Strengths and Limitations
disordered eating and psychological distress, weight loss, disordered eating
Study strengths included the multisite RCT study design, standard postoperative bariatric care control group, large sample size, high retention rate, and psychometrically sound outcome measures that have been commonly used in bariatric populations. This study also has several limitations. These included the short-term postintervention follow-up, which may have limited our ability to observe treatment effects on weight loss outcomes. Additionally, energy intake and expenditure were not collected and were not part of this intervention, which may explain why there were no changes in short-term weight loss outcomes given that no caloric-restricted dietary intervention was used. Data collection extending to 3 years after surgery is still in progress and may help determine whether improvements in disordered eating and psychological distress are maintained over time and lead to better weight outcomes 3 years after surgery. Moreover, patients at 1 year after surgery in this RCT may still be too early in their postbariatric surgery journey to experience significant risks of weight regain, and future studies could examine the effects of tele-CBT delivered beyond the first 2 years after surgery. Additionally, bariatric centers of excellence included in this multisite RCT offered routine postsurgery care in which behavioral health support from a dietitian, social worker, and psychologist, psychiatrist, or both was part of the care provided by the interprofessional team. The standard postoperative model of care received by the control group may not be the standard in all countries and practice contexts, and this additional integrated support may have provided sufficient support to attenuate weight loss outcome differences between tele-CBT and control groups. Nonetheless, it is noteworthy that significant differences were observed in disordered eating and psychological distress symptoms between groups despite the standard care control groups’ access to behavioral health supports. Future studies should examine the efficacy of this intervention in other contexts with different models of care. The intervention could be more scalable by developing an online training program to teach bariatric clinicians how to deliver the CBT protocol and by developing a user-friendly patient workbook to share with patients who underwent bariatric surgery. Previous research has found group CBT to be associated with improved disordered eating among patients who underwent bariatric surgery,