Do intensive preoperative and postoperative behavioural interventions impact on health-related bariatric surgery outcomes? A systematic review

Rationale: Although pre- and postoperative support by a multidisciplinary team (MDT) is recommended as best practice, it is unknown if intensive behavioural interventions improve outcomes beyond standard MDT support. This systematic review aimed to evaluate the effect that intensive pre- and postoperative behavioural interventions have on health-related outcomes post-surgery in adult bariatric surgery patients.
Methods: Six databases were searched for intervention studies in any language up until July 2018. Study quality was assessed using the Cochrane Risk of Bias tool.
Results: 6,871 records were screened, identifying 17 eligible publications (n=10 trials; n=1,169 participants in total) which mostly had low to unclear risk of bias. Intensive behavioural interventions addressed lifestyle (n=4 trials), physical activity (n=3 trials), or cognitive behavioural therapy (n=3 trial); which were delivered as preoperative interventions (n=3 trials), postoperative interventions (n=2 trials), or pre- and postoperative intervention (n=5 trials). Intensive interventions varied from weekly to quarterly in frequency, with a duration from 6-weeks to 24-months. No trial which concluded intervention delivery before 6-months post-surgery reported any effect compared with control (n=6 trials). All six trials which commenced or continued MDT delivery 6-months post-surgery reported significant improvements in weight and/or fat loss (n=4 trials) and depression (n=1 trial) compared with control.
Conclusions: For the best outcomes and most efficacious use of resources, intensive multidisciplinary behavioural interventions may be of the greatest value if they commence 6-months postoperatively; with standard multidisciplinary support provided pre- and early postoperatively.