Behavioural Interventions for Severe Obesity Before and/or After Bariatric Surgery: a Systematic Review and Meta-analysis

Fiona Stewart, Alison Avenell

Research output: Contribution to journalArticlepeer-review

53 Citations (Scopus)
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Significant, sustained weight loss through conventional, non-surgical interventions is often unattainable for people with severe obesity (e.g. BMI ≥40 or ≥35 kg/m2 with co-morbidities). Bariatric surgery is effective in treating severe obesity, but surgery alone without additional behaviour change management may not result in optimum long-term weight loss and maintenance. This systematic review and meta-analysis of randomised controlled trials evaluated the effectiveness of lifestyle interventions before and/or after bariatric surgery.

MEDLINE, Embase, Cochrane Central Register of Controlled Trials and clinical trials registers were searched for eligible studies. Key journals were handsearched. Last search date was on December 2014. Eligible interventions had the explicit aim of changing behaviour related to diet and/or physical activity, starting within 12 months of surgery, either pre- or post-operatively, and with at least 6 months’ follow-up. The primary outcome was weight change; secondary outcomes included surgical complications, quality of life and changes in co-morbidities. Random effect meta-analyses were undertaken. Study quality was assessed with the Cochrane Collaboration’s risk of bias tool.

Eleven trials met the inclusion criteria. Behavioural interventions appear to improve weight loss at 12 months after bariatric surgery. Secondary outcome data were lacking and weight outcomes were reported inconsistently. Overall, the methodological quality of the identified trials was low.

The strength of evidence is limited by the relatively small number of trials identified and by their low methodological quality and short follow-up duration. Well-designed randomised controlled trials (RCTs) with long-term follow-up are required.
Original languageEnglish
Pages (from-to)1203-1214
Number of pages12
JournalObesity Surgery
Issue number6
Early online date5 Sept 2015
Publication statusPublished - Jun 2016

Bibliographical note

We would like to thank the following study authors for providing additional data and clarifications: Alison Fielding, Haldis Lier, Monica Nijamkin, Jane Ogden, Anastasios Papalazarou, Manish Parikh, Brian Swenson, Andresa Triffoni, Jean Michel Oppert, Marie-France Langlois, David Sarwer and Dale Bond. We also thank Dr. Kevin Deans and the staff at the bariatric surgery clinic at Aberdeen Royal Infirmary. The Health Services Research Unit, University of Aberdeen, is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The views expressed are those of the authors.


  • severe obesity
  • bariatric surgery
  • complex Interventions
  • lifestyle management
  • behavior change
  • weight loss


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