New research looking at the mental health and eating behaviours of patients 1-year after bariatric surgery has found that a short, 7-session telephone cognitive behavioural therapy (Tele-CBT) intervention is helpful in reducing symptoms of depression, anxiety, binge eating and emotional eating. This is according to a paper entitled Efficacy of Telephone-Based Cognitive Behavioural Therapy for Weight Loss, Disordered Eating and Psychological Distress After Bariatric Surgery: A Randomized Clinical Trial published today in JAMA Network Open by a national research team including members from Obesity Canada.

This team, led by researchers out of the University Health Network (UHN), Centre for Addiction and Mental Health (CAMH), and Toronto Metropolitan University (TMU), recruited 306 patients across three bariatric surgery programs in Ontario – the UHN Bariatric Centre of Excellence, the Humber River Hospital Bariatric Surgery Program, and the Ottawa Hospital Bariatric Centre of Excellence. Approximately half of these patients received the Tele-CBT intervention 1-year after bariatric surgery, while the other half of patients received standard follow-up care provided by their respective hospital sites. These patients were followed up to a year and a half after surgery to see whether the Tele-CBT intervention helped to improve mood and eating behaviours commonly experienced by patients at this critical timepoint post-surgery.

The researchers found that compared to the standard care group, those who received the Tele-CBT intervention had significantly reduced depression and anxiety symptoms and reported significantly less binge eating and emotional eating symptoms. Moreover, these improvements were not only seen immediately after the Tele-CBT intervention, but were sustained when patients were followed up three months after the intervention as well.

“This is the largest CBT/psychological intervention trial for patients after bariatric surgery, which is an evidence-based obesity treatment,” said Dr. Sanjeev Sockalingam, the paper’s senior author, Psychosocial Director of the UHN Bariatric Centre of Excellence, Senior Scientist at the CAMH, and Scientific Director at Obesity Canada. “This study also supports the effectiveness of CBT delivered by telephone and is timely, given the growth of virtual care during the pandemic.”

These results provide more conclusive data and build on smaller studies, also done by this research team, that showed short term improvements in disordered eating, depression, and anxiety in patients after bariatric surgery. The current study also looked at whether the Tele-CBT intervention helped to improve weight loss outcomes, although no differences were found between patients’ weights in the two groups. According to Dr. Cassin, a co-lead on this study, “there are a few potential reasons why no changes in weight were observed, including that the follow-up period may have been too short, the intervention did not focus on calorie restriction, and the post-surgery model of care received from the standard care group may have provided enough support to diminish weight loss outcome differences between groups”.

Nonetheless, this research shows that CBT and psychological interventions are an important part of psychological aftercare in obesity treatment. Results from this research provide data to support the widespread use of CBT to support patients with difficulties after bariatric surgery.

The research team is continuing to update their findings as data collection for this study is still in progress. The researchers will be following these patients up to 3-years post-surgery to determine whether the improvements in mood and disordered eating are maintained over time, and whether they lead to better weight outcomes long term. This research is important and clearly demonstrates the positive impact of CBT delivered by telephone is both remarkable and timely, especially in the context of virtual care expansion. This research further supports the Canadian Adult Obesity Clinical Practice Guidelines in identifying CBT and psychological interventions as an evidence-based treatment option for individuals living with obesity.