Page 105 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg
P. 105

  Chapter 5 105
 Discussion
When examining preliminary outcome of the bariatric psychological treatment offered, one of the main findings is that, compared to non-bariatric patients, bariatric patients lost less weight and profited less from the interventions aimed at improving poor body image. It may be that bariatric patients were less motivated to participate in preoperative treatment aimed at behavioral change as they, rightfully, expect the surgical procedure itself to be helpful in gaining control over eating. In addition, bariatric patients may expect that once they have lost a significant amount of excess weight, their body image will improve and a significant maintaining factor related to over-eating, i.e. a poor body image, will have disappeared. So in their view, acquiring
skills aimed at uncontrolled overeating, may be, obsolete.
The offered interventions within the group therapy were not aimed at specific eating disorder pathology, but were aimed at establishing a regular eating pattern. We presumed that individuals with morbid obesity struggle with irregularities in their daily menu, as disturbed eating behavior is regularly reported by individuals who are severely obese (De Zwaan 2001; Wilson & Fairburn, 2007). It was assumed that offering interventions aimed at establishing a regular eating pattern and acquiring skills for (uncontrolled) overeating, would enhance effectiveness of bariatric surgery. We did not examine whether the ability to establish a regular eating pattern and /or the acquired self-control on overeating, did actually improve adherence to the post-operative required lifestyle and dietary recommendations, compared with patients who did not participate in pre-operative treatment.
At hindsight, several limitations with regard to the treatment offered, come to mind. First, the considerable number of patients who were regarded non-eligible for participation due to poor literacy was worrying. Literature suggests that in the Netherlands, the prevalence of obesity has increased in the period 1987-1991 parti- cularlyinthosewitharelativelyloweducationallevel(Seidell,Verschuren,&Kromhout, 1995). Nowadays, it is known that low socio-economic status, likely to be associated with the prevalence of poor literacy, is negatively associated with suboptimal weight loss after surgery (Wimmelmann et al., 2014). So presumably, an important part of the bariatric sample was not reached. The found high dropout rate in the two pilot studies may be indicative of a (partial) mismatch with the treatment demands or expectations of the participants.
Around 2009, partly due to the high dropout rate, the intensive cooperation with the hospital gradually came to an end. Up till now, the extent to which the presence of pre- operative eating disorder pathology should be considered an impediment to bariatric surgery is still controversial (Wimmelmann et al., 2014). Some Dutch hospitals exclude patients who are pre-operatively diagnosed with a binge eating disorder




























































































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