Skip to main content
Erschienen in: Obesity Surgery 6/2016

05.09.2015 | Original Contributions

Behavioural Interventions for Severe Obesity Before and/or After Bariatric Surgery: a Systematic Review and Meta-analysis

verfasst von: Fiona Stewart, Alison Avenell

Erschienen in: Obesity Surgery | Ausgabe 6/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

Significant, sustained weight loss through conventional, non-surgical interventions is often unattainable for people with severe obesity (e.g. BMI ≥40 or ≥35 kg/m2 with co-morbidities). Bariatric surgery is effective in treating severe obesity, but surgery alone without additional behaviour change management may not result in optimum long-term weight loss and maintenance. This systematic review and meta-analysis of randomised controlled trials evaluated the effectiveness of lifestyle interventions before and/or after bariatric surgery.

Methods

MEDLINE, Embase, Cochrane Central Register of Controlled Trials and clinical trials registers were searched for eligible studies. Key journals were handsearched. Last search date was on December 2014. Eligible interventions had the explicit aim of changing behaviour related to diet and/or physical activity, starting within 12 months of surgery, either pre- or post-operatively, and with at least 6 months’ follow-up. The primary outcome was weight change; secondary outcomes included surgical complications, quality of life and changes in co-morbidities. Random effect meta-analyses were undertaken. Study quality was assessed with the Cochrane Collaboration’s risk of bias tool.

Results

Eleven trials met the inclusion criteria. Behavioural interventions appear to improve weight loss at 12 months after bariatric surgery. Secondary outcome data were lacking and weight outcomes were reported inconsistently. Overall, the methodological quality of the identified trials was low.

