The effectiveness of psychosocial interventions to support psychological well- being in post-operative bariatric patients: a systematic review of evidence

Background: Bariatric surgery is considered an effective obesity management intervention for individuals with a BMI greater than 40, or 35 with co-morbidities. However, research documents that psychological difficulties prevalent amongst individuals seeking surgery may persist post-operatively. This systematic review aims to assess the evidence to show which psychosocial interventions support psychological well-being post-operatively. Methods: The review is registered with Prospero (CRD42018100280) and complies with PRISMA guidelines. The research protocol included grey literature and database searches of psychosocial interventions for post-operative bariatric patients, between November 2017 and September 2019. The primary outcome was psychological well-being; secondary outcomes included weight loss maintenance and quality of life. The primary reviewer screened titles and extracted data. Study quality was assessed independently by two reviewers, using the Effective Public Health Practice Project criteria. Due to heterogeneity across studies, narrative synthesis was considered suitable for data analysis. Results: Ten studies met inclusion criteria. Psychosocial intervention content was delivered in a variety of ways (e.g., clinic, internet-based). Overall, participants (N=382, Mage = 46.4) receiving psychosocial interventions post bariatric surgery, demonstrated improvements in psychological well-being and weight loss maintenance, compared to baseline measures and/or controls. The strength of evidence is currently limited by the small number of studies found and study quality, limiting the power to detect clinically meaningful changes; findings should therefore be considered preliminary. Conclusion: Preliminary findings suggest that interdisciplinary interventions including acceptance-based approaches, psycho- education, nutrition and lifestyle modification, delivered 1-year post-operative, are promising. Further scientific enquiry is warranted with well-designed studies and long-term follow-ups.