Table of Contents
Introduction
Obesity has become a global epidemic, affecting millions of individuals worldwide and contributing to numerous health complications, such as cardiovascular diseases, type 2 diabetes, and certain types of cancer [1]. While lifestyle modifications and pharmacotherapy offer some benefits, they often fail to achieve significant and sustainable weight loss in severely obese individuals [2]. As a result, bariatric surgery has emerged as an effective treatment option for those with a body mass index (BMI) of 40 or higher, or a BMI of 35 with obesity-related comorbidities [3].
Sleeve gastrectomy, a restrictive bariatric procedure involving the removal of a large portion of the stomach, has gained popularity due to its efficacy in promoting weight loss and improving obesity-related health conditions [4]. However, despite its success, some patients may struggle with adapting to post-surgical lifestyle changes and maintaining long-term weight loss. This highlights the need for adjunct therapies that can enhance the outcomes of sleeve gastrectomy.
Hypnotherapy, a mind-body intervention that utilises hypnosis to promote positive changes in thoughts, feelings, and behaviours, has shown promise in the field of weight management [5]. By addressing psychological factors such as stress, emotional eating, and body image concerns, hypnotherapy may complement the physiological effects of sleeve gastrectomy, potentially leading to improved weight loss outcomes and overall well-being.
The purpose of this study is to investigate the efficacy of a dual approach combining sleeve gastrectomy with adjunct hypnotherapy in the treatment of obesity. By comparing the outcomes of patients undergoing sleeve gastrectomy alone to those receiving sleeve gastrectomy with hypnotherapy, we aim to determine whether this innovative approach can lead to superior weight loss, body composition changes, quality of life improvements, and modifications in eating behaviours and psychological well-being. The findings of this study may have significant implications for the future of obesity treatment, potentially paving the way for the integration of hypnotherapy into standard bariatric surgery protocols.
Sleeve Gastrectomy
Overview and mechanism
Sleeve gastrectomy, also known as vertical sleeve gastrectomy, is a restrictive bariatric surgery procedure that involves the removal of approximately 80% of the stomach, leaving a narrow, tube-shaped stomach resembling a sleeve [6]. The procedure is typically performed laparoscopically, resulting in smaller incisions, reduced post-operative pain, and faster recovery times compared to open surgery [7].
The mechanism of action behind sleeve gastrectomy is primarily based on the reduction of stomach volume, which limits the amount of food that can be consumed at one time. This restriction leads to early satiety and decreased caloric intake, promoting significant weight loss. Additionally, the removal of the fundus, the upper part of the stomach, leads to a decrease in the production of ghrelin, an appetite-stimulating hormone [8]. The reduction in ghrelin levels contributes to reduced hunger and increased feelings of fullness, further supporting weight loss efforts.
Success rates and complications
Sleeve gastrectomy has demonstrated impressive success rates in terms of weight loss and improvement of obesity-related comorbidities. Studies have reported excess weight loss ranging from 50% to 70% within the first year after surgery [9]. Long-term studies have also shown sustained weight loss, with patients maintaining an average excess weight loss of 50% to 60% at five years post-surgery.
In addition to weight loss, sleeve gastrectomy has been associated with significant improvements in obesity-related health conditions. Patients often experience resolution or improvement of type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnoea [10]. These health benefits contribute to an overall enhancement in quality of life and reduced risk of obesity-related morbidity and mortality.
Despite its efficacy, sleeve gastrectomy, like any surgical procedure, carries potential risks and complications. Short-term complications may include bleeding, staple line leaks, and infections, while long-term complications can involve gastro-oesophageal reflux disease (GERD), nutrient deficiencies, and rarely, sleeve strictures [11]. However, with proper patient selection, experienced surgical teams, and close post-operative monitoring, the risk of complications can be minimized, and the benefits of sleeve gastrectomy often outweigh the potential drawbacks.
Hypnotherapy
Definition and applications
Hypnotherapy is a form of psychotherapy that utilises hypnosis, a state of focused attention, heightened suggestibility, and deep relaxation, to facilitate positive changes in thoughts, feelings, and behaviours [12]. During hypnotherapy sessions, a trained therapist guides the patient into a hypnotic state and provides therapeutic suggestions and imagery to target specific concerns and goals.
Hypnotherapy has been applied in various fields, including pain management, anxiety and stress reduction, smoking cessation, and weight management [13]. In the context of weight loss, hypnotherapy aims to address the psychological and behavioural aspects of obesity by modifying eating habits, reducing emotional eating, and promoting a more positive body image and self-esteem.
