Cognitive Behavioral Therapy Didn’t Lead to Additional Weight Loss After Bariatric Surgery

A woman talks to someone on her phone.
A new study looked at how therapy via the telephone helped people after bariatric surgery. Renata Angerami/Getty Images
  • Bariatric surgery is widely considered to be the most effective known treatment for adults living with severe obesity.
  • Now a new study finds that cognitive behavioral therapy may help people after bariatric surgery deal with disordered eating and anxiety.
  • The therapy is not linked to additional weightloss.

Keeping weight off after bariatric surgery is challenging, both mentally and physically. Now, it appears that a common counseling technique is effective at improving post-surgery mental health — and you can even do it over the phone.

Researchers studied how people, who had undergone bariatric surgery, were impacted by taking part in cognitive behavioral therapy (CBT) after the procedure.

Bariatric surgery is widely considered to be the most effective known treatment for adults living with severe obesity. Put simply: it helps individuals lose weight and keep it off long-term, while also often improving cholesterol and blood pressure. 

But just because it is effective, doesn’t mean that it’s easy. 

Patients who have undergone bariatric surgery have to actively maintain their weight loss through diet and exercise. That struggle can take a toll on mental health, as patients often simultaneously deal with depression, anxiety, and unhealthy eating habits.

And regaining weight after bariatric surgery has serious health implications as well.

The study found people getting CBT appeared to have less mental distress, but that they were not likely to have lost additional weight compared to the group who did not get the therapy.

Telephone-based CBT Appears Promising

Mental health, psychiatric disorders, and obesity are all closely intertwined.  Doctors have, therefore, taken the prudent step of researching how counseling can improve quality of life, mental health, and eating disorders for those who have undergone bariatric surgery.

In a new study, published August 3 in JAMA, researchers looked at how effective CBT administered by telephone one year after bariatric weight loss surgery was on weight loss, disordered eating, and psychological distress. The researcher’s primary objective was to identify if CBT was associated with a higher percentage of total weight loss compared to a control group. 

The researchers found that the CBT group did not see a high percentage of weight loss.

But they did find positive benefits of getting the therapy.

The study found that CBT was helpful in improving two other outcomes: disordered eating and mental distress. There’s also an additional silver lining to the study: highlighting the effectiveness of telephone-based counseling. 

“This study is significant as it is the largest randomized controlled trial examining the effectiveness of CBT on disordered eating, psychological distress and weight loss after bariatric surgery. The results showed significant improvements in eating behaviors and reductions in anxiety and depressive symptoms after bariatric surgery,” Dr. Sanjeev Sockalingam, a Professor of Psychiatry at the University of Toronto, Director of Obesity Canada, and lead author of the study told Healthline.

The Largest Randomized Controlled Trial On The Effectiveness Of CBT

The study involved 306 participants who had received bariatric surgery. Roughly half were put into a group that received telephone-based CBT as part of their post-surgical care. The other half, representing the control group, did not receive CBT. One year after surgery, patients in the CBT group received six weekly hour-long sessions, plus an additional “booster” session one month later. Researchers then followed up with patients six months later, 18 months after their surgery to look at outcomes. 

Sockalingam and his team looked at three outcomes: percentage total weight loss, disordered eating, and psychological distress. Disordered eating and psychological stress were analyzed using standardized psychological questionnaires and scales, like the Binge Eating Scale (BES) and Generalized Anxiety Disorder (GAD) scale. Percentage weight loss for both groups were almost identical (although the CBT group did see slightly more improvement). However, the CBT group saw significant improvement in scores for both disordered eating and psychological distress.

Dr. Debra L. Safer, a Psychiatrist and Professor of Psychiatry and Behavioral Sciences Stanford, and  Co-Director of Stanford’s eating disorder clinic, told Healthline, “It’s very encouraging that a relatively brief treatment, only six sessions, by telephone was effective in ways that were not only seen after the intervention but were maintained through followup.”

Dr. Safer wasn’t involved in the research.

Treating Obesity Requires Long-Term Solutions

She emphasized that treating obesity is a multifactorial endeavor: “You don’t only judge treatments based on weight loss,” she said.

Rachel Goldman, a Clinical Psychologist in private practice in NYC and Clinical Assistant Professor in the Dept of Psychiatry, NYU Grossman School of Medicine, unaffiliated with the research, told Healthline that the study shows that telehealth really works.

“CBT is an effective, evidence-based treatment for disordered eating and obesity, but this study adds to the current literature in the way that it can be provided in a telephone-based approach and still be effective,” she said.

As for the weight loss question: all three are optimistic that CBT could help with that as well, in the long run. Although the study included a large sample size, the follow-up time was relatively short for bariatric surgery. Sockalingam notes that most patients usually don’t start to experience weight regain until at least two years after surgery. But the fact that CBT was helpful in treating some of the base causes of weight regain — binge eating, emotional eating, anxiety, and depression — is promising for helping to keep weight off long term.

“We tend to call at least the first six months ‘the honeymoon phase,’” said Dr. Goldman. “It’s really not until the two-year point that we tend to start seeing some weight recurrence happening…Given the fact that CBT helped improve psychological outcomes, I would anticipate less weight recurrence.”

Who Should Get Bariatric Surgery?

Bariatric surgery is generally only recommended for individuals with a BMI of 35 or higher, or those who have obesity and also have certain comorbidities, like type 2 diabetes.

Obesity is defined by the CDC as having a body mass index (BMI) of 30 or greater. Obesity is also further stratified into three subcategories:  Class 1 (BMI of 30 to < 35), Class 2 (35 to < 40), and Class 3(40 or higher), also categorized as “severe” obesity. 

In the United States, more than 40% of all adults have obesity. Rates of the disease have risen dramatically in the past two decades: increasing from 30.5% in 1999 to 41.9% in 2021, while cases of severe obesity nearly doubled from 4.7% to 9.2%. The annual medical cost of obesity in 2019 was $173 billion dollars.

Bariatric surgery is effective, but is only recommended for individuals fitting certain criteria. The best prevention for obesity is everyday lifestyle changes, like getting more exercise, more sleep, and eating a healthier diet.

The Bottom Line

Researchers conducted the largest to-date randomized controlled trial on the effectiveness of CBT in people who have had bariatric surgery.

Telephone-based Cognitive Behavioral Therapy appears effective at improving binge eating, emotional eating, anxiety, and depression.

Implications from the study are positive for the effectiveness of telephone-based mental health solutions.

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