24‐Monthfollow‐upof randomized controlled trial of guided‐self‐helpfor loss‐of‐controleating after bariatric surgery

Abstract Background Loss‐of‐control (LOC)‐eating postoperatively predicts suboptimal longer‐term outcomes following bariatric surgery. This study examined longer‐term effects through 24‐month follow‐ups after completing treatments in a randomized controlled trial testing guided‐self‐help treatments (cognitive‐behavioral therapy [gshCBT] and behavioral weight‐loss [gshBWL]) and control (CON) delivered postoperatively for LOC‐eating. Methods 140 patients with LOC‐eating 6 months after bariatric surgery were randomized (5:5:2 ratio) to 3‐months of gshCBT ( n = 56), gshBWL ( n = 60), or CON ( n = 24) delivered by trained allied‐health clinicians. Independent assessments were performed throughout/after treatments and at 6‐, 12‐, 18‐, and 24‐month follow‐ups; 83% of patients were assessed at 24‐month follow‐up. Results Intention‐to‐treat analyses comparing the three groups (gshCBT vs. gshBWL vs. CON) in LOC‐eating abstinence at posttreatment (30%, 27%, 38%), 12‐month follow‐up (34%, 32%, 42%), and 24‐month follow‐up (45%, 32%, 38%) revealed no significant differences. Mixed‐models revealed significantly reduced LOC‐eating frequency through posttreatment, no significant changes in LOC‐eating frequency during follow‐up, and no differences between the three groups. Weight reduced significantly, albeit modestly, through posttreatment but increased significantly and substantially during follow‐ups, with no differences between groups. Conclusions Overall, the 12‐week scalable guided‐self‐help treatments did not differ from each other or control, were associated with significantly reduced frequency of LOC‐eating and modest weight loss at posttreatment but were followed by significant weight gain during the 24‐month follow‐up. Weight gain was substantial and nearly universal whereas the frequency of LOC‐eating did not change over time (i.e., LOC‐eating reductions and abstinence rates were well maintained through 24‐moth follow‐ups). Patients with postoperative LOC‐eating require more intensive adjunctive treatments. Public significance Loss‐of‐control (LOC) eating postoperatively predicts poorer bariatric surgery outcomes and the longer‐term effects of postoperative adjunctive postoperative interventions for LOC eating are unknown. In this 24‐month follow‐up of a controlled study of scalable guided‐self‐help treatments and a control condition, improvements in LOC‐eating frequency, eating‐disorder psychopathology, and depression during treatment were maintained well, with no differences between the three groups. Proportion of patients achieving abstinence from LOC‐eating at the 24‐month follow‐up ranged from 38% to 45% across the three groups. In contrast, weight increased significantly during the 24‐month follow‐ups, with no differences between the three groups. Findings suggest LOC‐eating following bariatric surgery might represent a “marker” for a subgroup of patients that are at risk for substantial weight gains over time. LOC eating following bariatric surgery is challenging to treat with low‐intensity scalable treatments and may require more intensive specialist treatments.