory of Depressive Symptomatology (QIDS), were administered presurgically. Internal consistency was assessed with mean inter-item correlations and item-total correlations. Construct validity was assessed using confirmatory factor analyses (CFAs) based on models identified in the literature and by measuring convergent and discriminant validity.

RESULTS

Participants (N = 939) were primarily female (83.4%) with a mean age of 41.7 (SD = 11.5) years and mean body mass index (BMI) of 47.5 kg/m2 (SD = 8.5). CFAs indicated excellent fit for 2-factor solutions for the PSQI and ISI. Internal consistency for the PSQI and ISI were acceptable. Convergent validity was demonstrated by large correlations between the PSQI and ISI (r = .80, p < .001), and moderate correlation between the PSQI, ISI, and QIDS (rs > .50, ps < .001). The PSQI and ISI were moderately correlated with QIDS items assessing sleep function (P < .001), but correlations with items assessing appetite change were small (r < .10), demonstrating good discriminant validity.

CONCLUSIONS

Results support the reliability and validity of the PSQI and ISI for patients undergoing MBS.

Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: a scoping review

INTRODUCTION

Overweight and obesity are growing public health problems worldwide. Both diet and physical activity have been the primary interventions for weight reduction over the past decade. With increasing rates of overweight and obesity, it is evident that a primary focus on diet and exercise has not resulted in sustained obesity reduction within the global population. There is now a case to explore other weight management strategies such as psychological therapies. However, there is a dearth of literature that has mapped the types of psychological interventions and the characteristics of these interventions as a means of achieving weight reduction.

OBJECTIVES

The key objectives focused on mapping the types and characteristics of psychological interventions versus usual care for weight reduction and sustained weight reduction in adults with overweight or obesity. The study followed the scoping review methodology by Arksey and O'Malley and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

ELIGIBILITY CRITERIA

Intervention studies were included if participants were 18 years and over, classified as overweight or obese (body mass index ≥25 kg/m2) and had received a psychological therapy intervention. Studies were excluded if they included a comparison with other active lifestyle interventions (unless classified as usual care), were not available in English, were not full-text articles or were non-peer-reviewed articles.

SOURCES OF EVIDENCE

Six electronic databases were searched from inception to April 2023 to identify relevant articles.

CHARTING METHODS

The study employed a systematic charting method and narrative synthesis to organise and synthesise the data.

RESULTS

A total of 31 studies met the eligibility criteria and were included in the review. 13 unique psychological interventions for weight reduction in adults with overweight or obesity were identified, with cognitive-behavioural therapy and motivational interviewing being the most common. Eight types of usual care were identified, which largely included education and training on nutrition and physical activity. Gaps in the current research were also identified.

CONCLUSION

The findings highlighted several gaps within the existing literature, largely due to a lack of evidence relating to adults with low socioeconomic status, non-white participants, individuals under 40 years of age and the integration of digital health technologies.

Recommendations for the Development of Psychological Smartphone Applications in the Context of Bariatric Surgery: Focus Groups with Professionals and Patients

To explore the experiences and preferences of patients and healthcare professionals regarding the development of an app to provide psychological intervention to improve emotion regulation in the context of bariatric surgery (BS). Sixteen people (6 patients who underwent BS and 10 professionals) participated in two separate focus group sessions. We performed a content analysis of transcribed focus group discussions to extract and organize categories, subcategories and areas. Both sets of stakeholders provided information about how to develop and implement an app. According to participants' comment, content should include information (i.e., nutrition, exercise) and emotional regulation skills. Patients and professionals mentioned that the app should include visual information, continuous emotional assessments and peer contact. It was also mentioned that the app should be used before and after BS and its contents should be developed by a multidisciplinary team (i.e., collaboration of endocrinologist, nutritionists and psychologists). Participants in both focus groups considered technology to be useful in the context of BS, especially as part of blended interventions (combining face-to-face and online sessions). Patients and professionals seem to be receptive towards the use of technology in a BS context. Specific recommendations are identified for designing and implementing app solutions for BS. More efforts should be made in the future to develop and implement evidence-based apps according to patients and professionals' needs.

