Original article
Feasibility and acceptability of an integrated behavioral medicine service within a post–bariatric surgery clinic

https://doi.org/10.1016/j.soard.2019.07.009Get rights and content

Highlights

  • Multidisciplinary care of obesity is essential in optimizing patient outcomes.

  • The integration of behavioral health into the weight loss surgery population has received little attention.

  • Behavioral medicine services were feasibly integrated into a post-bariatric surgery clinic, with two-fifths of patients receiving same-day behavioral health intervention.

  • Patients reported high levels of satisfaction and confidence in being able to carry out the plan created during the consult.

Abstract

Background

Long-term medical and psychological follow-up after weight loss surgery is associated with improved patient outcomes. Weight regain after weight loss surgery is a common concern that has behavioral and psychological components; however, most patients do not attend behavioral medicine (BMED) follow-up appointments post-surgery. Innovative treatment models are needed to improve access to BMED to optimize long-term outcomes.

Objectives

This study aimed to examine the feasibility and acceptability of an integrated BMED service within a bariatric surgery clinic.

Setting

University medical center, outpatient clinic.

Methods

Patients (n = 198) in a post–bariatric surgery clinic were screened for psychosocial/behavioral concerns and offered a same-day BMED consult, when appropriate. Patients rated their satisfaction with the consult and their confidence in being able to carry out the plan created during the consult.

Results

The top 3 concerns identified during screenings were emotional eating, body image, and cravings. The top 3 concerns addressed during consults were emotional eating, mood, and cravings. The mean length of consult was 26.1 minutes. The mean severity of problems addressed was 7 of 10. Patients’ confidence ratings had a mean of 9.4 of 10 (1 = low, 10 = high) and satisfaction ratings had a mean of 9.8 of 10.

Conclusions

In this clinic, the integration of a BMED service provided 40% of patients with behavioral intervention for psychosocial/behavioral concerns during routine surgery follow-up appointments. Patients indicated high satisfaction with consults and reported high confidence in being able to carry out the plan created during the consult.

Section snippets

Methods

Data for the present study were collected during a newly created integrated clinic for patients scheduled for surgical follow-up after bariatric surgery. The project was determined to be quality improvement, which was certified by the institutional review board. This clinic was piloted within a large digestive disease department with a longstanding, high-volume bariatric surgery program. The clinic is part of a major academic health center in the southeastern United States. The pilot integrated

Demographic characteristics

From September 2016 to March 2018, of 202 patients who attended visits during the designated time period, 198 patients were screened using the psychosocial screener. The 4 screeners not administered were due to human error (e.g., check-in nurse forgot to administer the screener). All patients were post–bariatric surgery (RYGB, SG, biliopancreatic diversion with duodenal switch, or laparoscopic adjustable gastric band) and were seen as part of their routine follow-up. The majority of patients

Discussion

Results of this program development project support the feasibility and patient acceptability of providing integrated behavioral medicine services in a post-WLS follow-up clinic. This suggests that applying the CCM to WLS populations is beneficial for patient care practices, particularly as it relates to the value of integrated, multidisciplinary care. Of note, 40% of patients screened for psychosocial concerns were seen for a same-day consultation visit by a behavioral medicine provider. This

Conclusions

This study provides initial support for both the feasibility and acceptability of using an integrated treatment model with post-WLS patients as part of their regular follow-up visits. Consistent with the CCM, this treatment model allows for increased access to care, earlier intervention with lower level of severity concerns, and targeted behavioral interventions for commonly reported concerns in a post-WLS population. Patients reported high levels of satisfaction with the model and confidence

Acknowledgments

The authors would like to thank Molly Jones, R.D.N., L.D., Amanda Peterson, R.D.N., L.D., and Nina Crowley, Ph.D., R.D.N., L.D., for their instrumental support and involvement in building and sustaining the integrated clinic.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (28)

  • T.D. Adams et al.

    Health benefits of gastric bypass surgery after 6 years

    JAMA

    (2012)
  • L. Sjostrom et al.

    Effects of bariatric surgery on mortality in Swedish obese subjects

    N Engl J Med

    (2007)
  • L. Sjostrom et al.

    Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery

    N Engl J Med

    (2004)
  • A.E. Pontiroli et al.

    Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients

    Obes Surg

    (2007)
  • Cited by (0)

    View full text