Discussion
anxiety, depressive, disordered eating, Postoperative disordered eating behaviors, weight loss
Disordered eating and psychological distress are well-documented risk factors associated with weight regain after bariatric surgery. This multisite RCT sought to test the efficacy of a tele-CBT intervention targeting these risk factors 1 year after surgery in weight loss outcomes 1.5 years after surgery. To our knowledge, this is the largest RCT examining psychosocial interventions to support patients after bariatric surgery. Contrary to our hypothesis, the tele-CBT and control groups did not significantly differ in percentage weight loss at 1.5 years after surgery. However, the tele-CBT group did demonstrate significant improvements in binge eating, emotional eating, and depressive and anxiety symptoms immediately after the intervention, and these improvements were maintained at 3 months after the intervention (1.5 years after bariatric surgery).The study showed a high engagement rate in tele-CBT at 1 year after surgery, with 123 patients (80.9%) completing both the treatment and the 1.5-year postsurgery follow-up, and a high engagement rate of the intervention itself, with a completion rate of 127 participants (83.6%) for tele-CBT. Given the high attrition rates related to follow-up after bariatric surgery and the expansion of virtual psychosocial interventions for patients who underwent bariatric surgery, the high acceptability of treatment and retention of patients in this telephone-delivered psychological intervention is noteworthy.Although tele-CBT did not significantly improve weight loss outcomes at 1.5 years after surgery in comparison with standard bariatric surgery aftercare, it did significantly improve disordered eating and psychological distress. Tele-CBT and control groups had BES, PHQ-9, and GAD-7 scores below the threshold of clinical significance. Despite this outcome, the tele-CBT group reported statistically significant improvement in these variables compared with the control group across time. Postoperative disordered eating behaviors, such as loss of control over eating, were found to be associated with attenuated weight loss outcomes and weight regain after bariatric surgery.The tele-CBT intervention also improved anxiety and depressive symptoms. A deterioration in postsurgery mental health–related quality of life has been negatively associated with increased depressive and anxiety symptoms.