Introduction
Despite the growing prevalence of obesity and related health conditions in the United States, bariatric surgery remains underutilized. While approximately 20% of Americans are eligible for the procedure, which includes those with a body mass index (BMI) over 35 or a BMI over 30 with conditions such as high blood pressure or type 2 diabetes, only 200,000 to 300,000 surgeries are performed annually. This represents just 1% of the people who qualify.
Moreover, even among those who undergo bariatric surgery, research shows that 20% to 50% of patients experience significant weight regain within a few years. This white paper explores the challenges contributing to weight regain and proposes a holistic, patient-centered coaching program to support sustainable weight management post-surgery.
The Challenges
Weight Regain After Bariatric Surgery
Many bariatric surgery patients experience initial weight loss success. However, over time, a significant portion of patients regain some or most of the lost weight. Studies have shown that participants, on average, regain 36% of their lost weight (with a range of 12% to 71%) within ten years after surgery. Factors contributing to weight regain include:
+ Physical and Mental Health Challenges: Increases in appetite, physical health issues, and mental health struggles such as depression and anxiety can interfere with a patient’s ability to maintain weight loss.
+ Psychosocial Factors: Eating in social settings, family difficulties, and loneliness further complicate long-term weight management.
+ Emotional Distress: Weight regain is often accompanied by feelings of shame, hopelessness, and frustration, contributing to a cycle of loss of control and disengagement from healthy habits.
The Mental Health-Obesity Connection
The association between weight loss and mental health is profound. For example:
+ People diagnosed with depression are 60% more likely to develop diabetes.
+ A meta-analysis of 120 studies found that individuals with serious mental illness are three times more likely to be obese compared to those without a mental illness.
+ 20% of individuals with heart attacks, 33% with congestive heart failure, and 31% with strokes experience major depression within a year.
+ Depression after a heart attack increases the likelihood of another heart attack by 50-100%, and if a person has already suffered a heart attack, depression doubles the risk of a subsequent event within a year.
+ Mental health challenges increase stress levels, leading to poor dietary habits and a sedentary lifestyle, creating a vicious cycle that affects long-term weight management.
The Solution
A Holistic Approach to Bariatric Surgery Aftercare
Recognizing the interconnectedness of physical and mental health, our solution offers a comprehensive metabolic health coaching program. This approach aims to support individuals at various stages—whether they are preparing for or recovering from gastric bypass surgery, managing hypertension, or dealing with type 1 or type 2 diabetes. The program also seeks to reduce healthcare costs for self-insured employers and health plans by improving long-term health outcomes for participants.
Key Benefits of Bariatric Surgery
Research has shown that bariatric surgery can lead to significant cost savings over time:
+ A study of 167,764 individuals with obesity (83,882 in the bariatric surgery group and 83,882 in a non-surgical control group) found that in follow-up years 2 through 10, the bariatric surgery group was associated with lower overall healthcare costs compared to the non-surgical group.
+ Another study showed that diabetes medication costs significantly decreased for surgery patients, with total costs dropping from $123 for non-surgical patients to $33 for surgery patients within the first three months post-surgery, and these savings continued over the duration of the study.
While bariatric surgery offers substantial benefits, including cost savings and improved health outcomes, it is essential to ensure that patients maintain these benefits long-term. This requires addressing the psychosocial and emotional challenges that can lead to weight regain.
Our Holistic Metabolic Health Coaching Program
Our metabolic health coaching program combines cognitive behavioral coaching (CBC) with a structured process involving WOOP (Wish, Outcome, Obstacle, Plan) goals, educational content, and regular accountability sessions. The program focuses on improving both physical and mental health, providing patients with the tools and support necessary to sustain long-term weight management post-surgery.
Core Components of the Program
Personalized Metabolic Health Focus
The educational content is tailored to each patient’s unique needs, whether they are preparing for surgery, recovering, managing hypertension, or addressing diabetes. Personalization ensures the information is relevant and actionable for each participant.
Cognitive Behavioral Coaching (CBC)
CBC helps patients identify and challenge limiting beliefs, build resilience, and enhance self-awareness. This approach empowers patients to develop new patterns of thinking and behavior, essential for maintaining long-term weight loss.
Nutritional Guidance
A key component of the program is educating patients on the impact of nutrition on metabolic health. Our coaches provide practical strategies to help patients maintain a balanced diet tailored to their specific needs.
Mindfulness and Stress Management
Recognizing the connection between mental and physical health, we integrate mindfulness techniques such as deep breathing exercises and meditation into the program. Stress management helps patients navigate the challenges of long-term weight maintenance.
Continuous Monitoring and Goal Adjustment
Regular assessments ensure that the program remains responsive to each patient’s evolving needs. Goals and strategies are adapted to reflect the patient’s progress and any new challenges they encounter.
Support System Engagement
Involving family members or close friends in the patient’s journey can significantly enhance the likelihood of success. We encourage the active involvement of support systems to provide both emotional and practical assistance.
Celebrating Success
Measurable metrics are established to track progress, and successes are celebrated to reinforce positive behavior changes and boost motivation.
App Demonstration
Program Delivery
A Digital and Human-Centered Approach
We delivered the program through a mobile app available for both iPhone and Android devices. The app connects patients with coaches, content, and support. Key features include:
Dedicated Cognitive Behavioral Coaches
Available for weekly coaching sessions and anytime messaging.
Self-Guided Roadmaps
Covering both metabolic and mental health, complemented by video-based educational content and writing assignments.
WOOP Goal Setting Model
Evidence-based goal-setting framework used in every coaching session.
Patient Health Monitoring
Continuous tracking of steps, mood check-ins, and objective mental health assessments using voice as a digital biomarker to measure anxiety, depression, and stress.
Messaging Follow-Ups
Based on health monitoring needs, personalized support between sessions is ensured.
Program Engagement and Outcomes
The First Six Weeks Engagement Data
Within the first six weeks of the program, patient engagement was high:
+ Activity Rate: 100% of patients actively participate.
+ Recurring Appointments: 95% of patients scheduled regular and recurring appointments with their coach.
+ Coaching Sessions: An average of 3.7 sessions per patient per month.
+ Messaging: Patients exchanged an average of 1 weekly message with their coach, and coaches responded with an average of 1.8 weekly messages.
Weight Loss Outcomes
Patients lost an average of 6.92 pounds in six weeks, with an average of 1.90 pounds lost per coaching session. Outcomes continue to improve.
In just six weeks, 13.3% of patients have already achieved the desired outcomes for weight loss, and more are trending toward reaching their goals. We anticipate that all will reach their goals in six months.
Participant Feedback
The program received high praise, with participants rating it 4.8 out of 5. Patients also referred the program to others, indicating satisfaction with the holistic approach to health improvement.
Success Stories and Testimonials
Client Stories
Quote from Anne Brown, CEO of the Cook Center for Human Connection
“We knew this was a needed resource, but I don’t know if we really knew just how deeply needed it was. Hearing stories of parents connecting with their children again, having the confidence and tools to navigate difficult conversations with the support of their mental health professional, and approaching parenting and their child’s mental health in a whole new way has been incredibly rewarding.”
Conclusion
Bariatric surgery offers life-changing benefits, but without adequate post-surgical support, many patients struggle with weight regain. Our holistic coaching program provides a solution that addresses both the physical and mental health challenges of weight management. Early results show that patients are achieving meaningful health outcomes, reducing anxiety and depression, and experiencing sustainable weight loss. This approach not only supports patients’ long-term success but also offers significant healthcare savings for employers and health plans.