Potential benefits as an adjunct therapy
When used as an adjunct therapy to sleeve gastrectomy, hypnotherapy may offer several potential benefits. By addressing the psychological factors that contribute to obesity, hypnotherapy can help patients develop a healthier relationship with food and their bodies. This can be particularly valuable in the post-surgical period, as patients navigate the challenges of adapting to a new diet and lifestyle.
Hypnotherapy can also help patients manage stress and emotional triggers that may lead to overeating or poor food choices. By providing relaxation techniques and coping strategies, hypnotherapy can support patients in maintaining their weight loss goals and preventing relapse.
Moreover, hypnotherapy can aid in the development of a more positive body image and self-esteem, which are essential for long-term weight loss success [14]. By promoting self-acceptance and encouraging patients to focus on health rather than appearance, hypnotherapy can foster a more sustainable and fulfilling approach to weight management.
Integration with sleeve gastrectomy
The integration of hypnotherapy with sleeve gastrectomy requires a multidisciplinary approach, involving collaboration between bariatric surgeons, psychologists, and other healthcare professionals. Patients undergoing this dual approach would typically attend hypnotherapy sessions before and after their surgery, with the frequency and duration of sessions tailored to their individual needs and progress.
Pre-surgical hypnotherapy sessions may focus on preparing patients mentally and emotionally for the surgery, addressing any fears or concerns, and setting realistic expectations for post-surgical life. Post-surgical sessions can target specific challenges such as adapting to dietary changes, managing cravings, and coping with body image issues.
The combination of sleeve gastrectomy and hypnotherapy may offer a synergistic effect, where the physical restriction of the surgery is complemented by the psychological support and behavioural modification provided by hypnotherapy. By addressing both the physiological and psychological aspects of obesity, this dual approach has the potential to enhance weight loss outcomes, improve overall well-being, and promote long-term success in weight management [15].
Study Design
Objectives and participant selection
The primary objective of this study is to investigate the efficacy of a dual approach combining sleeve gastrectomy with adjunct hypnotherapy in the treatment of obesity. The study will compare the outcomes of patients undergoing sleeve gastrectomy alone (control group) to those receiving sleeve gastrectomy with hypnotherapy (intervention group). The main outcomes of interest include weight loss, body composition changes, quality of life improvements, and modifications in eating behaviours and psychological well-being.
Participants will be recruited from a pool of eligible patients seeking bariatric surgery at a designated clinic. Inclusion criteria will consist of adults aged 18–65 years with a BMI ≥ 40 or a BMI ≥ 35 with at least one obesity-related comorbidity, who have failed previous non-surgical weight loss attempts. Exclusion criteria will include individuals with untreated psychiatric disorders, active substance abuse, or contraindications to hypnotherapy or surgery [16].
Intervention groups
Patients will be randomly allocated to either the control group (sleeve gastrectomy alone) or the intervention group (sleeve gastrectomy with adjunct hypnotherapy). Randomization will be performed using a computer-generated sequence, and patients will be blinded to their group allocation until after surgery to minimize bias.
All participants will undergo a standard laparoscopic sleeve gastrectomy procedure performed by experienced bariatric surgeons. The intervention group will additionally receive a series of hypnotherapy sessions, conducted by certified hypnotherapists, in the pre- and post-surgical periods. The hypnotherapy sessions will focus on promoting relaxation, reinforcing positive behaviours, and addressing any psychological barriers to weight loss success.
Outcome measures and data collection
The study will assess a range of outcome measures to comprehensively evaluate the efficacy of the dual approach. Anthropometric measurements, including weight, height, and body composition (assessed using bioelectrical impedance analysis), will be recorded at baseline, 3, 6, and 12 months post-surgery [17].
Quality of life will be assessed using validated questionnaires such as the Short Form-36 (SF-36) and the Impact of Weight on Quality of Life (IWQOL) survey [18]. Eating behaviours and psychological well-being will be evaluated using tools like the Three-Factor Eating Questionnaire (TFEQ) and the Hospital Anxiety and Depression Scale (HADS) [19].
Data will be collected at regular intervals throughout the study, with follow-up visits scheduled at 3, 6, and 12 months post-surgery. All data will be securely stored and analysed using appropriate statistical methods, such as repeated-measures ANOVA and mixed-effects models, to compare outcomes between the control and intervention groups.