Psychological Benefits of a Preoperative Educational Bridging Program for Bariatric Surgery: Does Face-to-Face versus Videoconference-Based Delivery Make a Difference?

INTRODUCTION

Short educational programs prior to metabolic and bariatric surgery (MBS) provide information to prepare patients adequately for surgery and subsequent changes. Our knowledge of the beneficial effects of these programs on stabilizing and improving mental health of patients with obesity awaiting surgery is incomplete. The objective of this study was to assess the effects of a group-based educational program before MBS on three key factors: (i) patients' mental health, (ii) the program's perceived helpfulness from the patients' perspective, and (iii) the effectiveness of delivering the program online via videoconferencing.

METHODS

Validated questionnaires for anxiety, depression, stress, and quality of life before and after the program were assessed. Additionally, participants' perspectives of benefits were assessed. Two subgroups, one participating in face-to-face classes, the other participating online via videoconferencing, were compared.

RESULTS

Three hundred five patients with obesity waiting for MBS participated in the program. The dropout rate was 3%. On mean average, symptoms of anxiety (-1.1 units [SD 4.6], p < 0.001), depression (-0.9 units [SD 4.6], p < 0.001), and stress (-4.6 units [SD 15.6], p < 0.001) improved, while physical quality of life (+1.7 units [SD 9.7], p = 0.016) and body weight (-0.3 kg [SD 8.7], p = 0.57) remained stable. Patients perceived the program as very beneficial. The results were similar between delivery methods (face-to-face vs. videoconferencing).

CONCLUSION

The educational program proved to be effective in bridging the gap in preoperative preparation while also stabilizing participants' mental health. In addition, participants perceived the program as supportive. Online participation via video conferencing can be offered as an equivalent option to face-to-face classes.

Health-promotion interventions targeting multiple behaviors: A meta-analytic review of general and behavior-specific processes of change

Although health-promotion interventions that recommend changes across multiple behavioral domains are a newer alternative to single-behavior interventions, their general efficacy and their mechanisms of change have not been fully ascertained. This comprehensive meta-analysis (6,878 effect sizes from 803 independent samples from 364 research reports, N = 186,729 participants) examined the association between the number of behavioral recommendations in multiple-behavior interventions and behavioral and clinical change across eight domains (i.e., diet, smoking, exercise, HIV [Human Immunodeficiency Virus] prevention, HIV testing, HIV treatment, alcohol use, and substance use). Results showed a positive, linear effect of the number of behavioral recommendations associated with behavioral and clinical change across all domains, although approximately 87% of the samples included between 0 and 4 behavioral recommendations. This linear relation was mediated by improvements in the psychological well-being of intervention recipients and, in several domains (i.e., HIV, alcohol use, and drug use), suggested behavioral cuing. However, changes in information, motivation, and behavioral skills did not mediate the impact of the number of recommendations on behavioral and clinical change. The implications of these findings for theory and future intervention design are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Peripheral inflammation associated with depression and reduced weight loss: a longitudinal study of bariatric patients

BACKGROUND

Research implicates inflammation in the vicious cycle between depression and obesity, yet few longitudinal studies exist. The rapid weight loss induced by bariatric surgery is known to improve depressive symptoms dramatically, but preoperative depression diagnosis may also increase the risk for poor weight loss. Therefore, we investigated longitudinal associations between depression and inflammatory markers and their effect on weight loss and clinical outcomes in bariatric patients.

METHODS

This longitudinal observational study of 85 patients with obesity undergoing bariatric surgery included 41 cases with depression and 44 controls. Before and 6 months after surgery, we assessed depression by clinical interview and measured serum high-sensitivity C-reactive protein (hsCRP) and inflammatory cytokines, including interleukin (IL)-6 and IL-10.

RESULTS

Before surgery, depression diagnosis was associated with significantly higher serum hsCRP, IL-6, and IL-6/10 ratio levels after controlling for confounders. Six months after surgery, patients with pre-existing depression still had significantly higher inflammation despite demonstrating similar weight loss to controls. Hierarchical regression showed higher baseline hsCRP levels predicted poorer weight loss (β = -0.28, p = 0.01) but had no effect on depression severity at follow-up (β = -0.02, p = 0.9). Instead, more severe baseline depressive symptoms and childhood emotional abuse predicted greater depression severity after surgery (β = 0.81, p < 0.001; and β = 0.31, p = 0.001, respectively).

