JMIR Publications

ABSTRACT

Background:

Despite bariatric surgery showing significant weight loss trajectories for many patients, a substantial proportion regain weight after the first-year surgery. The addition of telemedicine to standard care could support patients to engage into a more active lifestyle, and thus improve clinical outcomes.

Objective:

Our aim was to evaluate a telemedicine intervention program dedicated to the promotion of physical activity including digital devices and teleconsultation and telemonitoring the first six months following bariatric surgery.

Methods:

This study employed a mixed-methods design based on an open label randomized controlled trial. Patients were included during the first week after bariatric surgery then randomized in two intervention groups: the TelePhys group received a monthly telemedicine consultation focusing on physical activity coaching, while the TeleDiet group received a monthly telemedicine consultation on diet coaching. Data were collected using connected wireless watch pedometer and body-weight scale. The primary outcome was the difference in the mean number of steps at the first and sixth postoperative months between the two groups. Weight change was also evaluated, and focus groups and interviews were conducted to enrich the results and capture perceptions of the telemedicine provided.

Results:

Among the 90 patients (40.6 years (±10.4) mean (SD) age, 81% women, 69% gastric bypass) included, 70 completed the study until the sixth month (n=38 TelePhys; n=32 TeleDiet). Eighteen participants accepted to be interviewed (n=8 Telephys; n=10 TeleDiet). An increase of the mean number of steps between the first and the sixth month was found in both groups but this change was significant only in the TeleDiet group (p=0.010). No difference was found when comparing both intervention groups. Interviewed participants reported to have appreciated the teleconsultations as the individualized tailored counselling helped them to make better choices on the behaviors that could increase their likelihood of a daily life in better health. Weight loss, followed by social factors (as social support), were identified as the main facilitators to physical activity. Family responsibilities, professional constraints as well as poor urban policies promoting physical activities and lack of accessibility to sport infrastructures were their major barriers to postoperative lifestyle adherence.

Conclusions:

Our study did not show any difference of a telemedicine intervention dedicated to physical activity in mobility recovery after bariatric surgery. The early postoperative timing for our intervention may explain the null findings. Behavioral change-seeking e-health interventions carried by clinicians require to be supported by structured public health policies to tackle patients’ obesogenic environment in order to be efficient in their struggle against sedentary lifestyle-related pathologies. Further research will need to focus on long-term interventions. Clinical Trial: ClinicalTrials.gov NCT02716480, https://clinicaltrials.gov/ct2/show/NCT02716480