Effectiveness of an Early Postoperative Nurse-Led, Individualized Counseling Program on Lifestyle Adherence After Bariatric Surgery: A Randomized Controlled Trial (PONLCP)

**Background and Rationale**

Bariatric surgery is an effective treatment for severe obesity and is associated with substantial weight loss and improvement in obesity-related comorbidities. However, the long-term effectiveness of bariatric surgery depends not only on the surgical procedure but also on patients' ability to maintain recommended postoperative lifestyle behaviors.

Following bariatric surgery, patients are expected to adopt several behavioral and self-management recommendations, including adherence to staged dietary progression, appropriate food choices and portion sizes, adequate protein and fluid intake, regular physical activity, lifelong vitamin and mineral supplementation, adherence to prescribed medications, and attendance at scheduled postoperative follow-up appointments.

The early postoperative period represents an important stage for establishing these behaviors. During this period, patients may experience difficulties adapting to dietary restrictions, maintaining physical activity, remembering supplementation schedules, understanding postoperative recommendations, and managing practical or personal barriers to adherence.

Although routine postoperative education provides essential information, standardized educational approaches may not adequately address the individual needs and barriers experienced by each patient. A personalized nurse-led counseling approach may provide additional support by identifying individual challenges, tailoring educational messages, facilitating realistic goal setting, and strengthening patients' ability to manage postoperative lifestyle recommendations.

**Study Aim**

The aim of this randomized controlled trial is to evaluate the effectiveness of an early postoperative, nurse-led, individualized counseling program in improving adherence to recommended lifestyle behaviors among adults following bariatric surgery.

**Intervention Overview**

The intervention will consist of a structured, individualized counseling program delivered by a trained nurse in addition to routine postoperative care.

The counseling program will be designed to address the multiple behavioral requirements associated with postoperative bariatric care. Its main components will include:

1. Individualized assessment: Identification of patients' current self-management practices, educational needs, perceived barriers, and difficulties in following postoperative recommendations.
2. Dietary adherence counseling: Reinforcement of recommended postoperative dietary progression, portion control, appropriate food selection, protein intake, hydration, and strategies for managing common eating-related difficulties.
3. Physical activity counseling: Guidance on gradually adopting appropriate physical activity according to the patient's postoperative recovery stage and clinical recommendations.
4. Vitamin and mineral supplementation: Education about the importance of prescribed supplementation, appropriate administration, and strategies to improve consistency of use.
5. Medication adherence: Counseling regarding prescribed postoperative medications and strategies to overcome medication-taking difficulties.
6. Follow-up appointment adherence: Reinforcement of the importance of scheduled postoperative clinical visits and strategies to prevent missed appointments.
7. Personalized goal setting and action planning: Development of realistic, individualized behavioral goals and practical action plans based on each patient's identified needs.
8. Reinforcement and teach-back: Assessment of patients' understanding of recommendations through teach-back and reinforcement of important self-management messages.

The intervention will be delivered according to a standardized counseling protocol while allowing individualization based on participants' needs and identified barriers. Intervention fidelity will be supported through standardized educational materials and a structured counseling checklist.

**Control Group**

Participants assigned to the control group will receive routine postoperative care according to the standard practices of the participating clinical setting. This may include routine clinical follow-up and standard postoperative education provided by the healthcare team. No additional structured individualized nurse-led counseling program will be provided to this group.

**Study Hypothesis**

The study hypothesizes that adults receiving early postoperative individualized nurse-led counseling, in addition to routine postoperative care, will demonstrate greater adherence to recommended lifestyle behaviors than adults receiving routine postoperative care alone.

The study will provide evidence regarding the potential contribution of individualized nursing counseling to postoperative self-management and adherence following bariatric surgery.