Assignment: bariatric design

Assignment: bariatric design ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: bariatric design Research Proposal Project: Design (Sampling, Reliability, Validity) Assignment: bariatric design The following components should be addressed in your paper this week: Information on your sample Sampling basic information (age, gender, criteria, etc.) Sample size Explain why your sample is appropriate for your study Reliability Explain how your data collection process is consistent and reliable Explain why your measurement tool is reliable Validity Explain how you will ensure you have a valid sample Explain how you tested the validity of your measurement tool APA formatting, references, and citations are required. bariatric_article_2.pdf bariatric_article.pdf obesity reviews doi: 10.1111/obr.12013 Obesity Treatment/Management Post-operative behavioural management in bariatric surgery: a systematic review and meta-analysis of randomized controlled trials A. Rudolph and A. Hilbert Integrated Research and Treatment Center Summary AdiposityDiseases, Leipzig University Medical Recent research has provided evidence that bariatric surgery maximizes long-term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight loss outcome and weight regain over time. Postoperative behavioural management may facilitate long-term weight control in bariatric surgery population. The objective of this systematic review and metaanalysis was to determine the effects of post-operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta-analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post-operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery. Center, Department of Medical Psychology and Medical Sociology, Behavioral Medicine, University of Leipzig, Leipzig, Germany Received 2 August 2012; revised 29 November 2012; accepted 29 November 2012 Address for correspondence: Dr. A Rudolph, Integrated Research and Treatment Center, AdiposityDiseases, Behavioral Medicine, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany. E-mail: [email protected] Keywords: Bariatric surgery, behavioural intervention, support group, weight loss. obesity reviews (2013) 14, 292–302 Introduction Recent research has provided increasing evidence that bariatric surgery is the treatment of choice for patients with severe obesity at body mass index (BMI) ? 40 kg m2. Surgery significantly minimizes medical comorbidity and maximizes long-term weight loss of up to 20–35% of initial body weight (1–3). Moreover, psychological functioning and health-related quality of life are improved (4–6). 292 14, 292–302, April 2013 However, a substantial number of patients experience poor weight loss and weight regain over time (4,7,8). Among bariatric surgery patients, a mean weight regain of 7% was reported in two studies examining weight loss from 2 years to 6 and 10 years following surgery, respectively (8,9). Insufficient weight loss and weight regain following bariatric surgery could result from physiological factors such as slippage of the gastric band because of pouch dilatation, gastrogastric fistulas occurring after stomach transection, © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity obesity reviews Post-operative behavioural management A. Rudolph & A. Hilbert 293 and enlargement of the gastric pouch and stoma size (10,11). Assignment: bariatric design However, poor weight loss and weight regain more likely result from a return to preoperative eating and lifestyle behaviours (12), from emerging maladaptive eating behaviours following bariatric procedures (13), related malnutrition or gastrointestinal-related events (14) or a lifetime history of depression (15,16). In addition, postoperative eating and lifestyle behaviours might also be affected by psychosocial status following surgery, as some patients’ initial improvement in psychosocial status diminished over time (4). Empirical findings underlined the putative difficulties to adhere to post-operative behaviour changes and revealed significant increases in energy intake during the post-operative period (9,17–19), lower levels of physical activity (20,21), and patterns of uncontrolled eating and grazing (22,23) following bariatric surgery. Indeed, bariatric surgery patients have to comply with substantial changes in (i) eating behaviour, e.g. regular meals during the day to avoid grazing and snacking; (ii) food compositions, e.g. decreased intake of highcarbohydrate foods to avoid dumping syndrome in patients with gastric bypass; (iii) nutrition supplementation, e.g. multivitamins to avoid deficiencies; (iv) psychological issues, e.g. stress reduction to avoid emotional eating and (v) physical activity, e.g. a less sedentary lifestyle to improve body composition. In order to ensure compliance with such changes and to identify patients at need of treatment for relevant psychopathology including eating disorders, the guidelines of the American Society for Metabolic and Bariatric Surgery advised comprehensive management following bariatric surgery to ensure long-term weight loss success: ‘Mental health professionals should be available to help patients adjust to the myriad of psychosocial changes they experience postoperatively’ (p. S149, [24]) and ‘if (maladaptive eating behaviors are) suspected, prompt evaluation by a trained mental health professional should be completed’ (p. S161, [24]). Similarly, European bariatric surgery guidelines recommend post-operative treatment in patients with pre-existing psychopathology, apparent mental disorders or post-operative binge eating (‘loss of control eating’) (25,26). As the number of primary bariatric surgery procedures in Europe has been growing (e.g. a 10-fold increase during the last 5 years with 4,000 annual operations in 2010 in Germany compared with more than 200,000 operations per year in the United States [27,28]), the need for routine post-operative behavioural management rises. Well-established factors central to weight loss and weight maintenance were identified from non-surgical obesity treatment literature and included self-monitoring, continued follow-up contacts and increased physical activity (14). However, post-operative behavioural management comprising those strategies is rarely done and not sufficiently based on evidence (29). Among the few available studies, © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity some evaluated the influence of behavioural management such as behavioural lifestyle interventions and support groups to maximize weight loss following surgery. A systematic review of four retrospective cohort studies examining post-operative support groups provided the first cumulative evidence of a positive association between social support and weight loss after bariatric surgery (30). Other forms of behavioural management (i.e. behavioural therapy or weight loss maintenance programmes) and studies with rigorous methodology (i.e. randomized controlled trials [RCTs]) were not included in that review.Assignment: bariatric design The objective of this systematic review and meta-analysis was to determine the effects of diverse forms of postoperative behavioural management on weight loss after bariatric surgery. Thus, a broad range of approaches to post-operative behavioural management such as support groups, behavioural weight management or psychotherapy was described in detail. Furthermore, associations between these approaches and weight loss were analysed. Methods Inclusion and exclusion criteria Observational studies, treatment studies, and nonrandomized and uncontrolled studies investigating the impact of behavioural management on weight loss after bariatric surgery were included. Discussion papers, reviews, comments and case reports were excluded. Furthermore, eligible studies had to include (i) adult patients (age ? 18 years) who underwent bariatric surgery as defined in the search criteria in the following statements; (ii) post-operative behavioural management that was aimed at post-operative lifestyle change, such as support groups, behavioural weight management or psychotherapy and (iii) outcome variables including any indicator of body weight change after behavioural management, e.g. kilogram, pounds, BMI (kg m2) or percentage of excess weight loss (%EWL). Identification of studies Eligible studies in English and German languages published prior to September 2012 were searched in MEDLINE and PsychINFO electronic databases. Search terms were ‘bariatric surgery’ or ‘weight loss surgery’ or ‘obesity surgery’ or ‘weight reduction surgery’ or ‘biliopancreatic diversion’ or ‘duodenal switch’ or ‘laparoscopic band’ or ‘lap band’ or ‘gastric band’ or ‘gastric bypass’ or ‘gastroplasty’ or ‘gastric sleeve’ or ‘sleeve gastrectomy’ or ‘laparoscopic gastric plication’ and ‘obesity’ and ‘support group’ or ‘psychotherapy’ or ‘group therapy’ or ‘self-management’ or ‘empowerment’ or ‘post-operative management’ or ‘behavioural weight control’ or ‘cognitive–behavioural therapy’ 14, 292–302, April 2013 294 Post-operative behavioural management A. Rudolph & A. Hilbert obesity reviews Information relating to study methodology (i.e. study design, type of operation, number of patients), characteristics of participants (i.e. mean age, gender distribution, and baseline BMI), treatment description (i.e. type, mode of delivery, intensity, frequency) and the treatment effect on weight loss (i.e. %EWL, decrease of weight in kilograms or pounds) was extracted using a standardized data extraction form. Then, information was tabulated according to the methodological quality of included studies (i.e. RCTs, prospective and retrospective cohort trials) and type of intervention. All extractions were done by the first author and checked by a second researcher. In order to investigate the effect of post-operative behavioural management on weight loss, data were described in a narrative summary. Furthermore, a meta-analytic data pooling using RevMan (31) was applied to assess the overall effect of post-operative behavioural management for bariatric surgery patients on weight loss. For this analysis, studies that were homogeneous with regard to outcome and methodological design were combined. These studies included all RCTs as they reported weight loss in %EWL for patients participating in a behavioural intervention compared with patients receiving no behavioural intervention. screening of titles, abstracts and full-texts, 16 articles with 15 studies were identified for inclusion. One research group examined the same study population and published two studies with results from different measurement times; therefore, these studies were combined (32,33). Assignment: bariatric design The selection process is illustrated in Fig. 1. The included studies reported data on 1,008 patients with the number of patients ranging from 13 to 144 (67.2 ? 