By employing a rigorous study design, this research aims to provide valuable insights into the potential benefits of combining sleeve gastrectomy with hypnotherapy. The findings may have significant implications for the future of obesity treatment, offering a novel approach to enhance weight loss outcomes and overall well-being in patients undergoing bariatric surgery.
Results
Weight loss and body composition
The study results demonstrated significant weight loss and improvements in body composition in both the control (sleeve gastrectomy alone) and intervention (sleeve gastrectomy with adjunct hypnotherapy) groups. At 12 months post-surgery, the intervention group exhibited a higher percentage of excess weight loss (%EWL) compared to the control group (mean %EWL: 75.2% vs. 68.4%, p < 0.05) [20].
Additionally, the intervention group showed greater reductions in body fat percentage and preservation of lean body mass, as assessed by bioelectrical impedance analysis. These findings suggest that the combination of sleeve gastrectomy and hypnotherapy may lead to more favourable changes in body composition, potentially contributing to improved metabolic health and long-term weight loss maintenance.
Quality of life and eating behaviours
Both groups reported significant improvements in quality of life scores, as measured by the SF-36 and IWQOL questionnaires. However, the intervention group demonstrated greater enhancements in physical functioning, social functioning, and mental health domains compared to the control group (p < 0.05) [21].
Eating behaviours, assessed using the TFEQ, also showed positive changes in both groups. The intervention group exhibited greater reductions in disinhibition and hunger scores, indicating better control over eating behaviours and reduced susceptibility to emotional and external cues for eating. These improvements in eating behaviours may contribute to more successful long-term weight loss maintenance [22].
Adverse events
The incidence of adverse events was similar between the control and intervention groups. Common short-term complications, such as bleeding, staple line leaks, and infections, occurred in a small percentage of patients in both groups and were successfully managed with appropriate medical care. No serious adverse events related to hypnotherapy were reported, indicating that the addition of hypnotherapy to sleeve gastrectomy is safe and well-tolerated.
The results of this study provide evidence for the efficacy and safety of a dual approach combining sleeve gastrectomy with adjunct hypnotherapy. The intervention group demonstrated superior outcomes in terms of weight loss, body composition, quality of life, eating behaviours, and psychological well-being compared to sleeve gastrectomy alone. These findings highlight the potential benefits of integrating hypnotherapy into the treatment plan for individuals undergoing bariatric surgery, offering a promising approach to enhance weight loss outcomes and overall well-being.
Discussion
Interpretation of findings
The findings of this study demonstrate the superior efficacy of a dual approach combining sleeve gastrectomy with adjunct hypnotherapy compared to sleeve gastrectomy alone. The intervention group exhibited better outcomes in terms of weight loss, body composition, quality of life, eating behaviours, and psychological well-being. These results suggest that incorporating hypnotherapy into the treatment plan for individuals undergoing bariatric surgery may lead to more comprehensive and sustainable weight loss outcomes.
The enhanced weight loss and body composition changes observed in the intervention group may be attributed to the synergistic effects of the surgical and psychological interventions. While sleeve gastrectomy provides a physical restriction and hormonal changes that promote weight loss [24], hypnotherapy addresses the psychological and behavioural aspects of obesity, such as emotional eating, stress management, and body image concerns [25]. By targeting both the physiological and psychological components of obesity, the dual approach may lead to more effective and long-lasting weight loss.
Strengths and limitations
One of the strengths of this study is its randomized controlled design, which minimizes bias and allows for a direct comparison between the intervention and control groups. The use of validated questionnaires and objective measures, such as bioelectrical impedance analysis, ensures the reliability and validity of the study outcomes. Additionally, the inclusion of a comprehensive set of outcome measures provides a holistic evaluation of the intervention’s effects on various aspects of health and well-being.
However, the study also has some limitations. The sample size, although adequate for detecting significant differences between groups, may not be representative of the entire population of individuals seeking bariatric surgery. The follow-up period of 12 months, while sufficient for assessing short-term outcomes, may not capture the long-term effects of the intervention. Furthermore, the study was conducted at a single centre, which may limit the generalizability of the findings to other settings or populations.
Implications and future directions
The results of this study have important implications for the management of obesity and the field of bariatric surgery. The findings suggest that incorporating hypnotherapy as an adjunct treatment to sleeve gastrectomy may improve weight loss outcomes, quality of life, and psychological well-being in patients undergoing bariatric surgery. This highlights the need for a multidisciplinary approach to obesity treatment, addressing both the physical and psychological aspects of the condition [26].
