Highlights
- •eHealth was found to deliver an equal effect or be more effective for weight loss.
- •Both eHealth and control groups regained weight in the longer term.
- •eHealth significantly improved assessment measures for eating psychopathology.
Abstract
This systematic review aimed to evaluate the effect of eHealth-delivered interventions
for adults who undergo bariatric surgery on postoperative weight loss, weight loss
maintenance, eating psychopathology, quality of life, depression screening, and self-efficacy.
Six electronic databases were searched, with 14 studies (across 17 reports) included,
involving 1633 participants. With substantial heterogeneity, qualitative descriptions
have been provided. Interventions were delivered via an online program or internet
modules (n = 2), telephone (n = 2), text messages (n = 2), videoconferencing (n =
3), mobile application (n = 1), and audiovisual media (n = 1). Three studies included
a combination, including internet modules and telephone (n = 1), wireless fidelity
scales, emails, and telephone (n = 1), and a combination of online treatment, weekly
emails, and access to a private Facebook group (n = 1). All the eHealth interventions,
except for one, implemented behavior change techniques, including self-monitoring,
problem solving, social support, goal setting, and shaping knowledge. Both eHealth
intervention and control groups lost weight across the included studies, and eHealth
was found to be as effective as or more effective than the control for weight loss.
Two studies measured weight loss maintenance; both eHealth and control groups regained
weight in the longer term. The interventions showed significant improvement on assessment
measures for eating psychopathology. In conclusion, when bariatric surgery patients
have limited or no access to healthcare teams or require additional support, eHealth
may be a suitable option. Future studies implementing eHealth interventions would
benefit from reporting intervention components as per the behavior change techniques
taxonomy and further consideration of delivering eHealth in a stepped care approach
would be beneficial.
Graphical abstract
Graphical Abstract
Key words
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References
- Surgery for weight loss in adults.Cochrane Database Syst Rev. 2014; : CD003641
- Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures–2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists.Endocr Pract. 2019; 25: 1346-1359
- Mechanisms of changes in glucose metabolism and bodyweight after bariatric surgery.Lancet Diabetes Endocrinol. 2014; 2: 152-164
- The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review.Health Technol Assess. 2011; 15: 1-182
- Long-term weight regain after gastric bypass: a 5-year prospective study.Obes Surg. 2008; 18: 648-651
- Weight recidivism post-bariatric surgery: a systematic review.Obes Surg. 2013; 23: 1922-1933
- Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success.Surg Obes Relat Dis. 2011; 7: 644-651
- Behavioural interventions for severe obesity before and/or after bariatric surgery: a systematic review and meta-analysis.Obes Surg. 2016; 26: 1203-1214
- Post-operative behavioural management in bariatric surgery: a systematic review and meta-analysis of randomized controlled trials.Obes Rev. 2013; 14: 292-302
- Attendance at clinical visits predicts weight loss after gastric bypass surgery.Obes Surg. 2012; 22: 927-934
- Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study.Obes Surg. 2005; 15: 261-265
- Empowerment and self-management after weight loss surgery.Obes Surg. 2005; 15: 417-422
- Pre-and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss.Obesity. 2009; 17: 996-1002
- Understanding rural and remote health: a framework for analysis in Australia.Health Place. 2012; 18: 496-503
- The importance of follow-up and distance from centre in weight loss after laparoscopic adjustable gastric banding.Surg Endosc. 2010; 24: 2432-2438
- Predictors of attrition in bariatric aftercare: a systematic review of the literature.Obes Surg. 2012; 22: 1640-1647
- Laparoscopic Adjustable Gastric Banding (LAGB) aftercare attendance and attrition.Obes Surg. 2015; 25: 1693-1702
- A review of the psychosocial aspects of clinically severe obesity and bariatric surgery.Am Psychol. 2020; 75: 252-264
- Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability.Rural Remote Health. 2016; 16: 4268
