Behavioral Intervention for Weight Loss Failure After Bariatric Surgery

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

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Abstract

[unreadable] DESCRIPTION (provided by applicant): [unreadable] This R03 application is submitted in response to PAR-06-172: Small Grant Program for NIDDK K08/K23 Recipients. In collaboration with her mentors, the applicant plans to extend her Mentored Patient-Oriented Research Career Development Award (Optimizing Lifestyle Adjustment in Weight Loss Surgery, K23 DK62291) into the closely related area of the treatment of long-term weight loss failure. Failure, defined as inadequate weight loss or significant weight regain, occurs in approximately 20% of bariatric surgery patients. Although the mechanisms for postoperative weight loss and regain are not fully understood, several cross-sectional and retrospective studies indicate postoperative binge eating may play a role. We think that behavioral weight control is the logical first step in the management of failure in bariatric surgery because it is associated with both modest, short- term reductions in body weight as well as decreases in binge eating in individuals who are overweight or obese. However, to our knowledge, no published studies have utilized behavioral weight control for individuals with weight loss failure after bariatric surgery. [unreadable] In this application, we propose a pilot study to assess the feasibility and preliminary efficacy of a 17- session, manualized group treatment based on empirically supported techniques for weight control, Behavioral Intervention for Bariatric Surgery Failure (INTERVENTION). Following a startup period to refine our approach, 40 gastric bypass patients with long-term (defined as at least 2 years) weight loss failure (defined as being obese and no longer losing weight, with post-surgical weight loss less than 50% of excess weight) will be randomized to INTERVENTION or a wait list CONTROL group. Our first aim is to document feasibility of behavioral intervention as measured by the primary outcome of dropout among those randomized to INTERVENTION, as well as treatment attendance and program satisfaction. Our second aim is to document the preliminary efficacy of the approach by comparing patients in INTERVENTION to CONTROL with respect to the primary outcome of weight loss, as well as select outcomes in the domains of eating, activity, cardiovascular risk, and quality of life, at post- intervention as well as a 6- month post-treatment follow-up. Pilot data will support the submission of a full-scale R01 application at the end of the 2-year study period, and complement the applicant's programmatic patient-oriented research in bariatric surgery. [unreadable] Obesity is recognized as a public health crisis, associated with significant medical and psychosocial comorbidity, and high health care costs. Bariatric surgery is recommended for the growing population of adults who are severely obese, and the number of surgeries performed each year continues to rise. Efforts to identify feasible and efficacious treatments for the 1 in 5 patients who experience long-term weight loss failure after bariatric surgery, an understudied subgroup of the obese population, will have a major public health impact by informing the development of best practices for their longitudinal, multidisciplinary management. [unreadable] [unreadable]