OBJECTIVE: To document preoperative outcomes of a behavioral lifestyle intervention delivered to patients prior to bariatric surgery in comparison to treatment as usual (insurance-mandated physician supervised diet). DESIGN AND METHODS: After completing a baseline assessment, candidates for surgery were randomized to a 6-month, evidence-informed, manualized lifestyle intervention (lifestyle, n = 121) or to preoperative care as usual (usual care, n = 119). At 6 months, 187 participants remained candidates for bariatric surgery and were included in the analyses. RESULTS: Lifestyle participants lost significantly more weight than those receiving usual care (8.3 +/- 7.8 kg versus 3.3 +/- 5.5 kg, F[1,183] = 23.6, p < 0.0001), with an effect size of 0.72. Additionally, logistic regression modeling indicated that lifestyle patients were significantly more likely to lose at least 5% of initial body weight than those in usual care (OR (95% CI) 2.94 (1.253 to 6.903)), as were participants who were heavier (OR (95% CI) 1.07 (1.001 to 1.14) for each unit increase in BMI) or with larger improvements in eating behaviors (OR (95%CI) 1.1 (1.049 to 1.145) for each unit increase on the Eating Behavior Inventory). CONCLUSIONS: A behavioral lifestyle intervention for severely overweight individuals leads to clinically significant weight loss prior to bariatric surgery. Post-surgery follow-up will allow us to examine the impact of the preoperative intervention on postoperative outcomes.

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