Cognitive Behavioral Therapy Versus Usual Care Before Bariatric Surgery: One-Year Follow-Up Results of a Randomized Controlled Trial

Linda Paul, Colin van der Heiden, Daphne van Hoeken, Mathijs Deen, Ashley Vlijm, Rene A. Klaassen, L. Ulas Biter, Hans W. Hoek*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

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    Background Although early results of bariatric surgery are beneficial for most patients, some patients regain weight later. Cognitive behavioral therapy (CBT) has been suggested as a way to improve patients' psychological health and maintaining weight loss in the longer term. The added value of preoperative CBT to bariatric surgery was examined. Pre- and posttreatment and 1-year follow-up data are presented.

    Methods In a multi-center randomized controlled trial, CBT was compared to a treatment-as-usual (TAU) control group. Measurements were conducted pre- and posttreatment/pre-surgery (T0 and T1) and at 1-year post-surgery (T2). Patients in the intervention group received 10 individual, weekly sessions of preoperative CBT focused on modifying thoughts and behaviors regarding eating behavior, physical exercise, and postoperative life style. Outcome measures included weight change, eating behavior, eating disorders, depression, quality of life, and overall psychological health.

    Results Though no significant differences between conditions were found per time point, in the CBT, condition scores on external eating, emotional eating, depressive symptoms, and psychological distress decreased significantly more over time between pre- (T0) and posttreatment (T1) pre-surgery compared to TAU. No significant time x condition differences were found at 1-year post-surgery (T2).

    Conclusions Compared to TAU, preoperative CBT showed beneficial effects on eating behavior and psychological symptoms only from pretreatment to posttreatment/pre-surgery, but not from pre-surgery to 1-year post-surgery. Preoperative CBT does not seem to contribute to better long-term outcomes post-surgery. Recent studies suggest that the optimal time to initiate psychological treatment may be early in the postoperative period, before significant weight regain has occurred.

    Original languageEnglish
    Pages (from-to)970–979
    Number of pages10
    JournalObesity Surgery
    Early online date10-Nov-2020
    Publication statusPublished - Mar-2021


    • Cognitive behavioral therapy
    • Bariatric surgery
    • Weight loss
    • Weight change
    • Obesity
    • Eating behavior
    • Eating disorders
    • Depression
    • Quality of life
    • EDE-Q

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