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Table 1 Chapter from the self-help manual component of APOLO-Bari

From: APOLO-Bari, an internet-based program for longitudinal support of bariatric surgery patients: study protocol for a randomized controlled trial

Chapter Objectives Description and lifestyle changes
General information: obesity and bariatric surgery
Note: Provided in the open area of the homepage. All study participants will have access to this chapter after registering.
To educate about obesity and bariatric surgery as a long-term intervention treatment. Different procedures and their post-surgery implications;
Obesity, psychosocial impairments and maintenance mechanisms;
The role of bariatric surgery as a weight loss treatment for obesity.
Motivation for intervention and importance of monitoring weight To highlight individual responsibility and the need for long-term lifestyle modifications;
To educate about self-monitoring and regular self-weighing.
How to use the program;
The top ten recommendations of your bariatric surgeon;
How weight varies after surgery and in the long term;
Why and how to control your weight.
Healthy eating behavior To promote adequate eating behaviors;
To educate about strategies to maintain a regular eating plan;
To educate about the importance of the different nutrients and how to include them in a daily eating plan.
Nutritional changes and deficits after bariatric surgery;
Rules for a healthy eating patter after bariatric surgery;
Nutritional pyramid for post-bariatric patients;
Signs of problems with your eating behaviors;
Getting to know the different nutrients;
How to read food labels;
Stress management and problem solving To learn problem-solving strategies;
To identify problematic situations;
To anticipate and provide training on adequate coping strategies.
Different types of stress;
Symptoms of stress after bariatric surgery;
Steps in problem solving;
Identify and deal with problematic situations;
Stress management techniques;
Physical activity and physical exercise To promote an active lifestyle;
To educate about the importance of physical activity after surgery and to identify strategies to increase physical activity.
Benefits and myths of an active lifestyle after bariatric surgery;
How to begin and increase physical activity;
Use a pedometer and enhance your motivation;
Sedentary versus active attitudes;
Structured physical exercise: what is it and what is it not?
Identifying and managing barriers for regular physical activity.
Goals and expectations To adapt outcome expectations in different areas of life and throughout the weight loss process;
To identify the individual meaning of success and failure.
Unrealistic expectation regarding bariatric surgery;
Facts about weight loss after bariatric surgery;
Expected weight loss after surgery;
Identify non-weight related success outcomes after surgery;
Establish ‘SMART’ goals and rewards.
Emotions, thoughts and eating To understand the relationship between emotions and eating;
To cope with anxiety and mood changes after surgery.
Change your thoughts to change your behavior;
Think about your thinking – cognitive bias;
Consequences and characteristics of emotional eating;
Guidelines to deal with emotional situations;
Physical hunger vs emotional hunger;
Guidelines for challenging situations.
Self-concept and self-esteem To understand the main aspects of incorporating a developing self-worth system;
To identify low self-esteem negative thoughts.
Identify self-strengths, weaknesses, achievements and talents;
Challenging low self-esteem negative thoughts.
Body image To address common body image problems related to weight changes or extra hanging skin;
To inform about aesthetic surgery;
To educate about body checking and ‘feeling fat’.
Body image and (un)realistic expectations after bariatric surgery;
Excessive skin and plastic surgery;
Work on non-weight related positive qualities;
Accepting less positive body aspects;
Biased assumptions about the importance of body image;
Body checking and ‘feeling fat’.
Eating behavior problems To identifying persistent eating problems;
To identify and cope with triggers for problematic eating behaviors (e.g., emotional eating, binge eating, loss of control, grazing, dumping or plugging).
Persistent eating problems: binge eating and loss of control; excessive eating; grazing; night eating; restriction; sneak eating; chewing and spitting; food choices and restaurant choices;
Gastrointestinal problems: vomiting; dumping syndrome and plugging;
Reducing calories changing the way you eat;
Monitoring eating behaviors and identifying trigger for problematic eating.
Relationships and interpersonal difficulties To cope with new emerging problems;
To provide training on assertiveness and interpersonal skills.
Challenges experienced with social interactions;
Make social cues work for you;
Techniques to express yourself assertively.
Social support and significant others To promote an adequate social support system;
To identify helpers or those who might create challenging situations.
Communicating with significant others;
Pregnancy and contraception;
Changes experienced by your significant other;
Assessing your current social support:
Defining how others can help you.
Relapse prevention To explain the difference between a misstep and a relapse;
To alert for common problems associated with weight regain in the long term;
To identify risk behaviors and coping strategies.
How to keep motivated;
Anticipate problematic situations;
Relapse versus lapse;
Create a relapse-prevention plan.
  1. SMART = Specific, Measurable, Attainable/Achievable, Relevant, Timely