CONCLUSIONS

Depression was significantly associated with higher inflammation beyond the effect of obesity and other confounders. Higher inflammation at baseline predicted poorer weight loss 6 months after surgery, regardless of depression diagnosis. Increased inflammation, rather than depression, may drive poor weight loss outcomes among bariatric patients.

Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment

PURPOSE OF REVIEW

Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain.

RECENT FINDINGS

Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.

Establishment of a Nomogram Based on Inflammatory Response-Related Methylation Sites in Intraoperative Visceral Adipose Tissue to Predict EWL% at One Year After LSG

Background

Laparoscopic sleeve gastrectomy (LSG) is considered as an effective bariatric and metabolic surgery for patients with severe obesity. Chronic low-grade inflammation of adipose tissue is associated with obesity and obesity-related complications.

Objective

This study intends to establish a nomogram based on inflammatory response-related methylation sites in intraoperative visceral adipose tissue (VAT) to predict excess weight loss (EWL)% at one-year after LSG.

Methods

Based on EWL% at one-year after LSG, patients were divided into two groups: the satisfied group (group-A, EWL%≥50%) and the unsatisfied group (group-B, EWL%<50%). Next, we defined genes corresponding to the methylation sites in the 850 K methylation microarray as methylation-related genes (MRGs). We then took the intersection of MRGs and inflammatory response-related genes. After that, inflammatory response-related methylation sites were identified based on overlapping genes. Moreover, difference analysis was carried out to obtain inflammatory response-related differentially methylated sites (IRRDMSs) between group-A and group-B. LASSO analysis was used to identify the hub methylation sites. Finally, we developed a nomogram based on the hub methylation sites.

Results

There were 26 patients in the study, with 13 in group-A and 13 in group-B. After data filtering and difference analysis, 200 IRRDMSs were identified (143 hypermethylated sites and 57 hypomethylated sites). Then, we identified three hub methylation sites (cg03610073, cg03208951, and cg18746357) by LASSO analysis and built a predictive nomogram (Area under the curve=0.953).

Conclusion

The predictive nomogram based on three inflammatory-related methylation sites (cg03610073, cg03208951, and cg18746357) in intraoperative visceral adipose tissue can predict one-year EWL% after LSG effectively.

Three- and five-year follow-up results of a randomized controlled trial on the effects of cognitive behavioral therapy before bariatric surgery

OBJECTIVE

Up to 37% of bariatric surgery patients suffer from insufficient weight loss or weight regain and mental health symptoms in the longer term. Cognitive behavioral therapy (CBT) may be an effective adjunct intervention to optimize patients' psychological functioning and weight loss results. To examine the value of adding preoperative CBT to bariatric surgery, three- and five-year follow-up data are presented.

METHOD

In this multi-center randomized controlled trial (RCT; N = 130), a CBT group was compared to a treatment-as-usual (TAU) control group. Measurements were conducted at five time points: pretreatment (T0) and posttreatment/presurgery (T1) and at one- (T2; N = 120), three- (T3; N = 117), and five-year postsurgery (T4; N = 115). The intervention group received a 10-weeks, individual, preoperative CBT focused on self-monitoring, identifying triggers for disordered eating and goal setting for eating behavior and physical exercise, as well as postoperative lifestyle. Outcome measures included weight change, eating behavior, eating disorders, depression, quality of life (QoL), and overall psychological health.

RESULTS

Preoperative CBT was not associated with better three- and five-year results than TAU regarding weight, dysfunctional eating behaviors, eating disorders, depression, overall psychological health, and QoL.

DISCUSSION

Contrary to our hypothesis, three- and five-year postsurgery differences between groups regarding weight change and mental health were not significant.. Further exploration suggested that in both groups weight problems and depressive symptoms worsened at three and five-year follow-up. Future research should focus on long-term postoperative monitoring of weight and mood and on associated postoperative interventions and their specific timing.

