Obesity Surgery, Counseling, and Psychological Well-Being
Obesity Surgery, Counseling, and Psychological Well-Being
Obesity has become a global epidemic causing enormous human and economic costs. Incidence
 rates have doubled over the last few decades and obesity-related illnesses such as diabetes
 and cardiovascular diseases now constitute one of the major contributors to the global burden
 of disability. Overall, obesity has been recognized as one of the most pressing public health
 concerns worldwide and effective treatment and prevention strategies are urgently required.
 While behavioral and pharmacological treatments (e.g.low calorie diets, medication) are
 successful means for overcoming overweight and mild obesity, more severe cases of obesity
 usually fail to respond to such interventions. As a result, the demand for weight loss
 surgery is growing among this population. However, uncertainties about the effectiveness of
 obesity surgery persist and high relapse rates (i.e. weight regain) are common. Further
 research in this field is needed to identify risk factors that may trigger relapse and to
 understand patients' treatment needs in greater depth. Previous studies have pointed toward
 high levels of mental health problems among patients. However, the impact of preoperative
 psychopathology on actual surgery outcomes remains unclear. Similarly, few studies have
 investigated the effect of postoperative therapy on patients' psychological functioning and
 weight loss patterns. Research addressing these gaps is imperative to establish best-practice
 approaches. This challenge applies in particular to Middle East and North Africa(MENA)
 countries where research in the field of bariatric surgery and related mental health is
 largely missing. This is a major concern given the fact that the MENA region experienced the
 highest increase in overweight and obesity in recent decades compared to other countries.

 The proposed study aims to address this deficiency by examining obesity surgery patients in
 two Arab countries (UAE and Jordan). The goals of the project are to investigate the nature
 and extent of psychological health concerns among these patients before and after surgery and
 potential associations with treatment outcomes. Moreover, it will test the efficacy of
 post-operative counseling to improve weight loss and psychological health. For this purpose,
 a randomized clinical trial design will be employed so that cause and effect relationships
 between postoperative counseling and treatment outcomes(i.e. weight loss and psychological
 functioning) can be examined experimentally. The study will start by assessing participants'
 psychological health prior to surgery by using standardized self-report measures.

 After surgery, participants will be randomly assigned to either the intervention condition
 consisting of 3-monthly post-operative medical checkups plus group counseling or the
 treatment as usual condition (i.e. 3-monthly standard medical checkups only). Additionally,
 participants' psychological health will be reassessed in both groups at 3, 6, 9 and 12 months
 after surgery. The benefit of the experimental study design is that it allows comparing
 patient outcomes between groups while at the same time controlling for a wide range of
 potential confounding variables.

 The data collected are expected to make a significant contribution to the treatment challenge
 of one of the most pressing public health concerns worldwide. Study results will add to
 clinical practice by broadening and deepening our knowledge of the treatment needs of obese
 patients. By identifying psychological health concerns that may threaten successful treatment
 outcomes high-risk patient groups can be recognized early, which in turn may help to reduce
 postoperative weight regain and other complications.

 To the best of the PI's knowledge, the proposed work would be the first study of this kind in
 the Arab world. Findings will be helpful for developing culturally sensitive and
 evidence-based best-practice guidelines, which are vital to achieve satisfying long-term
 outcomes. Moreover, study results will be relevant for research communities and practitioners
 outside the MENA region since empirical support for the effectiveness of obesity surgery
 remains weak internationally.
Obesity has become a global epidemic causing enormous human and economic costs. According to
 the World Health Organization in 2011 overweight and obesity represent the fifth leading risk
 of death globally, with 2.8 million adults dying each year as a result of excess weight.
 Worldwide, estimates of overweight and obesity have reached 1.5 billion and 500 million
 respectively. In addition to an overall increased mortality among this population, a large
 body of evidence has shown that excess weight is linked to several chronic illnesses
 including cardiovascular diseases (e.g. stroke), diabetes mellitus (type 2), certain cancers
 (e.g. breast and colon cancer) and osteoarthritis. Furthermore, obesity inflicts major
 economic losses. Past research has confirmed that obesity is associated not only with higher
 medical expenditures due to greater usage of medical services but also with increased
 non-medical costs, for example due to absenteeism from work.

