The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial

Sanjeev Sockalingam; Samantha E Leung; Clement Ma; Raed Hawa; Susan Wnuk; Satya Dash; Timothy Jackson; Stephanie E Cassin

doi:10.1007/s11695-022-05981-6

The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial

Obes Surg. 2022 Jun;32(6):1884-1894. doi: 10.1007/s11695-022-05981-6. Epub 2022 Feb 25.

Authors

Sanjeev Sockalingam^{1

2

3

4}, Samantha E Leung⁵, Clement Ma^{6

7}, Raed Hawa^{5

8

9}, Susan Wnuk^{5

8

9}, Satya Dash^{5

10}, Timothy Jackson^{5

11}, Stephanie E Cassin^{8

9

12}

Affiliations

¹ Bariatric Surgery Program, University Health Network, Toronto, ON, M5T 2S8, Canada. sanjeev.sockalingam@camh.ca.
² Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada. sanjeev.sockalingam@camh.ca.
³ Centre for Addiction and Mental Health, ON, M6J 1H4, Toronto, Canada. sanjeev.sockalingam@camh.ca.
⁴ Centre for Mental Health, University Health Network, Toronto, ON, M5G 2C4, Canada. sanjeev.sockalingam@camh.ca.
⁵ Bariatric Surgery Program, University Health Network, Toronto, ON, M5T 2S8, Canada.
⁶ Centre for Addiction and Mental Health, ON, M6J 1H4, Toronto, Canada.
⁷ Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.
⁸ Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.
⁹ Centre for Mental Health, University Health Network, Toronto, ON, M5G 2C4, Canada.
¹⁰ Department of Medicine, University of Toronto, Toronto, ON, M5S 3H2, Canada.
¹¹ Division of General Surgery, University Health Network, University of Toronto, Toronto, ON, M5T 2S8, Canada.
¹² Department of Psychology, Ryerson University, Toronto, ON, M5B 2K3, Canada.

Abstract

Background: Patients undergoing bariatric surgery have high rates of psychiatric comorbidity, which may increase their vulnerability to COVID-19-related mental health distress. Exacerbation of mental health distress and disordered eating could have significant negative effects on long-term weight management and quality of life for these patients if untreated.

Objective: To determine the efficacy of a telephone-based cognitive behavioral therapy (Tele-CBT) intervention in improving depressive, anxiety, and disordered eating symptoms during COVID-19.

Methods: Participants were recruited as part of a larger randomized controlled trial study (clinicaltrials.gov ID: NCT03315247) between March 2020 and March 2021 and randomized 1:1 to receive Tele-CBT or standard bariatric care. Outcomes of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Emotional Eating Scale (EES), and Binge Eating Scale (BES) were measured at baseline, immediately post-intervention, and 3 months post-intervention. Linear mixed models were used to test the effect of intervention group, time, and group-by-time interaction for each outcome.

Results: Eighty-one patients were included in the intention-to-treat analysis. Mean (SD) age of participants was 47.68 (9.36) years and 80.2% were female. There were significant group-by-time interactions for all outcomes and significant differences between groups across time. There were significant decreases in mean GAD-7 (p = 0.001), PHQ-9 (p < 0.001), EES-Total (p = 0.001), EES-Anger (p = 0.003), EES-Anxiety (p < 0.001), EES-Depression (p < 0.001), and BES (p = 0.002) scores for the Tele-CBT group at post-intervention and follow-up when compared to baseline and the control group.

Conclusion: Tele-CBT is a feasible and effective treatment for improving psychological distress and disordered eating among post-operative bariatric surgery patients during the COVID-19 pandemic.

Keywords: China; Covid-19; Discipline and resistance; Foucault; Online compulsory education.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Bariatric Surgery* / methods
COVID-19*
Cognitive Behavioral Therapy* / methods
Feeding and Eating Disorders* / therapy
Female
Humans
Male
Mental Health
Middle Aged
Obesity, Morbid* / surgery
Pandemics
Quality of Life
Telephone
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03315247

Grants and funding

317877/CIHR/Canada