title: Preoperative lifestyle intervention in bariatric surgery: a randomized clinical trial.
abstract: BACKGROUND
  Studies on the impact of presurgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed.
  
  
  OBJECTIVE
  To evaluate whether a presurgery behavioral lifestyle intervention improves weight loss through a 24-month postsurgery period.
  
  
  METHODS
  Bariatric Center of Excellence at a large, urban medical center.
  
  
  METHODS
  Candidates for bariatric surgery were randomized to a 6-month behavioral lifestyle intervention or to 6 months of usual presurgical care. The lifestyle intervention consisted of 8 weekly face-to-face sessions, followed by 16 weeks of face-to-face and telephone sessions before surgery; the intervention also included 3 monthly telephone contacts after surgery. Assessments were conducted 6, 12, and 24 months after surgery.
  
  
  RESULTS
  Participants who underwent surgery (n = 143) were 90.2% female and 86.7% White. Average age was 44.9 years, and average body mass index was 47.5 kg/m(2) at study enrollment. At follow-up, 131 (91.6%), 126 (88.1%), 117 (81.8%) patients participated in the 6-, 12-, and 24-month assessments, respectively. Percent weight loss from study enrollment to 6 and 12 months after surgery was comparable for both groups, but at 24 months after surgery, the lifestyle group had significantly smaller percent weight loss compared with the usual care group (26.5% versus 29.5%, respectively, P = .02).
  
  
  CONCLUSIONS
  Presurgery lifestyle intervention did not improve weight loss at 24 months after surgery. The findings from this study raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Duquesne University School of Nursing, Pittsburgh, Pennsylvania. Electronic address: kalarchianm@duq.edu.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Kalarchian
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Marsha D
authors.initials: MD
authors.lastname: Marcus
authors.affiliation: Department of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Anita P
authors.initials: AP
authors.lastname: Courcoulas
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Michele D
authors.initials: MD
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery; D001521:Behavior Therapy / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult
keywords: Bariatric surgery; Behavioral weight control.; Preoperative intervention