 While the continuous rise of overweight and obesity is a major concern globally, it has
 reached particular urgency in the MENA region where prevalence rates of both conditions have
 risen to alarming levels. For example, two recent systematic literature reviews focusing on
 the Arabian Gulf States reported overweight and obesity rates from 25 to 48% and 13 to 49%
 respectively across the six countries. UAE-specific data showed obesity rates ranging from 26
 to 47%. Additionally, the authors identified the UAE as the Gulf state with the highest
 hypertension and diabetes rates. In fact, the 2011 UAE diabetes figure of 19% has been
 confirmed to be one of the highest in the world. When looking at MENA countries outside the
 Gulf, the highest obesity rates were reported for Syria and Jordan (38% and 35%,
 respectively).

 In order to tackle the increasing burden of obesity, effective intervention and prevention
 approaches are required. While behavioral and pharmacological treatments (e.g. low calorie
 diets, exercise, medication) are successful means for overcoming overweight and mild obesity,
 cases of more severe obesity usually fail to respond to such interventions. Instead, more
 radical measures such as bariatric surgery are typically needed to achieve substantial weight
 loss. Past research has shown that most patients lose significant amounts of weight after
 surgery. However, weight loss maintenance remains problematic with weight regain and other
 adjustment difficulties (e.g. adapting healthy eating behaviors) being common. Yet, little is
 known about the risk factors that may trigger weight relapse. Previous research in this
 context has pointed toward high levels of mental health problems among obese individuals
 including bariatric surgery patients. Affective, anxiety and eating disorders (in particular
 binge eating symptoms) were most commonly reported with prevalence rates reaching up to 84%.
 However, the impact of preoperative psychopathology on actual surgery outcomes is not well
 understood. Results remain inconsistent and further research is needed to determine whether
 or not psychological factors jeopardize successful surgery outcomes. Another important
 question in this regard is whether postoperative interventions that focus on patients'
 psychological health are helpful in sustaining the achieved weight loss and in coping with
 postoperative adjustment difficulties. Until now, only few empirical studies have addressed
 this question. Findings so far indicated a positive impact of postoperative counseling on
 patients' weight management and overall well-being. However, small sample sizes, differences
 in study methodology (e.g. qualitative vs. quantitative), and the diversity of therapeutic
 interventions provided impede any firm conclusions.

 In addition to these uncertainties, it is important to recognize that research in the field
 of bariatric surgery and mental health has been almost entirely restricted to Western
 countries. Despite repeated searches of several databases (e.g. PsycInfo, Academic Search
 Premier, and Medline) and examination of bibliographies of relevant papers no matching
 studies from MENA countries could be found. This lack of regional data is a major concern
 given the difficulty of generalizing findings cross-culturally on the one hand and the high
 obesity rates in this part of the world on the other. MENA-based research in this field would
 yield vital insights for policy makers, commissioners and practitioners in the management and
 delivery of evidence-based best-practice and patient-oriented care.

 Therefore, the proposed study aims to:

 1. Examine psychological health before and after bariatric surgery among obese patients in
 the UAE and Jordan

 2. Investigate the impact of patients' psychological health on postoperative weight loss,
 and

 3. Assess the efficacy of group-based counseling to improve patient outcomes (i.e. weight
 loss and psychological health) after bariatric surgery

 The study hypotheses are as follows:

 1. Participants with higher levels of psychological health problems before surgery will
 lose less weight (in %) during the first 12 months after surgery than patients with
 lower levels of psychological health problems.

 2. Participants who receive postoperative counseling in addition to standard treatment will
 lose more weight (in %) during the first 12 months after surgery than patients who are
 provided with standard treatment only.

 3. Participants who receive postoperative counseling in addition to standard treatment will
 show less psychological health problems at 12 months after surgery than patients who are
 provided with standard treatment only.
Inclusion Criteria:

 -  Patients registered for bariatric surgery

 Exclusion Criteria:

 -  Not applicable