PUBLIC SIGNIFICANCE

After bariatric surgery, in the longer term weight problems re-occur in 30% of patients, which is probably partly related to psychopathology. We investigated whether cognitive behavior therapy (CBT) prior to bariatric surgery improved weight maintenance and mental health after surgery. Our study provided definite proof that preoperative CBT is not effective. Long-term postoperative monitoring and prompt psychological intervention after first signs of deterioration, are important to prevent further problems.

Management of Weight Regain Following Bariatric Surgery: Behavioral Intervention and Pharmacotherapy

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.

S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study

BACKGROUND

Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education.

PURPOSE

To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes.

METHODS

This was a prospective randomized study of bariatric surgery patients who experienced less than 50th percentile excess body weight loss (%EWL) at 3 weeks. Subjects with EWL < 18% were randomized into two groups: an intervention (IV) arm or a control (NI, no intervention) arm. The IV arm was offered a program with 7-weekly behavioral support sessions, while the NI patients received routine post-operative care.

RESULTS

A total of 128 patients were randomized: 65 NI and 63 IV. In the IV group, 20 attended all sessions, 7 attended < 4, and 36 did not participate. There was no difference in baseline demographics, procedure type, or BMI. At 1 year, there was no difference in %EWL (ratio 0.993, 95% CI 0.873, 1.131), %EBMIL (ratio 0.997, 95% CI 0.875, 1.137), and %TWL (ratio 1.016, 95% CI 0.901, 1.146) between groups. A subgroup analysis including only the subjects who participated in all seven sessions showed similar results.

CONCLUSION

Patients who present with suboptimal weight loss early after bariatric surgery do not experience a significant weight loss improvement with a structured behavioral support program. Importantly, despite being alerted to their poor early weight loss, patients demonstrated poor adherence to the proposed interventions.

Weight-loss interventions for improving emotional eating among adults with high body mass index: A systematic review with meta-analysis and meta-regression

OBJECTIVES

To evaluate the effectiveness of weight-loss interventions on emotional eating among adults with high body mass index (BMI).

METHODS

A systematic review, meta-analysis and meta-regression were performed on randomized controlled trials published from inception until 19 March 2021.

RESULTS

Thirty-one studies were included, representing 1203 participants with mean ages ranging from 21.8 to 57.3 years old and BMI 27.2-43.5 kg/m2 . We found small-to-medium interventional effects on emotional eating (n = 18; Hedges' g = 0.22; p = 0.01, I2  = 61.7%), uncontrolled eating (n = 16; Hedges' g = 0.46; p < 0.001, I2  = 71.6%) and cognitive restraint (n = 18; Hedges' g = 0.42; p < 0.001, I2  = 75.8%). Small-to-medium interventional effects were only found for emotional eating (n = 8; Hedges' g = 0.45; p = 0.02, I2  = 74.3%) 3-month post-intervention, and on BMI (n = 4; Hedges' g = 0.43; p < 0.05, I2  = 33.4%) and weight (n = 6; Hedges' g = 0.36; p < 0.01, I2  < 10.4%) 12-month post-intervention. Age, male proportion, baseline BMI, attrition rate and intervention length were not significant moderators of the heterogeneity between studies.

CONCLUSION

Interventions improved emotional eating and weight loss along a year-long trajectory.

Screening, assessment and diagnosis in the eating disorders: findings from a rapid review

BACKGROUND

Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems.

METHODS

This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review.

RESULTS

Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males.

CONCLUSIONS

A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.

Psychological Interventions and Bariatric Surgery among People with Clinically Severe Obesity-A Systematic Review with Bayesian Meta-Analysis

AIM

To assess the effectiveness of perioperative psychological interventions provided to patients with clinically severe obesity undergoing bariatric surgery regarding weight loss, BMI, quality of life, and psychosocial health using the Bayesian approach.

METHODS

We considered randomised trials that assessed the beneficial and harmful effects of perioperative psychological interventions in people with clinically severe obesity undergoing bariatric surgery. We searched four data sources from inception to 3 October 2021. The authors independently selected studies for inclusion, extracted data, and assessed the risk of bias. We conducted a meta-analysis using a Bayesian approach.

PROSPERO

CRD42017077724.

RESULTS

Of 13,355 identified records, we included nine studies (published in 27 papers with 1060 participants (365 males; 693 females, 2 people with missing data)). Perioperative psychological interventions may provide little or no benefit for BMI (the last reported follow-up: MD [95% credible intervals] = -0.58 [-1.32, 0.15]; BF01 = 0.65; 7 studies; very low certainty of evidence) and weight loss (the last reported follow-up: MD = -0.50 [-2.21, 0.77]; BF01 = 1.24, 9 studies, very low certainty of evidence). Regarding psychosocial outcomes, the direction of the effect was mainly inconsistent, and the certainty of the evidence was low to very low.

CONCLUSIONS

Evidence is anecdotal according to Bayesian factors and uncertain whether perioperative psychological interventions may affect weight-related and psychosocial outcomes in people with clinically severe obesity undergoing bariatric surgery. As the results are ambiguous, we suggest conducting more high-quality studies in the field to estimate the true effect, its direction, and improve confidence in the body of evidence.

Behaviour change theories and techniques used to inform nutrition interventions for adults undergoing bariatric surgery: A systematic review

AIM

This systematic review aimed to describe behaviour change theories and techniques used to inform nutrition interventions for adults undergoing bariatric surgery.

METHODS

A systematic search was conducted across PubMed, PsycInfo, CENTRAL, EMBASE and CINAHL from inception until 09 March 2021. Eligible studies were randomised controlled trials involving nutrition interventions performed by a healthcare provider, to adults that were waitlisted or had undergone bariatric surgery and received a nutrition intervention explicitly informed by one or more behaviour change theories or behaviour change techniques. Screening was conducted independently by two authors. Behaviour change techniques were examined using the behaviour change technique taxonomy version one which includes 93 hierarchical techniques clustered into 16 groups. Quality of included studies was assessed using Cochrane risk of bias 2.0.

RESULTS

Twenty-one publications were included, involving 15 studies and 14 interventions, with 1495 participants. Bias was low or had some concerns. Two interventions reported using behaviour change theories (transtheoretical model and self-determination theory). Thirteen behaviour change technique taxonomy groupings and 29 techniques were reported across 14 interventions. Common techniques included '1.2 Problem solving' (n = 9 studies), '3.1 Social support (unspecified)' (n = 9 studies), '1.1 Goal setting (behaviour)' (n = 6 studies) and '2.3 Self-monitoring of behaviour' (n =- 6 studies).

CONCLUSION

While behaviour change techniques have been included, behaviour change theory is not consistently reported and/or adopted to inform nutrition interventions for adults undergoing bariatric surgery. Integrating behaviour change theory and techniques in nutrition interventions is important for researchers and bariatric surgery teams, including dietitians, to effectively target behaviours for this population.

Restriction of range effects in post-metabolic and bariatric surgery outcomes research: considerations for clinical decision making

BACKGROUND

Preoperative psychopathology does not consistently predict postoperative outcomes in patients who undergo metabolic and bariatric surgery (MBS). Individuals with elevated pre-MBS psychopathology may be less likely to undergo surgery, which may create a floor effect given the limited range of scores on measures of psychopathology included in postoperative analyses, thereby decreasing the power to detect clinically significant differences between groups.

OBJECTIVES

Our objective was to compare rates of clinically significant pre-MBS psychopathology across domains of functioning in patients who did and did not undergo MBS: surgical completers (SCs, n = 286) and nonsurgical completers (NSCs, n = 125).

SETTING

Academic medical center, United States.

METHODS

Participants (n = 411) were a racially diverse sample of MBS candidates who completed a preoperative psychosocial evaluation including measures of disordered eating, alcohol and tobacco use, pain catastrophizing, anxiety, and depressive symptomatology.

RESULTS

Compared with SCs, NSCs had larger scale score variance on measures of psychopathology and were more likely to be Black; to report clinically significant scores on measures of binge eating, depression, anxiety, and pain catastrophizing; and to use tobacco.

CONCLUSION

Results support the presence of a restriction-of-range effect but do not demonstrate a floor effect. These data suggest that current outcome data for MBS patients may not generalize to those who report clinically significant psychopathology at the pre-MBS psychosocial evaluation and may warrant caution when using the current literature to inform clinical decision making for this group. Findings also suggest a need for interventions that will better engage Black patients.