Alternative healthcare delivery strategies to prevent weight regain after bariatric surgery

Abstract

Obesity has reached epidemic proportions worldwide (Chooi, Ding, and Magkos 2018; OECD 2019) and bariatric surgery remains the most effective treatment for severe obesity resulting in clinically significant weight loss and improvements in obesity-related comorbidities (Angrisani et al. 2015). However, a significant subset of patients present suboptimal results or experience substantial weight regain, producing heavy economic burdens (Kalarchian et al. 2019), suggesting the need for ongoing weight loss management after bariatric surgery. Current literature has supported the importance of postoperative cognitive-behavioral interventions to prevent weight-regain, promote adherence to post-surgical recommendations, and changes in lifestyle, behavioral, and psychosocial factors (L. Bradley 2013; Rudolph and Hilbert 2013; David, Sijercic, and Cassin 2020). However, in an environment with limited healthcare resources to deal with the rising bariatric population, alternative time-efficient and cost-effective interventions are needed. Such interventions should consider the heterogeneity of the bariatric population, and the difficulties in the accessibility of specialized treatment centers (McCarthy and Hart 2011). With the dramatic growth in web technologies, online platforms represent a powerful and cost-effective alternative tool to deliver validated interventions, attempting to narrow the gap between clinical support services and patients. Given the marked variability in individual outcomes, recent research also suggested the need for personalized approaches. Stepped-care approaches are clinically relevant allowing an efficient allocation of resources, starting with minimal, low-intensity, cost-effective strategies for all patients and successively adding components of increasing intensity if needed (Kalarchian and Marcus 2018). This chapter aims to summarise the main studies in the field of psychological interventions for bariatric surgery patients exploring the advances on new online therapeutic and management strate