Carlos M Grilo1,2, Valentina Ivezaj1, Andrew J Duffy3, Ralitza Gueorguieva1,4. 1. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. 2. Department of Psychology, Yale University, New Haven, Connecticut, USA. 3. Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA. 4. Department of Biostatistics, Yale School Public Health, New Haven, Connecticut, USA.
Abstract
OBJECTIVE: Loss-of-control (LOC) eating postoperatively is a consistent predictor of suboptimal longer-term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of two guided self-help treatments (cognitive behavioral therapy [gshCBT] and behavioral weight loss [gshBWL]) compared with a control (CON) for reducing LOC eating and weight. METHODS: A total of 140 patients with recurrent LOC eating approximately 6 months after bariatric surgery were randomly assigned (5:5:2 ratio) to one of three conditions: gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24). Three-month treatments were delivered by trained allied health clinicians to increase generalizability to bariatric surgery settings. Independent assessments were performed by doctoral research-clinicians using established interviews/measures; posttreatment outcomes were obtained for 89% of patients. RESULTS: Mixed models revealed significant improvements for LOC eating frequency and weight loss but no significant differences between treatments; race neither predicted (main effect) nor moderated (interaction effect) treatment outcomes. Intent-to-treat categorical analyses of abstinence from LOC eating (30% for gshCBT, 27% for gshBWL, 38% for CON) and proportion attaining 5% weight loss (20%, 22%, 17%) revealed no significant differences between treatments; non-White participants had a higher proportion achieving LOC eating abstinence but a lower proportion attaining 5% weight loss compared with White participants. CONCLUSIONS: In this 12-week randomized controlled trial following bariatric surgery, significant LOC eating reductions and weight loss did not differ significantly between treatments. Race was associated with posttreatment categorical outcomes.
OBJECTIVE: Loss-of-control (LOC) eating postoperatively is a consistent predictor of suboptimal longer-term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of two guided self-help treatments (cognitive behavioral therapy [gshCBT] and behavioral weight loss [gshBWL]) compared with a control (CON) for reducing LOC eating and weight. METHODS: A total of 140 patients with recurrent LOC eating approximately 6 months after bariatric surgery were randomly assigned (5:5:2 ratio) to one of three conditions: gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24). Three-month treatments were delivered by trained allied health clinicians to increase generalizability to bariatric surgery settings. Independent assessments were performed by doctoral research-clinicians using established interviews/measures; posttreatment outcomes were obtained for 89% of patients. RESULTS: Mixed models revealed significant improvements for LOC eating frequency and weight loss but no significant differences between treatments; race neither predicted (main effect) nor moderated (interaction effect) treatment outcomes. Intent-to-treat categorical analyses of abstinence from LOC eating (30% for gshCBT, 27% for gshBWL, 38% for CON) and proportion attaining 5% weight loss (20%, 22%, 17%) revealed no significant differences between treatments; non-White participants had a higher proportion achieving LOC eating abstinence but a lower proportion attaining 5% weight loss compared with White participants. CONCLUSIONS: In this 12-week randomized controlled trial following bariatric surgery, significant LOC eating reductions and weight loss did not differ significantly between treatments. Race was associated with posttreatment categorical outcomes.
Authors: Carol B Peterson; James E Mitchell; Scott J Crow; Ross D Crosby; Stephen A Wonderlich Journal: Am J Psychiatry Date: 2009-11-02 Impact factor: 18.112
Authors: Anita P Courcoulas; Wendy C King; Steven H Belle; Paul Berk; David R Flum; Luis Garcia; William Gourash; Mary Horlick; James E Mitchell; Alfons Pomp; Walter J Pories; Jonathan Q Purnell; Ashima Singh; Konstantinos Spaniolas; Richard Thirlby; Bruce M Wolfe; Susan Z Yanovski Journal: JAMA Surg Date: 2018-05-01 Impact factor: 14.766