Introduction
Materials and Methods
Trial Design, Setting, and Participants
Interventions
Sessions | Session content |
---|---|
Session 1 (face-to-face) Both groups | • Establishing rapport with the patient in order to facilitate a good therapeutic working alliance. • Providing information about the interventions to all patients. • Conducting the baseline measurements and perform the randomization and informing the patients about their allocated group. |
Session 2 (face-to-face) | • Introduction to the underlying principles of the therapy (working transparently, collaboratively, time-limited, and using a manual). • Informing the patient about CBT and the treatment plans in the study. • Psychoeducation focusing on the relationships between eating behaviors, cognitive and behavioral patterns, affect regulation, and obesity, thus introducing the patients to the CBT model. • Introducing and explaining homework sheets for sessions 3 and 4. |
Sessions 3 + 4 (telephone) | • Reviewing the patient’s homework sheets. • Recognizing and addressing dysfunctional eating behaviors. • Working with the patient’s behavioral eating patterns (what triggers eating), and the associated cognitions and emotions. • Providing the patients’ means to assess their own perception about recognizing improvement in dysfunctional cognitions and eating behaviors. |
Session 5 (face-to-face) | • Coping with situational “triggers” that may lead to dysfunctional cognitive and eating behavioral patterns. • Working with the patient’s cognitive and behavioral eating patterns (“triggers,” cognition, emotion, and eating behavior). • Introducing and explaining homework sheets for sessions 6 and 7 |
Sessions 6 and 7 (telephone) | • Reviewing the patient’s homework sheets. • Continuing the intervention techniques. • Reinforcing positive changes in eating behaviors. |
Session 8 (face-to-face) | • Continuation or refining intervention techniques (as session 5) by guiding the patient in avoiding situational “triggers” and making a plan for practicing new eating behaviors. • Introducing and explaining home-work sheets for sessions 9 and 10. |
Sessions 9 and 10 (telephone) | • Reviewing the patient’s home-work sheets. • Continuation or refining intervention techniques. |
Session 11 (face-to-face) | • Relapse prevention. • Ending of treatment and helping the patient to maintain positive changes. |
Prespecified Outcomes
Measurements
Dysfunctional Eating Behaviors
Anxiety and Depression
Neuroticism
Resilience
Weight-Related HRQoL
Body Weight and BMI
Sample Size
Randomization
Ethics
Statistical Methods
Results
Participant Characteristics
Total (n = 61) | Intervention (n = 28) | Controls (n = 33) | P value | |
---|---|---|---|---|
Female (yes) | 43 (70%) | 16 (57%) | 27 (82%) | .05 |
Age (years) | 42.4 (10.1) | 44.4 (10.0) | 40.6 (10.2) | .16 |
BMI | 43.5 (4.4) | 43.6 (4.5) | 43.5 (4.4) | .97 |
Procedure | ||||
Gastric bypass | 49 (80%) | 23 (82%) | 26 (79%) | > .99 |
Sleeve | 12 (20%) | 5 (18%) | 7 (21%) |
Primary Outcomes
Outcome variables | Before surgery (T1, n = 98) | 1 year after surgery (T2, n = 80) | 4 years after surgery (T3, n = 61) | ||||||
---|---|---|---|---|---|---|---|---|---|
Mean (95% CI) | Mean difference (95% CI) | g (P value) | Mean (95% CI) | Mean difference (95% CI) | g (P value) | Mean (95% CI) | Mean difference (95% CI) | g (P value) | |
Emotional eating | |||||||||
CBT | 30.5 (25.1, 35.9) | − 18.5 (− 26.0, − 11.0) | .71 (< .001) | 21.4 (15.6, 27.1) | − 7.3 (− 15.6, 1.0) | .31 (.09) | 40.2 (33.3, 47.0) | 5.8 (− 3.5, 15.1) | − .22 (.22) |
Control | 49.0 (43.8, 54.3) | 28.6 (22.7, 34.6) | 34.3 (28.0, 40.7) | ||||||
Uncontrolled eating | |||||||||
CBT | 30.4 (26.4, 34.3) | − 18.2 (− 23.8, − 12.7) | .97 (< .001) | 17.8 (13.5, 22.0) | − 5.6 (− 11.7, 0.6) | .28 (.08) | 30.0 (25.0, 35.2) | 2.6 (− 4.4, 9.5) | − .16 (.47) |
Control | 48.6 (44.7, 52.5) | 23.3 (18.9, 27.7) | 27.5 (22.8, 32.2) | ||||||
Cognitive restraint | |||||||||
CBT | 68.9 (63.6, 74.2) | 20.2 (12.8, 27.6) | .98 (< .001) | 62.6 (56.9, 68.2) | 5.9 (− 2.2, 14.0) | .30 (.16) | 58.5 (51.8, 65.1) | 6.1 (− 3.0, 15.2) | .38 (.19) |
Control | 48.7 (43.6, 53.9) | 56.7 (50.9, 62.5) | 52.4 (46.2, 58.6) | ||||||
BMI | |||||||||
CBT | 42.2 (41.8, 42.5) | − 1.36 (− 1.95, − 0.77) | .28 (< .001) | 30.0 (28.9, 31.1) | 0.47 (− 1.05, 2.00) | − .10 (.72) | 32.0 (30.3, 33.8) | 0.47 (− 1.05, 2.00) | − .05 (.76) |
Control | 43.6 (43.1, 44.1) | 29.5 (28.5, 30.6) | 31.7 (30.3, 33.2) | ||||||
Anxiety | |||||||||
CBT | 4.9 (4.1, 5.6) | − 2.4 (− 3.5, − 1.4) | .69 (< .001) | 4.4 (3.6, 5.2) | − 1.8 (− 2.9, − 0.6) | .57 (.003) | 6.8 (5.8, 7.7) | 0.9 (− 0.4, 2.3) | − .24 (.16) |
Control | 7.3 (6.6, 8.1) | 6.2 (5.3, 7.0) | 5.8 (4.9, 6.7) | ||||||
Depression | |||||||||
CBT | 2.5 (1.6, 3.3) | − 2.6 (− 3.8, − 1.4) | .78 (< .001) | 1.5 (0.9, 2.1) | − 0.5 (− 1.3, 0.4) | .24 (.26) | 3.4 (2.4, 4.4) | 1.6 (0.2, 2.9) | − .56 (.02) |
Control | 5.0 (4.2–5.9) | 2.0 (1.4, 2.6) | 1.9 (1.0, 2.8) |