41.1). One-third of the studies (n = 5) had a sample size of 100 or more patients. In all but one study (34), the predominant gender was female. Baseline BMI ranged from 42.7 to 51.6 kg m2 (47.6 ? 3.4). Five studies focused on Roux-en-Y gastric bypass (34–38), three on laparoscopic adjustable gastric banding (32,33,39,40), two on vertical banded gastroplasty (41,42) and one on laparoscopic gastric plication (43). The remaining four studies enrolled patients who underwent any of the previously mentioned procedures or revision surgeries (44–47). All but three studies (40,41,43) comprised American samples. Although the original search terms targeted a variety of approaches to behavioural management, studies included in the analyses comprised either behavioural lifestyle interventions or support groups. Among the eight studies on behavioural lifestyle interventions, five were conducted as RCTs (38,41,44,46), two were prospective cohort trials (40,43), and one was a retrospective cohort trial (36). All support group studies used retrospective cohort designs (32–35,37,39,42,45). Most forms of behavioural management were carried out in group settings; only four were conducted individually (40,41,44,46). A majority of the studies delivered treatment directly after surgery; however, three studies included patients who had undergone surgery before 6 months, 18 months or 3 years, respectively (36, 38,44). The duration of the included studies ranged from 2 months to 3 years. Active treatment periods varied between 2 and 36 months, with half of the treatments ranging from 6 to 12 months (32–34,38,39,42–44,46). Only two studies utilized patient follow-up assessments (44,46). Most studies reported post-operative weight loss for the treatment and control groups. Six studies reported %EWL (34,38,41,43,44,46) and three others measured BMI (40), BMI decrease (32,33) or weight loss in pounds (42). The remaining studies did not report weight loss for both groups, but did report the relation of weight loss and behavioural management (35–37,39,45). The summarized characteristics of included studies are presented in Table 1. Results Post-operative weight loss: systematic review or ‘lifestyle intervention’ or ‘lifestyle modification’ or ‘psychological treatment’ or ‘psychological management’ or ‘psychological intervention’ or ‘psychological support’ or ‘psychosocial management’ or ‘psychosocial support’ or ‘behavioural management’ or ‘behavioural intervention’ or ‘behaviour control’ or ‘behaviour therapy’ or ‘behaviour modification’. This search strategy was adapted to each database. Furthermore, reference lists of retrieved articles and pertinent journals were searched by hand to identify additional studies. Selection of studies First, the lead author removed duplicates among the identified papers. Second, one author (AR) and a master-level researcher independently screened the relevance of the remaining titles and abstracts and, if there was insufficient information, the full paper was retrieved and reviewed. Finally, both researchers screened full-text articles for inclusion and exclusion criteria. Disagreements were resolved by discussion until consensus was reached.Assignment: bariatric design Data extraction Selected studies The literature search provided a total of 414 citations. After removal of duplicates and exclusions on the basis of 14, 292–302, April 2013 In the following sections, descriptions of the studies, design and interventions (i.e. number and length of sessions, group leader and number of patients per group) as well as patients’ inclusion criteria and patients’ dropout are © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity obesity reviews Post-operative behavioural management A. Rudolph & A. Hilbert 295 Records identified through database searching MEDLINE (n = 276), PsychINFO (n = 114) Additional records identified through other sources (n = 24) Records after duplicates (n = 10) removed (n = 404) Records screened (n = 404) Records excluded based on title and abstract (n = 359) Full-text articles assessed for eligibility (n = 45) Full-text articles excluded (n = 29): Studies included in qualitative synthesis (n = 16) Figure 1 Selection of studies (PRISMA flow diagram). Non-systematic review articles (n = 16) No psychosocial intervention (n = 6) Preoperative intervention (n = 6) No weight-related outcome (n = 1) Studies included in quantitative synthesis (meta-analysis) (n = 5) reported. Unless otherwise specified, treatment was delivered directly after surgery. In addition, weight loss following post-operative behavioural management is summarized in a narrative way at the end of each section. For a detailed overview of weight loss parameters in treatment and control groups, see Table 2. Due to differences in analytic strategies and weight loss units, 95% confidence