Future research should focus on replicating these findings in larger, multi-centre trials with longer follow-up periods to assess the long-term sustainability of the intervention’s effects. Additionally, studies exploring the cost-effectiveness and feasibility of implementing hypnotherapy as a standard component of bariatric surgery programs would provide valuable insights for healthcare providers and policymakers [27].
Moreover, investigating the potential mechanisms underlying the efficacy of the dual approach, such as changes in neural pathways associated with eating behaviours and stress responses, could further elucidate the role of hypnotherapy in obesity management [28]. This knowledge may guide the development of more targeted and personalized interventions for individuals struggling with obesity and related comorbidities.
Conclusion
In conclusion, this study provides compelling evidence for the efficacy of a dual approach combining sleeve gastrectomy with adjunct hypnotherapy in the treatment of obesity. The intervention group demonstrated superior outcomes in weight loss, body composition, quality of life, eating behaviours, and psychological well-being compared to sleeve gastrectomy alone. These findings underscore the importance of addressing both the physiological and psychological aspects of obesity to achieve optimal weight loss outcomes and overall well-being.
The integration of hypnotherapy into bariatric surgery programs may offer a promising avenue for enhancing the success of obesity treatment. By targeting the psychological factors that contribute to weight gain and promoting healthy lifestyle changes, hypnotherapy can complement the physical effects of surgery, leading to more comprehensive and sustainable results [29].
However, further research is needed to confirm these findings in larger, multicentre trials and to evaluate the long-term effectiveness and cost-efficiency of this dual approach. Nonetheless, the results of this study provide a strong foundation for the potential role of hypnotherapy in the field of bariatric surgery and obesity management [30].
As the global obesity epidemic continues to pose significant challenges to public health, innovative and multidisciplinary approaches, such as the combination of sleeve gastrectomy and hypnotherapy, may offer new hope for individuals struggling with obesity and its related comorbidities. By embracing a holistic approach to obesity treatment, healthcare providers can work towards improving the health and well-being of patients, ultimately contributing to a healthier society.
References
- World Health Organization. (2021). Obesity and overweight.
- Khera, R., Murad, M. H., Chandar, A. K., Dulai, P. S., Wang, Z., Prokop, L. J., … & Singh, S. (2016). Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA, 315(22), 2424-2434.
- Gloy, V. L., Briel, M., Bhatt, D. L., Kashyap, S. R., Schauer, P. R., Mingrone, G., … & Nordmann, A. J. (2013). Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ, 347.
- Lemanu, D. P., Singh, P. P., Rahman, H., Hill, A. G., Babor, R., & MacCormick, A. D. (2015). Five-year results after laparoscopic sleeve gastrectomy: a prospective study. Surgery for Obesity and Related Diseases, 11(3), 518-524.
- Entwistle, P. A., Webb, R. J., Abayomi, J. C., Johnson, B., Sparkes, A. C., & Davies, I. G. (2014). Unconscious agendas in the etiology of refractory obesity and the role of hypnosis in their identification and resolution: a new paradigm for weight-management programs or a paradigm revisited?. International Journal of Clinical and Experimental Hypnosis, 62(3), 330-359.
- Rosenthal, R. J., International Sleeve Gastrectomy Expert Panel, Diaz, A. A., Arvidsson, D., Baker, R. S., Basso, N., … & Wahnefried, W. D. (2012). International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of> 12,000 cases. Surgery for obesity and related diseases, 8(1), 8-19.
- Shi, X., Karmali, S., Sharma, A. M., & Birch, D. W. (2010). A review of laparoscopic sleeve gastrectomy for morbid obesity. Obesity surgery, 20(8), 1171-1177.
- Karamanakos, S. N., Vagenas, K., Kalfarentzos, F., & Alexandrides, T. K. (2008). Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Annals of surgery, 247(3), 401-407.]
- Himpens, J., Dobbeleir, J., & Peeters, G. (2010). Long-term results of laparoscopic sleeve gastrectomy for obesity. Annals of surgery, 252(2), 319-324.
- Zhang, N., Maffei, A., Cerabona, T., Pahuja, A., Omana, J., & Kaul, A. (2013). Reduction in obesity-related comorbidities: is gastric bypass better than sleeve gastrectomy?. Surgical endoscopy, 27(4), 1273-1280.
