The Impact of a Bariatric Rehabilitation Service on Patient Outcomes
The Impact of a Bariatric Rehabilitation Service on Patient Outcomes
Obesity is a major health problem that is affecting more and more people's lives. One of the
 most successful treatments 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.
 Interviews with patients and discussions with patient support groups indicate that many of
 the 'unsuccessful' patients feel unprepared for the operation and describe how although the
 surgery fixes their body it neglects their mind. They would therefore like to have more
 psychological support.

 The present study aims to set up and evaluate a health psychology led bariatric
 rehabilitation service (BRS) and determine the impact of such a service on patient outcomes
 following surgery. The BRS would offer information, support and mentoring pre and post
 surgery and address psychological issues such as dietary control, self esteem, coping and
 emotional eating. It is predicted that a bariatric rehabilitation service would primarily
 improve weight loss following surgery but would also aid changes in other aspects of the
 patient's well being.

 Obesity is a risk factor for a multitude of 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 bariatric rehabilitation service should help to improve the effectiveness of
 surgery which in the longer term is likely to be cost effective.

 This research is a direct response to the needs identified by patients and by offering a more
 comprehensive bariatric service the success and subsequent health and well being of obese
 patients should be improved.
Design: The study will involve a trial (open randomised parallel group control trial) with
 patients allocated to receive either usual care or the bariatric rehabilitation service (BRS)
 pre and post bariatric (obesity) surgery. Follow up measures will be recorded at 3, 6 and 12
 months post-surgery at routine follow-up clinics. In addition, qualitative interviews will be
 carried out with 20 participants from both arms of the trial (BRS n=10; usual care n=10).

 Piloting: The contents of the bariatric service and the follow up measures are based on pilot
 work. This pilot work has already been completed exploring what bariatric patients want and
 why bariatric surgery either fails or succeeds from the patients' perspective. Furthermore,
 pilot research has explored the impact of bariatric surgery on changes in mood, cognitions
 and eating behaviours. The quantitative measures and qualitative responses derived from these
 studies will form the basis of the intervention and the measures for the present study.

 Sample: St Richard's Hospital in Chichester, West Sussex offers a NHS based bariatric service
 for obese patients with a BMI over 40 (or 35 with serious co morbidities). This is the
 largest centre in the UK, with 600 patients per year receiving a bariatric operation at this
 clinic (70% being a primary bypass and 20% bands (the remaining 10% are revisions)). Patients
 will be recruited if they have been approved for surgery and had their date set for their
 operation. The consultant surgeon, Mr Chris Pring is a collaborator on this proposal.

 Procedure: Ethical approval will be in place before the start of the project. In the week
 before their operation patients attend the bariatric clinic for routine tests. When patients
 are sent their appointment letters they will be sent the information sheet along with it to
 give them approximately 2 weeks to think about whether they would like to take part. At the
 appointment patients will see the researcher who will explain the trial, obtain consent and
 randomly allocate the patient to either the usual care condition or the bariatric
 rehabilitation service (BRS) condition.

 Randomisation: All patients who fulfil the inclusion criteria will be approached by the
 researcher, asked to read an information sheet and if interested offered a written consent
 form. Once a patient is consented the researcher will contact the clinical trial unit at
 Surrey University who will provide third party blinded randomization to either the BRS or
 usual care.

 Timeline: The study will take 34 months. New patients will be recruited over a 12 month
 period and followed up for 12 months postoperatively. The first 6 months will involve
 preparation, setting up procedures for data collection and training the health psychologist.
 The next 25 months will involve rolling out the intervention, recruitment, randomly
 allocating patients to the 2 conditions, providing the BRS and collecting data on the
 evaluation of service. At 18 months the 20 interviews will take place and be transcribed. The
 final 3 months will be spent analyzing the data, assessing cost-effectiveness, disseminating
 the results to patients and health professionals and writing up findings for publication.
Inclusion Criteria:

 -  if they consent

 -  aged 18 or over

 -  have attended the bariatric clinic at Chichester

 -  been accepted for surgery

 -  have funding in place for surgery (i.e. their primary care trust has agreed to pay for
 their surgery).

 Exclusion Criteria:

 -  those who do not wish to take part in the randomisation

 -  those who do not wish to take part in the intervention

 -  those who will not be having bariatric surgery because they are not a suitable patient

 -  those who will not be having bariatric surgery because they can not secure funding
 from their primary care trust for the surgery

 -  those who cannot effectively read or speak English, as this would pose a difficulty in
 implementing the intervention and for data collection.