intervals (CI) of standardized mean differences were calculated to compare weight loss in both groups. Missing SDs were recovered from available ranges. If descriptive or inferential statistics are not reported in this systematic review, they were not specified in the original paper. Behavioural lifestyle interventions Eight studies on behavioural lifestyle interventions were included in this review. The first study was conducted by Tucker et al. (46) in which they randomly assigned patients to either a treatment group or a control group. Both groups received basic information about eating and lifestyle changes, but only treatment group members received individual monthly behavioural consultations led by a supervised clinical psychology graduate student. A loss to follow-up of 21.9% was reported. Two RCTs compared behavioural lifestyle interventions with usual care in which trained dietitians delivered interventions. One included female candidates for bariatric © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity surgery only and applied a long-term intervention with a tapering dose (41). Consultations were scheduled weekly for the first 3 months after surgery, biweekly for the following 3 months, monthly for the next half-year and quarterly for the second post-operative year. Whereas control group members obtained general information on a healthier lifestyle, treatment group members attended additional individual sessions.Assignment: bariatric design In the second study (47), treatment was either provided with brief telephone interviews or in-person visits every other week for 4 months. Retention rates declined from baseline (86.9%) to 24-month follow-up (44.0%). Two other RCTs applied behavioural lifestyle interventions, but for patients who had undergone bariatric surgery more than 6 months before intervention. Kalarchian et al. (44) patients’ inclusion criteria were a surgery date of at least 3 years before study entry and a report of suboptimal weight loss defined as ?50% EWL. Master-level therapists were trained in obesity treatment and bariatric surgery. Patients in the treatment group received weekly group sessions and biweekly individual telephone coaching sessions (15–20 min each), whereas patients in the control group were randomized to a wait list. Retention rate did not differ by group and was 91.7% at 6 months and 80.5% at 12 months. Inclusion criterion for the study by Nijamkin et al. (38) was surgery at 6 months before study entry. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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Assignment: bariatric design

Assignment: bariatric design ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: bariatric design Research Proposal Project: Design (Sampling, Reliability, Validity) Assignment: bariatric design The following components should be addressed in your paper this week: Information on your sample Sampling basic information (age, gender, criteria, etc.) Sample size Explain why your sample is appropriate for your study Reliability Explain how your data collection process is consistent and reliable Explain why your measurement tool is reliable Validity Explain how you will ensure you have a valid sample Explain how you tested the validity of your measurement tool APA formatting, references, and citations are required. bariatric_article_2.pdf bariatric_article.pdf obesity reviews doi: 10.1111/obr.12013 Obesity Treatment/Management Post-operative behavioural management in bariatric surgery: a systematic review and meta-analysis of randomized controlled trials A. Rudolph and A. Hilbert Integrated Research and Treatment Center Summary AdiposityDiseases, Leipzig University Medical Recent research has provided evidence that bariatric surgery maximizes long-term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight loss outcome and weight regain over time. Postoperative behavioural management may facilitate long-term weight control in bariatric surgery population. The objective of this systematic review and metaanalysis was to determine the effects of post-operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta-analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post-operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery. Center, Department of Medical Psychology and Medical Sociology, Behavioral Medicine, University of Leipzig, Leipzig, Germany Received 2 August 2012; revised 29 November 2012; accepted 29 November 2012 Address for correspondence: Dr. A Rudolph, Integrated Research and Treatment Center, AdiposityDiseases, Behavioral Medicine, University of Leipzig, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany. E-mail: [email protected] Keywords: Bariatric surgery, behavioural intervention, support group, weight loss. obesity reviews (2013) 14, 292–302 Introduction Recent research has provided increasing evidence that bariatric surgery is the treatment of choice for patients with severe obesity at body mass index (BMI) ? 40 kg m2. Surgery significantly minimizes medical comorbidity and maximizes long-term weight loss of up to 20–35% of initial body weight (1–3). Moreover, psychological functioning and health-related quality of life are improved (4–6). 