Title: The impact of an investment based intervention on weight-loss and beliefs about food in patients post bariatric surgery.
Funder: Department of Health (England)

Abstract: Background: Obesity is a major health problem that is becoming increasingly common. Although the majority of people try to lose weight through changes in diet and exercise, the most successful treatment for obesity is weight loss surgery. Not all patients, however, lose the desired amount of weight; some regain weight and some have the surgery reversed. Research by the present author has explored why the outcome of surgery varies between patients and has highlighted the role for a number of psychological factors. In particular, research indicates that successful weight loss is related to the sense of investment that the patient has made in their operation. For example, if a person feels that the operation (or operations) has involved financial cost, has disrupted their work and family life and has been painful and difficult then studies indicate that they will be more likely to lose weight and keep this weight off. Furthermore, a recent pilot study asked patients to focus on the investment they had made in their operation which resulted in increased weight loss by follow up. This study, however, was only small scale and the follow up was only 3 months. Aims: The present study aims to evaluate an investment based intervention on a larger sample with a longer term follow up to determine the impact of such an intervention on weight loss and patient beliefs and behaviours up to 12 months following surgery. Method: Patients from UCH will be recruited 2 weeks before their operation. Measures will be taken at baseline (2 weeks pre operation) then 3, 6 and 12 months post surgery. Half will receive the investment intervention and half will receive usual care. For the intervention, patients will be asked to rate and describe the impact of the operation on their lives in terms of financial factors (eg. ‘Did the operation cost you money?’), social factors (eg’ Did the operation interfere with your social life?’), physical factors (eg.’How painful was the operation?’) and personal factors (eg. ‘Did the operation influence your family life?’). This will involve a simple paper and pen questionnaire and will be given at baseline and 3 months, tailored to the experiences of the patient at that time point. It is predicted that this focus will raise the salience of patients’ investment in weight loss surgery thus encouraging them to feel more motivated to lose weight and make the surgery a success. The intervention will be evaluated in terms of weight loss. In addition its impact on beliefs about food, eating and exercise behavior and intentions to change behavior will also be assessed. Impact on the NHS: Obesity is a risk factor for illnesses such as heart disease, diabetes and cancer. If effective, obesity surgery improves a patient’s health and reduces their need for NHS care. If unsuccessful then the costs include not only subsequent NHS costs due to these other illnesses but also the costs of the unsuccessful operation and the emotional cost to the patient. The investment based intervention should help to improve the effectiveness of surgery which in the longer term is likely to be cost effective. How the results may affect treatment of patients: This research is based upon a small scale pilot study that showed that a simple investment based intervention which encouraged patients to consider their personal investment in having weight loss surgery, improved weight loss by 7kg by 3 months follow up. If this is reproduced in the current larger scale study and persists into the longer term then such a simple, easy to adminster and low cost intervention could become routine practice for bariatric patients.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: STROKE;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL