Purpose: Bariatric surgery is one of the most effective treatments of obesity, but some patients regain weight post-operatively. Continuum of disordered eating behaviors and emotional eating are among the main predictors of weight regain. The purpose of this study was to investigate the effects of cognitive behavioral therapy (CBT) on Body Mass Index (BMI), emotional eating and mindful eating of post-bariatric surgery patients. We also aimed to find out the best time for post-surgical application of CBT.
Study design: The study was designed as a randomized control trial. A total of 60 post-bariatric surgery patients were randomized into two groups: (1) 30 patients received only nutritional education (ONE group); (2) 30 patients received CBT + Nutritional education (CBT + NE group). Acute treatment phase consisted of 5 one in two week sessions, maintenance phase consisted of 3 monthly sessions, and a follow-up session was made at the end of 1 year. Patients were further divided into 3 subgroups: (1) The patients who had surgery more than 2 years ago, (2) The patients who had surgery 1-2 years ago, (3) The patients who had surgery 6 months-1 year ago. All patients were evaluated for BMI, and the Emotional Eating Scale (EES) and Mindful Eating Questionnaire (MEQ) were applied at baseline (1st session), after the acute phase (5th session), at the last session of the maintenance phase (8th session), and at the 1-year follow-up.
Results: BMI of both groups decreased significantly at the end of the acute and maintenance phase, but mean BMI of ONE group increased at the end of the 1st year follow-up while the CBT group preserved the weight loss. EES decreased significantly for both groups at the end of the maintenance phase, but increased for ONE-1 group at the end of the 1 year follow-up while all sub-groups of CBT preserved the decrease of mean EES scores at the 1st year follow-up. For ONE group, there was an increase in MEQ scores and this increase began as early as the 5th session, especially for ONE-3 sub-group (mean scores of MEQ increase from 97.5 to 121.25, p= 0.022), but this increase was not statistically significant for ONE group at the 8th session and 1 year follow-up (p=0.072). For NE + CBT group, the increase in MEQ scores began as early as at the 5th session for NE + CBT-1 (mean scores of MEQ increase from 93.3 to 107.1) and NE + CBT-3 (mean scores of MEQ increase from 86 to 97.14), and remained statistically significant even at the 1-year follow-up (p=0.000).
Conclusion: CBT is effective for continuum of weight loss, decrease of emotional eating and increase of mindful eating of post-bariatric patients, and these beneficial effects of CBT are preserved at the end of 1 year.
Key words: cognitive behavioral therapy, weight loss, bariatric surgery, body mas index, emotional eating, mindful eating
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