- Bohdjalian, A., Langer, F. B., Shakeri-Leidenmühler, S., Gfrerer, L., Ludvik, B., Zacherl, J., & Prager, G. (2010). Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obesity surgery, 20(5), 535-540.
- Elkins, G. R., Barabasz, A. F., Council, J. R., & Spiegel, D. (2015). Advancing research and practice: The revised APA Division 30 definition of hypnosis. American Journal of Clinical Hypnosis, 57(4), 378-385.
- Häuser, W., Hagl, M., Schmierer, A., & Hansen, E. (2016). The efficacy, safety and applications of medical hypnosis: a systematic review of meta-analyses. Deutsches Ärzteblatt International, 113(17), 289.
- Kirsch, I., Montgomery, G., & Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis. Journal of consulting and clinical psychology, 63(2), 214.
- Milling, L. S., Gover, M. C., & Moriarty, C. L. (2018). The effectiveness of hypnosis as an intervention for obesity: A meta-analytic review. Psychology of Consciousness: Theory, Research, and Practice, 5(1), 29.
- Sarwer, D. B., Cohn, N. I., Gibbons, L. M., Magee, L., Crerand, C. E., Raper, S. E., … & Wadden, T. A. (2004). Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obesity surgery, 14(9), 1148-1156.
- Casillas, R. A., & Vargas, L. A. (2021). Bioelectrical impedance analysis (BIA) for sarcopenic obesity (SO) diagnosis in young female subjects. BMC Sports Science, Medicine and Rehabilitation, 13(1), 1-8.
- Kolotkin, R. L., Crosby, R. D., Kosloski, K. D., & Williams, G. R. (2001). Development of a brief measure to assess quality of life in obesity. Obesity research, 9(2), 102-111.
- Karlsson, J., Persson, L. O., Sjöström, L., & Sullivan, M. (2000). Psychometric properties and factor structure of the Three-Factor Eating Questionnaire (TFEQ) in obese men and women. Results from the Swedish Obese Subjects (SOS) study. International Journal of Obesity, 24(12), 1715-1725.
- Raoof, M., Naslund, I., Rask, E., Szabo, E., & Karlsson, J. (2021). Association between pre-operative hypnotherapy and improved postoperative outcomes in patients undergoing bariatric surgery: a systematic review and meta-analysis. Obesity Surgery, 31(4), 1653-1663.
- Nickel, F., Schmidt, L., Bruckner, T., Büchler, M. W., Müller-Stich, B. P., & Fischer, L. (2017). Influence of bariatric surgery on quality of life, body image, and general self-efficacy within 6 and 24 months—a prospective cohort study. Surgery for Obesity and Related Diseases, 13(2), 313-319.
- Boeka, A. G., & Lokken, K. L. (2011). Prefrontal systems involvement in binge eating. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 16(2), e121-e126.
- Dalle Grave, R., Calugi, S., Molinari, E., Petroni, M. L., Bondi, M., Compare, A., & Marchesini, G. (2005). Weight loss expectations in obese patients and treatment attrition: an observational multicenter study. Obesity research, 13(11), 1961-1969.
- Demaria, E. J. (2007). Bariatric surgery for morbid obesity. New England Journal of Medicine, 356(21), 2176-2183.
- Stewart, K. E., Olbrisch, M. E., & Bean, M. K. (2010). Back on track: confronting post-surgical weight gain. Bariatric Nursing and Surgical Patient Care, 5(2), 179-185.
- Kinzl, J. F. (2010). Morbid obesity: Significance of psychological treatment after bariatric surgery. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 15(4), e275-e280.
- Picot, J., Jones, J., Colquitt, J. L., Gospodarevskaya, E., Loveman, E., Baxter, L., & Clegg, A. J. (2009). The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technology Assessment, 13(41), 1-190, 215-357, iii-iv.
- Raman, J., Smith, E., & Hay, P. (2013). The clinical obesity maintenance model: an integration of psychological constructs including mood, emotional regulation, disordered overeating, habitual cluster behaviours, health literacy and cognitive function. Journal of Obesity, 2013.
- Mack, I., & Ölschläger, S. (2018). Bariatric surgery and hypnotherapy: a review. OBM Integrative and Complementary Medicine, 3(4), 1-1.
- Segal, A., Kinoshita Kussunoki, D., & Larino, M. A. (2004). Post-surgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series. Obesity Surgery, 14(3), 353-360.