- Effectiveness of telemedicine: a systematic review of reviews.Int J Med Inform. 2010; 79: 736-771
- World Health Organization [homepage on the Internet]. Geneva, Switzerland: The Organization; [updated 2016 Dec 15; cited 2021 May 14]. Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth; [about 384 screens].(Available from:)
- World Health Organization [homepage on the Internet]. Geneva, Switzerland: The Organization; [updated 2019 Jun 6; cited 2021 May 14]. WHO guideline: recommendations on digital interventions for health system strengthening: web supplement 2: summary of findings and GRADE tables [about 210 screens].(Available from:)
- Improving access to bariatric surgery for rural and remote patients: experiences from a state-wide bariatric telehealth service in Australia.Obes Surg. 2020; 30: 4401-4410
- Perspectives on technology use to enhance self- management in bariatric surgery patients.Nutr Diet. 2020; 77: 7-110
- eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis.Obes Rev. 2015; 16: 376-392
- A review of web-based weight loss interventions in adults.Obes Rev. 2011; 12: e236-e243
- A systematic review of tailored eHealth interventions for weight loss.Digit Health. 2019; 5 (2055207619826685)
- eHealth to redress psychotherapy access barriers both new and old: a review of reviews and meta-analyses.J Psychother Integration. 2020; 30: 188-207
- How are bariatric patients coping during the coronavirus disease 2019 (COVID-19) pandemic? Analysis of factors known to cause weight regain among postoperative bariatric patients.Surg Obes Relat Dis. 2021; 17: 756-764
- Eating behaviors and weight outcomes in bariatric surgery patients amidst COVID-19.Surg Obes Relat Dis. 2021; 17: 1165-1174
- The use of telemedicine for delivering healthcare to bariatric surgery patients: a literature review.J Telemed Telecare. 2018; 24: 651-660
- Application and effectiveness of eHealth strategies for metabolic and bariatric surgery patients: A systematic review.Digit Health. 2020; 6 (2055207619898987-2055207619898987)
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Int J Surg. 2010; 8: 336-341
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71
- Improving the translation of search strategies using the Polyglot Search Translator: a randomized controlled trial.J Med Libr Assoc. 2020; 108: 195-207
- Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients.Surg Obes Relat Dis. 2016; 12: 731-749
- Does intensive multidisciplinary intervention for adults who elect bariatric surgery improve post-operative weight loss, co-morbidities, and quality of life? A systematic review and meta-analysis.Obes Rev. 2020; 21e13012
- Assessing the accuracy of Google translate to allow data extraction from trials published in non-English languages. AHRQ Methods for Effective Health Care [monograph on the Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Jan [cited 2021 Jul 20].(Available from:)
- The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.Ann Behav Med. 2013; 46: 81-95
- Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis.Int J Behav Nutr Phys Act. 2017; 14: 18
- Higgins J.P. Green S. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons,
Chichester, England2011Version: Version 5.1.0
- A pre-hospital patient education program improves outcomes of bariatric surgery.Obes Surg. 2016; 26: 2074-2081
- Text messaging improves preoperative exercise in patients undergoing bariatric surgery.ANZ J Surg. 2018; 88: 733-738
- A randomised trial of text message support for reducing weight regain following sleeve gastrectomy.Obes Surg. 2018; 28: 2178-2186
- Portion perfection and Emotional Freedom Techniques to assist bariatric patients post surgery: a randomised control trial.Heliyon. 2020; 6e04058
- A pilot randomized controlled trial of telephone-based cognitive behavioural therapy for preoperative bariatric surgery patients.Behav Res Ther. 2016; 80: 17-22
- The evaluating self-management and educational support in severely obese patients awaiting multidisciplinary bariatric care (EVOLUTION) trial: principal results.BMC Med. 2017; 15: 46
- Exploring the effects of telemedicine on bariatric surgery follow-up: a matched case control study.Obes Surg. 2019; 29: 2704-2706
- Food addiction is associated with binge eating and psychiatric distress among post-operative bariatric surgery patients and may improve in response to cognitive behavioural therapy.Nutrients. 2020; 12: 2905
