The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recommended that all elective metabolic and bariatric procedures should be postponed until the end of the new coronavirus pandemic [1, 2]. While some studies have already been performed in a time of pandemic, the delay of operation may affect patients’ health in different ways [3–5].
Obesity is an epidemic disease that is a major problem in public health, it affects over 1.5 billion people globally and is directly associated with co-morbidities such as arterial hypertension, diabetes, dyslipidemia, obstructive sleep apnea syndrome, fatty liver disease, and depression [6–8]. Bariatric surgery is one of the most effective methods for the treatment of severe obesity that might lead to a long-term reduction in weight and can enhance individuals’ psychological well-being and body image satisfaction [9, 10]. After bariatric surgery, people are expected to abandon unhealthy eating habits such as emotional eating, eating at night, drinking high-calorie beverages, and returning to the pre-surgery lifestyle .
Emotions, attitudes, and behaviors toward eating play a very important role in obesity, negative emotions can be a powerful predictor of overeating [12, 13]. Overweight and obese women in comparison to the healthy group, are less aware of their emotions and have difficulty regulating their emotions, and feelings of loneliness or embarrassment which leads to binge eating . Adaptive cognitive emotion regulation (CER) strategies are significant to well-being and successful functioning. It is vital for the commencement, motivation, and organization of adaptive behaviors. However, maladaptive CER strategies can cause maladaptive behaviors that are not conducive to each person's rehabilitation . Mental health and eating behaviors may improve after bariatric surgery, and these beneficial effects may have an effect on weight reduction and maintenance . Nevertheless, these advantages do not appear to endure beyond the years right away after surgery . In patients with minor or considerable indications of depression, CBT was associated with weight loss before and four years after bariatric surgery . While studying the need for implementing CER strategies in women who underwent bariatric surgery seems necessary in the modern world of today, research on the subject and its
application is still in its infancy not only in Iran but in other countries as well. Some studies demonstrated that cooperation in group-based psychotherapy positively affects weight loss results among post-operative bariatric patients [18, 19]. Therefore, psychotherapy will be helpful to improve CER strategies in patients with obesity.
The goal of psychological therapy for obesity is training clients to differentiate between emotional hunger and physiological hunger and don't respond to their emotional stimuli and ruminants by eating . According to a schema-based approach, patients with obesity learn some reactions and coping strategies since childhood to cope with the schemas. So, they can avoid experiencing intense emotions that resulted from early maladaptive schemas, and they are more likely to suffer from negative self-esteem . Maladaptive thoughts and dysfunctional beliefs about physical shape, heaviness, and ingesting issues are important variables in obesity [20, 21]. This treatment is planned to assist each person to spoil those negative designs of thinking, feeling, and behaving, and develop more beneficial choices to substitute them .
After bariatric surgery, some individuals failed in attaining or keeping up ideal weight reduction and it is far said that 18% of 500 bariatric applicants failed to attain excess weight loss after bariatric surgery. One of the foremost commonplace reasons is overeating to manage emotional distress [6, 23]. Emotional eating (EE) or eating in reaction to emotional distress is related to suboptimal weight reduction and has been found to comply with bariatric operations , and group schema therapy improves the eating disordered symptoms . Medical weight management procedures may promote postoperative consequences, but empirical evidence is controversial . So far, the effects of various psychotherapies such as motivational interviewing , acceptance and commitment therapy , and cognitive-behavioral therapy (CBT) have been conducted for post-bariatric surgery patients [29–32], but no research has examined the effect of schema therapy on CER strategies in these patients. Therefore, this study aims to evaluate the effectiveness of schema therapy on the CER strategies in women who underwent bariatric surgery.