A nurse-led perioperative intervention enhances self-care and supports long-term weight loss after bariatric surgery: a randomized controlled trial.

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Original abstract

<h4>Background</h4>Bariatric surgery is an effective intervention for severe obesity, but long-term success relies on sustained self-care behaviors, self-efficacy for exercise, and weight management. Nurse-led case management has shown promise in enhancing patient outcomes, yet robust evidence from randomized controlled trials remains limited.<h4>Objective</h4>This study evaluated the impact of a nurse-led case management intervention (NURLIFE) on pre- and post-operative weight loss and self-care behaviors in bariatric patients.<h4>Methods</h4>A single-centre randomized controlled trial was conducted from January 2024 to August 2025 in a public hospital in southern Portugal. Forty patients were randomized to an intervention group (IG, n=20) receiving NURLIFE (personalized counselling, goal setting, and follow-up) or a control group (CG, n=20) receiving standard care. Outcomes, including weight, Self-Care of Chronic Illness Inventory (SCII), Self-Efficacy for Exercise (SEE), and Social Appearance Anxiety Scale (SAAS), were assessed at baseline, pre-surgery, and 12 months post-surgery. Data were analysed using mixed-model ANOVA and post-hoc tests with Bonferroni correction.<h4>Results</h4>The IG exhibited significant pre-operative weight loss (7.36 ± 7.09 kg vs. -0.10 ± 7.33 kg in CG, p = 0.001), corresponding to a % total weight loss (TWL) of 5.88% in the intervention group versus -0.62% in the control group. At 12 months, the intervention group achieved a %TWL of 42.29% compared with 34.97% in the control group. Significant improvements were observed pre-operatively in SCII Monitoring (p = 0.001), Management (p= 0.001), and in SEE (p < 0.001) and in SCII Maintenance (p = 0.050) and SEE (p < 0.011) at 12 months. These results suggest a potential additional contribution of the nursing intervention in relation to surgery. In addition, sustained improvements in self-efficacy (SEE) and maintenance of self-care behaviors were observed.<h4>Conclusion</h4>The NURLIFE intervention significantly enhanced pre-operative weight loss, which was maintained post-surgery, alongside improvements in self-care and exercise self-efficacy. These findings suggest a potential role of nurse-led case management into perioperative care to optimize bariatric outcomes.

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