Background

Though surgical interventions are effective in treating patients with severe obesity, approximately 50% will experience weight reoccurrence within the first 1.5 to 2 years. Research from the largest randomized controlled trial (RCT) to date on telephone-based cognitive behavioural therapy (Tele-CBT) for bariatric surgery patients demonstrated sustained improvements in eating pathology and psychological distress 3-months post-intervention. During the follow-up phase of this large multi-site RCT, we examined whether 7-sessions of Tele-CBT delivered at 1-year post-surgery was efficacious in sustaining improvements in emotional eating and psychological distress at 3-years post-surgery.

Methods

306 participants (Tele-CBT, n=152; Control n=154) were recruited from 3 bariatric centres and randomized 1:1 to receive Tele-CBT or standard bariatric care. Eligible participants were 1-year post-operative bariatric surgery. Outcome variables included the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Emotional Eating Scale (EES), and Binge Eating Scale (BES) administered at baseline (1-year post-op), post-intervention, 1.5 years, and 3 years post-surgery.

Results

There were significant decreases on the PHQ-9 (p<.001) GAD-7 (p<.001), BES (p=.003), EES-Total (p<.001), EES-Anger (p<.001), EES-Anxiety (p<.001) and EES-Depression (p<.001) post-Tele-CBT and these significant decreases on outcome variables were maintained 3-months post-intervention. However, 1.5-years post-intervention (i.e., 3-years post-operative), these psychosocial/eating improvements were only maintained on the EES-Total (p=.014), EES-Anger (p=.007), and EES-Anxiety (p=.004).

Conclusions

The short-term benefits of Tele-CBT were not sustained 1.5 years later with the exception of some sustained benefit in emotional eating 3-years post-surgery. Further research is needed on the optimal booster dose of CBT and additional factors contributing to response.