title: Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study.
abstract: BACKGROUND
  (Extreme) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences. Bariatric surgery is an effective intervention for obesity, but approximately 20 to 30% of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies. This study examines the added value of pre-operative cognitive behavioral therapy (CBT) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style. We hypothesize that pre-operative CBT will result in better weight loss maintenance, reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone.
  
  
  METHODS
  One hundred and twenty eight patients that are on a waiting list for bariatric surgery are randomly assigned to the control or treatment condition. Patients in the treatment condition receive 10 sessions of CBT before surgery aimed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery. Weight loss, eating behavior, eating disorders, depression, quality of life and psychological distress are assessed before and after treatment, as well as 1, 3, and 5 year following surgery.
authors: Department of Eating Disorders PsyQ, Parnassia Psychiatric Institute, Rotterdam, The Netherlands. Electronic address: l.paul@psyq.nl.
authors: Linda
authors: L
authors: Paul
authors: Department of Eating Disorders PsyQ, Parnassia Psychiatric Institute, Rotterdam, The Netherlands; Department of bariatric surgery, Sint Franciscus Hospital, Rotterdam, The Netherlands.
authors: Sofie
authors: S
authors: van Rongen
authors: Parnassia Academy, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors: Daphne
authors: D
authors: van Hoeken
authors: Parnassia Academy, Parnassia Psychiatric Institute, The Hague, The Netherlands; Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands.
authors: Mathijs
authors: M
authors: Deen
authors: Department of bariatric surgery, Maasstad Hospital, Rotterdam, The Netherlands.
authors: René
authors: R
authors: Klaassen
authors: Department of bariatric surgery, Sint Franciscus Hospital, Rotterdam, The Netherlands.
authors: L Ulas
authors: LU
authors: Biter
authors: Parnassia Academy, Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA.
authors: Hans W
authors: HW
authors: Hoek
authors: Department of Research and Development PsyQ, Parnassia Psychiatric Institute, Rotterdam, The Netherlands.
authors: Colin
authors: C
authors: van der Heiden
mesh_terms: D050110:Bariatric Surgery / Q000379:methods* / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology; D015444:Exercise; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D013315:Stress, Psychological / Q000523:psychology; D015431:Weight Loss
keywords: Bariatric surgery; Cognitive behavioral therapy; Obesity; Randomized controlled trial