Page 124 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg
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  124 Chapter 6
 with weight loss [37]. Positive or negative post-operative weight loss is associated with the degree to which patients benefited from psychological treatment in the past. Our findings were not supported by previous studies, in which was found that patients who had received previous psychological treatment had improved weight loss compared with individuals without pervious psychological treatment [37, 59]. Due to the lack of additional information with regard to the nature of these psycho- logical treatments in this study further interpretations cannot be made.
We found an association between higher baseline BMI at time of surgery, particu- larly pre-operative super-obesity, and suboptimal weight loss. This is in line with the literature [13]. The predictor found in other studies for suboptimal weight loss when being over 40 years at the time of surgery was not found in this study, probably due to the small number of participants below the age of 40.
Our finding that the duration of the follow-up period was associated to subopti- mal weight loss needs additional research in the form of a longitudinal study. It is advisable to have a measurement at a predefined time after BS. A possible explana- tion could be that a higher impulsivity leads to difficulties maintaining the required behavioral adjustments. Bariatric surgery patients in need of support due to subop- timal weight loss, may feel at loss for help and guidance with regard to the required behavioral adjustment [60]. Among BS patients there is a demand for improved infor- mation preoperatively, to prepare for post-operative issues.
The strength of our study is that we studied the impact of post-operative behavioral as well as the psychological factors on suboptimal weight loss. Since there is only a limited body of research addressing the impact of post-operative psychological and behavioral factors on suboptimal weight loss, this study is an extension of the existing body of literature. Identifying variables associated with successful weight loss is of importance because suboptimal weight loss, considered a long- term complication, can lead to the re-emergence of obesity related comorbidities and an impaired quality of life. Another strength of our study is the average duration of the follow-up post-op- erative, since this is associated with suboptimal weight loss. A long follow-up duration is essential to observe the impact of behavioral and psychological factors on weight loss post-operative. Our findings that increased impulsivity post-operative and eating disorder pathology post-operative are associated with suboptimal weight loss are of importance for clinical implications.
This study has some potential limitations that should be taken in considera- tion when interpreting the findings. There was a recruitment bias: the participants recruited through a Dutch treatment facility and the participants recruited through Dutch online platforms and Dutch general hospitals were heterogeneous. The study by Fitzgibbon and colleagues (1993) indicates that obese individuals seeking treat-





























































































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