title: APOLO-Bari, an internet-based program for longitudinal support of bariatric surgery patients: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Despite evidence of successful weight loss for bariatric surgery patients, some patients experience considerable weight regain over the long term. Given the strong association between post-surgery health behaviors and outcomes, aftercare intervention to address key behaviors appears to be a reasonable relapse-prevention strategy. As the burden of obesity rates increases in healthcare centers, an internet-based program appears to be a reasonable strategy for supporting bariatric surgery patients in the long term. The primary purpose of the current project is to develop and test the efficacy and perceived utility of APOLO-Bari.
  
  
  METHODS
  This study is a randomized control trial, which will be conducted in two hospital centers in the North of Portugal; it includes a control group receiving treatment as usual and an intervention group receiving the APOLO-Bari program for one year in addition to treatment as usual. A total of 180 male and female participants who underwent bariatric surgery (gastric sleeve or gastric bypass surgery) for 12 to 20 months will be recruited. Both groups will complete a similar set of questionnaires at baseline, every 4 months until the end of the intervention, and at 6 and 12 months follow-up. Assessment includes anthropometric variables and psychological self-report measures. The primary outcome measure will be weight regain measured at the end of treatment, and at 6 and 12 months follow-up. The secondary aims are to test the cost-effectiveness of the intervention and to investigate psychological predictors and trajectories of weight regain. APOLO-Bari was developed to address the weight regain problem in the bariatric population by offering additional guidance to bariatric patients during the postoperative period. The program includes: (a) a psychoeducational cognitive-behavioral-based self-help manual, (b) a weekly feedback messaging system that sends a feedback statement related to information reported by the participant, and (c) interactive chat sessions scheduled with a trained psychologist in the field.
  
  
  CONCLUSIONS
  APOLO-Bari may play an important role in broadening therapeutic reach to bariatric patients who would not otherwise have continuous support, with important implications for public health treatment.
  
  
  BACKGROUND
  Current Controlled Trials: ISRCTN37668662 .
authors.affiliation: School of Psychology, University of Minho, Campus Gualtar, 4710-037, Braga, Portugal. econceicao@psi.uminho.pt.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Conceição
authors.affiliation: School of Psychology, University of Minho, Campus Gualtar, 4710-037, Braga, Portugal. pmachado@psi.uminho.pt.
authors.forename: Paulo P P
authors.initials: PP
authors.lastname: Machado
authors.affiliation: School of Psychology, University of Minho, Campus Gualtar, 4710-037, Braga, Portugal. anavaz@psi.uminho.pt.
authors.forename: Ana Rita
authors.initials: AR
authors.lastname: Vaz
authors.affiliation: School of Psychology, University of Minho, Campus Gualtar, 4710-037, Braga, Portugal. anapintobastos@hotmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Pinto-Bastos
authors.affiliation: School of Psychology, University of Minho, Campus Gualtar, 4710-037, Braga, Portugal. sofiaramalho@psi.uminho.pt.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ramalho
authors.affiliation: School of Psychology, University of Minho, Campus Gualtar, 4710-037, Braga, Portugal. catiasbsilva@psi.uminho.pt.
authors.forename: Cátia
authors.initials: C
authors.lastname: Silva
authors.affiliation: School of Psychology, University of Minho, Campus Gualtar, 4710-037, Braga, Portugal. filipa.arrojado@gmail.com.
authors.forename: Filipa
authors.initials: F
authors.lastname: Arrojado
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000886:Anthropometry; D050110:Bariatric Surgery / Q000191:economics; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy; D003362:Cost-Benefit Analysis; D030141:Feedback, Psychological; D005247:Feeding Behavior; D005260:Female; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000601:surgery*; D010353:Patient Education as Topic; D011174:Portugal; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D012008:Recurrence; D012107:Research Design; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted / Q000191:economics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain; D015431:Weight Loss; D055815:Young Adult