Conclusions

The strength of evidence is limited by the relatively small number of trials identified and by their low methodological quality and short follow-up duration. Well-designed randomised controlled trials (RCTs) with long-term follow-up are required.
Literatur
2.
Zurück zum Zitat Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. CrossRef Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. CrossRef
3.
Zurück zum Zitat Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. CrossRefPubMedPubMedCentral Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. J Am Med Assoc. 2013;310(22):2416–25. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. J Am Med Assoc. 2013;310(22):2416–25.
6.
Zurück zum Zitat Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93. CrossRefPubMed Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93. CrossRefPubMed
7.
Zurück zum Zitat Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA - J Am Med Assoc. 2014;311(22):2297–304. CrossRef Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA - J Am Med Assoc. 2014;311(22):2297–304. CrossRef
8.
Zurück zum Zitat Sarwer DB, Dilks RJ, West-Smith L. Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. Surg Obes Relat Dis. 2011;7(5):644–51. CrossRefPubMed Sarwer DB, Dilks RJ, West-Smith L. Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. Surg Obes Relat Dis. 2011;7(5):644–51. CrossRefPubMed
9.
12.
Zurück zum Zitat Expert panel report. Guidelines (2013) for the management of overweight and obesity in adults. Obesity. 2014;22(Suppl2):S41–410. Expert panel report. Guidelines (2013) for the management of overweight and obesity in adults. Obesity. 2014;22(Suppl2):S41–410.
13.
Zurück zum Zitat Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(Suppl1):S1–27. CrossRefPubMedPubMedCentral Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(Suppl1):S1–27. CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Livhits M, Mercado C, Yermilov I, et al. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Relat Dis. 2009;5(6):713–21. CrossRefPubMed Livhits M, Mercado C, Yermilov I, et al. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Relat Dis. 2009;5(6):713–21. CrossRefPubMed
15.
Zurück zum Zitat Livhits M, Mercado C, Yermilov I, et al. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obes Rev. 2011;12(2):142–8. CrossRefPubMed Livhits M, Mercado C, Yermilov I, et al. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obes Rev. 2011;12(2):142–8. CrossRefPubMed
16.
Zurück zum Zitat Rudolph A, Hilbert A. Post-operative behavioural management in bariatric surgery: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2013;14(4):292–302. CrossRefPubMed Rudolph A, Hilbert A. Post-operative behavioural management in bariatric surgery: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2013;14(4):292–302. CrossRefPubMed
17.
Zurück zum Zitat Beck NN, Johannsen M, Stoving RK, et al. Do postoperative psychotherapeutic interventions and support groups influence weight loss following bariatric surgery? A systematic review and meta-analysis of randomized and nonrandomized trials. Obes Surg. 2012;22(11):1790–7. CrossRefPubMed Beck NN, Johannsen M, Stoving RK, et al. Do postoperative psychotherapeutic interventions and support groups influence weight loss following bariatric surgery? A systematic review and meta-analysis of randomized and nonrandomized trials. Obes Surg. 2012;22(11):1790–7. CrossRefPubMed
20.
Zurück zum Zitat Dodsworth A, Warren-Forward H, Baines S. Feasibility of a protein-enriched diet after laparoscopic adjustable gastric banding: results from a pilot intervention. e-SPEN J. 2012;7(2):e57–63. CrossRef Dodsworth A, Warren-Forward H, Baines S. Feasibility of a protein-enriched diet after laparoscopic adjustable gastric banding: results from a pilot intervention. e-SPEN J. 2012;7(2):e57–63. CrossRef
21.
Zurück zum Zitat Lier HO, Biringer E, Stubhaug B, et al. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial. Patient Educ Couns. 2012;87(3):336–42. CrossRefPubMed Lier HO, Biringer E, Stubhaug B, et al. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial. Patient Educ Couns. 2012;87(3):336–42. CrossRefPubMed
22.
Zurück zum Zitat Nijamkin MP, Campa A, Sosa J, et al. Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial. J Acad Nutr Diet. 2012;112(3):382–90. CrossRefPubMed Nijamkin MP, Campa A, Sosa J, et al. Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial. J Acad Nutr Diet. 2012;112(3):382–90. CrossRefPubMed
24.
Zurück zum Zitat Papalazarou A, Yannakoulia M, Kavouras SA, et al. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Obesity. 2010;18:1348–53. CrossRefPubMed Papalazarou A, Yannakoulia M, Kavouras SA, et al. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Obesity. 2010;18:1348–53. CrossRefPubMed
25.
Zurück zum Zitat Parikh M, Dasari M, McMacken M, et al. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study. Surg Endosc. 2012;26(3):853–61. CrossRefPubMed Parikh M, Dasari M, McMacken M, et al. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study. Surg Endosc. 2012;26(3):853–61. CrossRefPubMed
26.
Zurück zum Zitat Sarwer DB, Moore RH, Spitzer JC, et al. A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Surg Obes Relat Dis. 2012;8(5):561–8. CrossRefPubMed Sarwer DB, Moore RH, Spitzer JC, et al. A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Surg Obes Relat Dis. 2012;8(5):561–8. CrossRefPubMed
27.
Zurück zum Zitat Swenson BR, Saalwachter SA, Edwards MJ, et al. The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial. J Surg Res. 2007;142:308–13. CrossRefPubMed Swenson BR, Saalwachter SA, Edwards MJ, et al. The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial. J Surg Res. 2007;142:308–13. CrossRefPubMed
28.
Zurück zum Zitat Lier HO, Biringer E, Stubhaug B, et al. Psychiatric disorders and participation in pre- and postoperative counselling groups in bariatric surgery patients. Obes Surg. 2011;21(6):730–7. CrossRefPubMed Lier HO, Biringer E, Stubhaug B, et al. Psychiatric disorders and participation in pre- and postoperative counselling groups in bariatric surgery patients. Obes Surg. 2011;21(6):730–7. CrossRefPubMed
29.
Zurück zum Zitat Solomon H, Liu GY, Alami R, et al. Benefits to patients choosing preoperative weight loss in gastric bypass surgery: new results of a randomized trial. J Am Coll Surg. 2009;208:241–5. CrossRefPubMed Solomon H, Liu GY, Alami R, et al. Benefits to patients choosing preoperative weight loss in gastric bypass surgery: new results of a randomized trial. J Am Coll Surg. 2009;208:241–5. CrossRefPubMed
