Elsevier

Surgery for Obesity and Related Diseases

Volume 11, Issue 6, November–December 2015, Pages 1349-1360
Surgery for Obesity and Related Diseases

Integrated health original article
A 1-year videoconferencing-based psychoeducational group intervention following bariatric surgery: results of a randomized controlled study

https://doi.org/10.1016/j.soard.2015.05.018Get rights and content

Abstract

Background

For severely obese patients, bariatric surgery has been recommended as an effective therapy.

Objectives

The Bariataric Surgery and Education (BaSE) study aimed to assess the efficacy of a videoconferencing-based psychoeducational group intervention in patients after bariatric surgery.

Setting

The BaSE study is a randomized, controlled multicenter clinical trial involving 117 patients undergoing bariatric surgery (mean preoperative body mass index [BMI] 49.9 kg/m2, SD 6.4). Patients were enrolled between May 2009 and November 2012 and were randomly assigned to receive either conventional postsurgical visits or, in addition, a videoconferencing-based 1-year group program.

Methods

Primary outcome measures were weight in kilograms, health-related quality of life (HRQOL), and general self-efficacy (GSE). Secondary outcome measures were depression symptoms and eating behavior.

Results

94% of the patients completed the study. Mean weight loss for all patients was 45.9 kg (SD 16.4) 1 year after surgery (mean excess weight loss [EWL] 63%). Intention-to-treat analyses revealed no differences in weight loss, EWL, HRQOL, or self-efficacy between study groups at 1 year after surgery. However, patients with clinically significant depression symptoms (CSD) at baseline assigned to the intervention group (n = 29) had a significantly better HRQOL (P = .03), lower depression scores (P = .02), and a trend for a better EWL (.06) 1 year after surgery compared with the control group (n = 20).

Conclusion

We could not prove the efficacy of the group program for the whole study sample. However, results indicate that the intervention is effective for the important subgroup of patients with CSD.

Section snippets

Study design and participants

BaSE was a multicenter and randomized controlled efficacy trial in adult patients who underwent bariatric surgery. In 2009 the study was established at the University Hospital of Heidelberg, University Hospital of Tübingen, and the Hospital Sachsenhausen, Frankfurt, Germany. Between May 2009 and November 2012, we included 117 patients from the 3 surgical departments. Inclusion criteria were adult patients aged≥18 years; severe obesity (BMI≥40 kg/m2 or BMI≥35 kg/m2 with somatic co-morbidities);

Participant characteristics

Of 306 patients approached for the trial, 49 did not meet the eligibility criteria, 95 met at least one exclusion criterion, and 45 patients declined to participate; eventually 117 patients were included in the study. One year after surgery (end of study) 7 patients (6%) were lost to follow-up. Three patients were excluded from the ITT analysis: 1 had not undergone bariatric surgery, and for 2 patients only baseline values were available.

Rates of loss to follow-up did not differ between the

Discussion

To our knowledge, the BaSE study is the first multicenter RCT investigating the effect of a 1-year multidisciplinary psychoeducational program aimed at improving weight loss and psychosocial factors in patients following bariatric surgery. Results of our study provide important and necessary evidence because for many years clinicians, researchers, and health insurers have debated the presumed necessity of a postoperative intervention program.

In summary, patients in our study had reduced their

Conclusion

Results of our RCT study indicate that a videoconferencing-based psychoeducational program is effective for the subgroup of patients with depressive symptoms at baseline. Therefore, the challenge is to detect the patients at risk for psychological complications and noncompliance and to treat them appropriately. As a conclusion of the BaSE study we therefore suggest a stepped care approach for bariatric surgery patients. In the first year, all patients could be monitored at a very low level.

Disclosures

All authors declare no conflict of interest. This work was supported by the Kompetenznetz Adipositas (Competence Network of Obesity) research focus Obesity and the GI Tract, funded by the Federal Ministry of Education and Research (No. 01 GI0843). The funding organization had no influence on the conduct of the study, data analysis, and preparation of the manuscript.

Acknowledgments

The authors would like to thank the participants who made this study possible. We also thank N. Rieber, M. Kramer, and D. Niehoff for their support of the study.

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  • Cited by (0)

    This study was funded by the Federal Ministry of Education and Research (No. 01 GI0843).

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