292 14, 292–302, April 2013 However, a substantial number of patients experience poor weight loss and weight regain over time (4,7,8). Among bariatric surgery patients, a mean weight regain of 7% was reported in two studies examining weight loss from 2 years to 6 and 10 years following surgery, respectively (8,9). Insufficient weight loss and weight regain following bariatric surgery could result from physiological factors such as slippage of the gastric band because of pouch dilatation, gastrogastric fistulas occurring after stomach transection, © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity obesity reviews Post-operative behavioural management A. Rudolph & A. Hilbert 293 and enlargement of the gastric pouch and stoma size (10,11). Assignment: bariatric design However, poor weight loss and weight regain more likely result from a return to preoperative eating and lifestyle behaviours (12), from emerging maladaptive eating behaviours following bariatric procedures (13), related malnutrition or gastrointestinal-related events (14) or a lifetime history of depression (15,16). In addition, postoperative eating and lifestyle behaviours might also be affected by psychosocial status following surgery, as some patients’ initial improvement in psychosocial status diminished over time (4). Empirical findings underlined the putative difficulties to adhere to post-operative behaviour changes and revealed significant increases in energy intake during the post-operative period (9,17–19), lower levels of physical activity (20,21), and patterns of uncontrolled eating and grazing (22,23) following bariatric surgery. Indeed, bariatric surgery patients have to comply with substantial changes in (i) eating behaviour, e.g. regular meals during the day to avoid grazing and snacking; (ii) food compositions, e.g. decreased intake of highcarbohydrate foods to avoid dumping syndrome in patients with gastric bypass; (iii) nutrition supplementation, e.g. multivitamins to avoid deficiencies; (iv) psychological issues, e.g. stress reduction to avoid emotional eating and (v) physical activity, e.g. a less sedentary lifestyle to improve body composition. In order to ensure compliance with such changes and to identify patients at need of treatment for relevant psychopathology including eating disorders, the guidelines of the American Society for Metabolic and Bariatric Surgery advised comprehensive management following bariatric surgery to ensure long-term weight loss success: ‘Mental health professionals should be available to help patients adjust to the myriad of psychosocial changes they experience postoperatively’ (p. S149, [24]) and ‘if (maladaptive eating behaviors are) suspected, prompt evaluation by a trained mental health professional should be completed’ (p. S161, [24]). Similarly, European bariatric surgery guidelines recommend post-operative treatment in patients with pre-existing psychopathology, apparent mental disorders or post-operative binge eating (‘loss of control eating’) (25,26). As the number of primary bariatric surgery procedures in Europe has been growing (e.g. a 10-fold increase during the last 5 years with 4,000 annual operations in 2010 in Germany compared with more than 200,000 operations per year in the United States [27,28]), the need for routine post-operative behavioural management rises. Well-established factors central to weight loss and weight maintenance were identified from non-surgical obesity treatment literature and included self-monitoring, continued follow-up contacts and increased physical activity (14). However, post-operative behavioural management comprising those strategies is rarely done and not sufficiently based on evidence (29). Among the few available studies, © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity some evaluated the influence of behavioural management such as behavioural lifestyle interventions and support groups to maximize weight loss following surgery. A systematic review of four retrospective cohort studies examining post-operative support groups provided the first cumulative evidence of a positive association between social support and weight loss after bariatric surgery (30). Other forms of behavioural management (i.e. behavioural therapy or weight loss maintenance programmes) and studies with rigorous methodology (i.e. randomized controlled trials [RCTs]) were not included in that review.Assignment: bariatric design The objective of this systematic review and meta-analysis was to determine the effects of diverse forms of postoperative behavioural management on weight loss after bariatric surgery. Thus, a broad range of approaches to post-operative behavioural management such as support groups, behavioural weight management or psychotherapy was described in detail. Furthermore, associations between these approaches and weight loss were analysed. Methods Inclusion and exclusion criteria Observational studies, treatment studies, and nonrandomized and uncontrolled studies investigating the impact of behavioural management on weight loss after bariatric surgery were included. Discussion papers, reviews, comments and case reports were excluded. Furthermore, eligible studies had to include (i) adult patients (age ? 