30.
Zurück zum Zitat Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3:141–5. CrossRefPubMed Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3:141–5. CrossRefPubMed
31.
Zurück zum Zitat Hollywood A, Ogden J, Pring C. The impact of a bariatric rehabilitation service on weight loss and psychological adjustment—study protocol. BMC Public Health. 2012;12:275. CrossRefPubMedPubMedCentral Hollywood A, Ogden J, Pring C. The impact of a bariatric rehabilitation service on weight loss and psychological adjustment—study protocol. BMC Public Health. 2012;12:275. CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Coen PM, Tanner CJ, Helbling NL, et al. Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity. J Clin Investig. 2015;125(1):248–57. CrossRefPubMedPubMedCentral Coen PM, Tanner CJ, Helbling NL, et al. Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity. J Clin Investig. 2015;125(1):248–57. CrossRefPubMedPubMedCentral
33.
Zurück zum Zitat Nijamkin MP, Campa A, Samiri Nijamkin S, et al. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic americans. J Nutr Educ Behav. 2013;45(6):620–6. CrossRef Nijamkin MP, Campa A, Samiri Nijamkin S, et al. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic americans. J Nutr Educ Behav. 2013;45(6):620–6. CrossRef
35.
Zurück zum Zitat Tucker JA, Samo JA, Rand CSW, et al. Behavioral interventions to promote adaptive eating behavior and lifestyle changes following surgery for obesity: results of a two-year outcome evaluation. Int J Eat Disord. 1991;10:689–98. CrossRef Tucker JA, Samo JA, Rand CSW, et al. Behavioral interventions to promote adaptive eating behavior and lifestyle changes following surgery for obesity: results of a two-year outcome evaluation. Int J Eat Disord. 1991;10:689–98. CrossRef
39.
Zurück zum Zitat Shah M, Snell PG, Rao S, et al. High-volume exercise program in obese bariatric surgery patients: a randomized, controlled trial. Obesity. 2011;19:1826–34. CrossRefPubMed Shah M, Snell PG, Rao S, et al. High-volume exercise program in obese bariatric surgery patients: a randomized, controlled trial. Obesity. 2011;19:1826–34. CrossRefPubMed
40.
Zurück zum Zitat Marchesi F, De Sario G, Reggiani V, et al. Road running after gastric bypass for morbid obesity: rationale and results of a new protocol. Obes Surg. 2014. doi: 10.​1007/​s11695-014-1517-2. Marchesi F, De Sario G, Reggiani V, et al. Road running after gastric bypass for morbid obesity: rationale and results of a new protocol. Obes Surg. 2014. doi: 10.​1007/​s11695-014-1517-2.
41.
Zurück zum Zitat Bond DS, Thomas JG, King WC, et al. Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Obesity. 2015;23(3):536–42. CrossRefPubMedPubMedCentral Bond DS, Thomas JG, King WC, et al. Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Obesity. 2015;23(3):536–42. CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Egberts K, Brown WA, Brennan L, et al. Does exercise improve weight loss after bariatric surgery? A systematic review. Obes Surg. 2012;22(2):335–41. CrossRefPubMed Egberts K, Brown WA, Brennan L, et al. Does exercise improve weight loss after bariatric surgery? A systematic review. Obes Surg. 2012;22(2):335–41. CrossRefPubMed
44.
Zurück zum Zitat Kalarchian MA, Marcus MD, Courcoulas AP, et al. Optimizing long-term weight control after bariatric surgery: a pilot study. Surg Obes Relat Dis. 2012;8(6):710–5. CrossRefPubMedPubMedCentral Kalarchian MA, Marcus MD, Courcoulas AP, et al. Optimizing long-term weight control after bariatric surgery: a pilot study. Surg Obes Relat Dis. 2012;8(6):710–5. CrossRefPubMedPubMedCentral
45.
Zurück zum Zitat Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51. CrossRefPubMed Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008;18(6):648–51. CrossRefPubMed
46.
Zurück zum Zitat Giordano S, Victorzon M. The impact of preoperative weight loss before laparoscopic gastric bypass. Obes Surg. 2014;24(5):669–74. CrossRefPubMed Giordano S, Victorzon M. The impact of preoperative weight loss before laparoscopic gastric bypass. Obes Surg. 2014;24(5):669–74. CrossRefPubMed
47.
Zurück zum Zitat Leahey TM, Bond DS, Irwin SR, et al. When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery? Surg Obes Relat Dis. 2009;5(1):99–102. CrossRefPubMed Leahey TM, Bond DS, Irwin SR, et al. When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery? Surg Obes Relat Dis. 2009;5(1):99–102. CrossRefPubMed
48.
Zurück zum Zitat Heinberg LJ, Schauer PR. Pilot testing of a portion-controlled, commercially available diet on presurgical weight loss and metabolic outcomes in patients undergoing bariatric surgery. Obes Surg. 2014;24(10):1817–20. CrossRefPubMed Heinberg LJ, Schauer PR. Pilot testing of a portion-controlled, commercially available diet on presurgical weight loss and metabolic outcomes in patients undergoing bariatric surgery. Obes Surg. 2014;24(10):1817–20. CrossRefPubMed
49.
Zurück zum Zitat Hopkins JC, Howes N, Chalmers K, et al. Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. Obes Rev. 2015;16(1):88–106. CrossRefPubMed Hopkins JC, Howes N, Chalmers K, et al. Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. Obes Rev. 2015;16(1):88–106. CrossRefPubMed
50.
Zurück zum Zitat van de Laar A. Bariatric Outcomes Longitudinal Database (BOLD) suggests excess weight loss and excess BMI loss to be inappropriate outcome measures, demonstrating better alternatives. Obes Surg. 2012;22(12):1843–7. CrossRefPubMed van de Laar A. Bariatric Outcomes Longitudinal Database (BOLD) suggests excess weight loss and excess BMI loss to be inappropriate outcome measures, demonstrating better alternatives. Obes Surg. 2012;22(12):1843–7. CrossRefPubMed
51.
Zurück zum Zitat Kalarchian M, Turk M, Elliott J, et al. Lifestyle management for enhancing outcomes after bariatric surgery. Obes Surg. 2014;14(10):540. Kalarchian M, Turk M, Elliott J, et al. Lifestyle management for enhancing outcomes after bariatric surgery. Obes Surg. 2014;14(10):540.
Metadaten
Titel
Behavioural Interventions for Severe Obesity Before and/or After Bariatric Surgery: a Systematic Review and Meta-analysis
verfasst von
Fiona Stewart
Alison Avenell
Publikationsdatum
05.09.2015
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 6/2016
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1873-6

Weitere Artikel der Ausgabe 6/2016

Obesity Surgery 6/2016 Zur Ausgabe

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Chirurgie und bleiben Sie gut informiert – ganz bequem per eMail.