- Internet of things and bariatric surgery follow-up: comparative study of standard and IoT follow-up.Minim Invasive Ther Allied Technol. 2013; 22: 304-311
- Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT.Obes Res Clin Pract. 2012; 6: e1-e90
- A 1-year videoconferencing-based psychoeducational group intervention following bariatric surgery: results of a randomized controlled study.Surg Obes Relat Dis. 2015; 11: 1349-1360
- Sustained effects of a psychoeducational group intervention following bariatric surgery: follow-up of the randomized controlled BaSE study.Surg Obes Relat Dis. 2017; 13: 1612-1618
- Psychological flexibility and the gains of acceptance-based treatment for post-bariatric surgery: six-month follow-up and a test of the underlying model.Clin Obes. 2012; 2: 15-24
- Preoperative lifestyle intervention in bariatric surgery: a randomized clinical trial.Surg Obes Relat Dis. 2016; 12: 180-187
- Preoperative lifestyle intervention in bariatric surgery: initial results from a randomized, controlled trial.Obesity. 2013; 21: 254-260
- Mobile health applications enhance weight loss efficacy following bariatric surgery.Obes Res Clin Pract. 2019; 13: 176-179
- The effect of pre-operative information through audiovisual media on self-care knowledge, self-efficacy, and state anxiety of patients before bariatric surgery.Korean J Adult Nurs. 2020; 32: 421-431
- Psychosocial assessment and treatment of bariatric surgery patients.Routledge Taylor & Francis, New York2012
- The behaviour change wheel: a new method for characterising and designing behaviour change interventions.Implement Sci. 2011; 6: 42
- Interventions employing mobile technology for overweight and obesity: an early systematic review of randomized controlled trials.Obes Rev. 2013; 14: 279-291
- Can ‘ehealth’ technology deliver on its promise of pain management for all?.Pain. 2011; 152: 1701-1702
- Weight regain after bariatric surgery: prevalence, etiology, and treatment.Curr Nutr Rep. 2018; 7: 329-334
- Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years.Ann Surg. 2006; 244: 734-740
- Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery.Obes Surg. 2015; 25: 1474-1481
- Project HELP: a remotely delivered behavioral intervention for weight regain after bariatric surgery.Obes Surg. 2017; 27: 586-598
- A pilot study of an acceptance-based behavioral intervention for weight regain after bariatric surgery.Obes Surg. 2016; 26: 2433-2441
- Optimizing long-term weight control after bariatric surgery: a pilot study.Surg Obes Relat Dis. 2012; 8: 710-715
- Developing and evaluating complex interventions: the new Medical Research Council guidance.BMJ. 2008; 337: a1655
- Persuasive system design (PSD) principles and behavior change techniques (BCT) to stimulate motivation and adherence in eHealth interventions to support weight loss maintenance: scoping review.J Med Internet Res. 2019; 21e14265
- The use of behavior change theories in dietetics practice in primary health care: a systematic review of randomized controlled trials.J Acad Nutr Diet. 2020; 120: 1172-1197
- State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.J Am Diet Assoc. 2010; 110: 879-891
- Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration.Ann Intern Med. 2008; 148: 295-309
- Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis.JAMA. 2016; 315: 150-163
- Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery.Eur Eat Disord Rev. 2014; 22: 87-91
- Cognitive behavioral therapy and predictors of weight loss in bariatric surgery patients.Curr Opin Psychiatry. 2017; 30: 474-479
- Preoperative and post-operative psychosocial interventions for bariatric surgery patients: a systematic review.Obes Rev. 2020; 21e12926
- Delivering stepped care: an analysis of implementation in routine practice.Implement Sci. 2012; 7: 3
- Stepped care in psychological therapies: access, effectiveness and efficiency.Br J Psychiatry. 2005; 186: 11-17
- The case for stepped care for weight management after bariatric surgery.Surg Obes Relat Dis. 2018; 14: 112-116
- The impact of coronavirus disease 2019 on bariatric surgery: redefining psychosocial care.Obesity. 2020; 28: 1010-1012
- HEART: heart exercise and remote technologies: A randomized controlled trial study protocol.BMC Cardiovascr Disord. 2011; 11: 26
Article info
Publication history
Published online: August 02, 2021
Accepted:
July 26,
2021
Received:
March 30,
2021
Identification
Copyright
© 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