18 years) who underwent bariatric surgery as defined in the search criteria in the following statements; (ii) post-operative behavioural management that was aimed at post-operative lifestyle change, such as support groups, behavioural weight management or psychotherapy and (iii) outcome variables including any indicator of body weight change after behavioural management, e.g. kilogram, pounds, BMI (kg m2) or percentage of excess weight loss (%EWL). Identification of studies Eligible studies in English and German languages published prior to September 2012 were searched in MEDLINE and PsychINFO electronic databases. Search terms were ‘bariatric surgery’ or ‘weight loss surgery’ or ‘obesity surgery’ or ‘weight reduction surgery’ or ‘biliopancreatic diversion’ or ‘duodenal switch’ or ‘laparoscopic band’ or ‘lap band’ or ‘gastric band’ or ‘gastric bypass’ or ‘gastroplasty’ or ‘gastric sleeve’ or ‘sleeve gastrectomy’ or ‘laparoscopic gastric plication’ and ‘obesity’ and ‘support group’ or ‘psychotherapy’ or ‘group therapy’ or ‘self-management’ or ‘empowerment’ or ‘post-operative management’ or ‘behavioural weight control’ or ‘cognitive–behavioural therapy’ 14, 292–302, April 2013 294 Post-operative behavioural management A. Rudolph & A. Hilbert obesity reviews Information relating to study methodology (i.e. study design, type of operation, number of patients), characteristics of participants (i.e. mean age, gender distribution, and baseline BMI), treatment description (i.e. type, mode of delivery, intensity, frequency) and the treatment effect on weight loss (i.e. %EWL, decrease of weight in kilograms or pounds) was extracted using a standardized data extraction form. Then, information was tabulated according to the methodological quality of included studies (i.e. RCTs, prospective and retrospective cohort trials) and type of intervention. All extractions were done by the first author and checked by a second researcher. In order to investigate the effect of post-operative behavioural management on weight loss, data were described in a narrative summary. Furthermore, a meta-analytic data pooling using RevMan (31) was applied to assess the overall effect of post-operative behavioural management for bariatric surgery patients on weight loss. For this analysis, studies that were homogeneous with regard to outcome and methodological design were combined. These studies included all RCTs as they reported weight loss in %EWL for patients participating in a behavioural intervention compared with patients receiving no behavioural intervention. screening of titles, abstracts and full-texts, 16 articles with 15 studies were identified for inclusion. One research group examined the same study population and published two studies with results from different measurement times; therefore, these studies were combined (32,33). Assignment: bariatric design The selection process is illustrated in Fig. 1. The included studies reported data on 1,008 patients with the number of patients ranging from 13 to 144 (67.2 ? 41.1). One-third of the studies (n = 5) had a sample size of 100 or more patients. In all but one study (34), the predominant gender was female. Baseline BMI ranged from 42.7 to 51.6 kg m2 (47.6 ? 3.4). Five studies focused on Roux-en-Y gastric bypass (34–38), three on laparoscopic adjustable gastric banding (32,33,39,40), two on vertical banded gastroplasty (41,42) and one on laparoscopic gastric plication (43). The remaining four studies enrolled patients who underwent any of the previously mentioned procedures or revision surgeries (44–47). All but three studies (40,41,43) comprised American samples. Although the original search terms targeted a variety of approaches to behavioural management, studies included in the analyses comprised either behavioural lifestyle interventions or support groups. Among the eight studies on behavioural lifestyle interventions, five were conducted as RCTs (38,41,44,46), two were prospective cohort trials (40,43), and one was a retrospective cohort trial (36). All support group studies used retrospective cohort designs (32–35,37,39,42,45). Most forms of behavioural management were carried out in group settings; only four were conducted individually (40,41,44,46). A majority of the studies delivered treatment directly after surgery; however, three studies included patients who had undergone surgery before 6 months, 18 months or 3 years, respectively (36, 38,44). The duration of the included studies ranged from 2 months to 3 years. Active treatment periods varied between 2 and 36 months, with half of the treatments ranging from 6 to 12 months (32–34,38,39,42–44,46). Only two studies utilized patient follow-up assessments (44,46). Most studies reported post-operative weight loss for the treatment and control groups. Six studies reported %EWL (34,38,41,43,44,46) and three others measured BMI (40), BMI decrease (32,33) or weight loss in pounds (42). The remaining studies did not report weight loss for both groups, but did report the relation of weight loss and behavioural management (35–37,39,45). The summarized characteristics of included studies are presented in Table 1. Results Post-operative weight loss: systematic review or ‘lifestyle intervention’ or ‘lifestyle modification’ or ‘psychological treatment’ or ‘psychological management’ or ‘psychological intervention’ or ‘psychological support’ or ‘psychosocial management’ or ‘psychosocial support’ or ‘behavioural management’ or ‘behavioural intervention’ or ‘behaviour control’ or ‘behaviour therapy’ or ‘behaviour modification’. This search strategy was adapted to each database. Furthermore, reference lists of retrieved articles and pertinent journals were searched by hand to identify additional studies. Selection of studies First, the lead author removed duplicates among the identified papers. Second, one author (AR) and a master-level researcher independently screened the relevance of the remaining titles and abstracts and, if there was insufficient information, the full paper was retrieved and reviewed. Finally, both researchers screened full-text articles for inclusion and exclusion criteria. Disagreements were resolved by discussion until consensus was reached.Assignment: bariatric design Data extraction Selected studies The literature search provided a total of 414 citations. After removal of duplicates and exclusions on the basis of 14, 292–302, April 2013 In the following sections, descriptions of the studies, design and interventions (i.e. number and length of sessions, group leader and number of patients per group) as well as patients’ inclusion criteria and patients’ dropout are © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity obesity reviews Post-operative behavioural management A. Rudolph & A. Hilbert 295 Records identified through database searching MEDLINE (n = 276), PsychINFO (n = 114) Additional records identified through other sources (n = 24) Records after duplicates (n = 10) removed (n = 404) Records screened (n = 404) Records excluded based on title and abstract (n = 359) Full-text articles assessed for eligibility (n = 45) Full-text articles excluded (n = 29): Studies included in qualitative synthesis (n = 16) Figure 1 Selection of studies (PRISMA flow diagram). Non-systematic review articles (n = 16) No psychosocial intervention (n = 6) Preoperative intervention (n = 6) No weight-related outcome (n = 1) Studies included in quantitative synthesis (meta-analysis) (n = 5) reported. Unless otherwise specified, treatment was delivered directly after surgery. In addition, weight loss following post-operative behavioural management is summarized in a narrative way at the end of each section. For a detailed overview of weight loss parameters in treatment and control groups, see Table 2. Due to differences in analytic strategies and weight loss units, 95% confidence intervals (CI) of standardized mean differences were calculated to compare weight loss in both groups. Missing SDs were recovered from available ranges. If descriptive or inferential statistics are not reported in this systematic review, they were not specified in the original paper. Behavioural lifestyle interventions Eight studies on behavioural lifestyle interventions were included in this review. The first study was conducted by Tucker et al. (46) in which they randomly assigned patients to either a treatment group or a control group. Both groups received basic information about eating and lifestyle changes, but only treatment group members received individual monthly behavioural consultations led by a supervised clinical psychology graduate student. A loss to follow-up of 21.9% was reported. Two RCTs compared behavioural lifestyle interventions with usual care in which trained dietitians delivered interventions. One included female candidates for bariatric © 2013 The Authors obesity reviews © 2013 International Association for the Study of Obesity surgery only and applied a long-term intervention with a tapering dose (41). Consultations were scheduled weekly for the first 3 months after surgery, biweekly for the following 3 months, monthly for the next half-year and quarterly for the second post-operative year. Whereas control group members obtained general information on a healthier lifestyle, treatment group members attended additional individual sessions.Assignment: bariatric design In the second study (47), treatment was either provided with brief telephone interviews or in-person visits every other week for 4 months. Retention rates declined from baseline (86.9%) to 24-month follow-up (44.0%). Two other RCTs applied behavioural lifestyle interventions, but for patients who had undergone bariatric surgery more than 6 months before intervention. Kalarchian et al. (44) patients’ inclusion criteria were a surgery date of at least 3 years before study entry and a report of suboptimal weight loss defined as ?50% EWL. Master-level therapists were trained in obesity treatment and bariatric surgery. Patients in the treatment group received weekly group sessions and biweekly individual telephone coaching sessions (15–20 min each), whereas patients in the control group were randomized to a wait list. Retention rate did not differ by group and was 91.7% at 6 months and 80.5% at 12 months. Inclusion criterion for the study by Nijamkin et al. (38) was surgery at 6 months before study entry. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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