Page 152 - When surgery alone won’t cut it - Valerie Maureen Monpellier
P. 152

Summary - English
psychological problems should be assessed.
Bariatric surgery generally results in significant weight loss, has positive effect on health and HRQoL. However, 20-30% of the post-bariatric patients will experience insufficient weight loss or significant weight regain. To improve weight loss results, we need to know which patients will have “unsuccesfull” weight loss. Most previous research focused on factors that can’t be influenced, like age, gender and comorbid conditions. The role of patient related factors, like physical activity, eating style and psychological disorders, in weight loss remains unclear. These factors are very im- portant because they have been linked to weight loss in the obese population and, more importantly, they can be influenced. This thesis studied the relationship between physical and psychological factors and weight loss in patients who have undergone bariatric surgery.
The clinical studies in this thesis were conducted in patients in treatment at the Ned- erlandse Obesitas Kliniek (NOK, Dutch Obesity Clinic). The treatment program of the NOK consists of extensive group counselling before and after bariatric surgery by a multidisciplinary team consisting of a physician, a dietician, a physiotherapist and a psychologist. This counselling is focused on long-term behavioural change.
The first part of this thesis focused on the relationship between weight loss and com- pliance to follow-up, physical activity, psychopathology, depressive disorders, eating disorders, HRQoL and body image. The studies in this part of the thesis were all in primary RYGB patients, to avoid bias in the results by differences in types of bariatric surgery, and secondary or tertiary procedures.
In chapter 2 we started with a systematic review and meta-analysis, to study what research was available so far. This study showed that almost no research in the bar- iatric population was focused on HRQoL and body image. We could conduct a me-f ta-analysis for the following factors: compliance, physical activity, depressive symp-n toms and binge eating. The results showed that patients with better compliance to post-operative follow-up had significantly higher weight loss, than patients with lower compliance. Higher physical activity was also related to better weight loss results. Contrary to expectations, we did not see a negative effect of depressive symptoms or binge-eating on weight loss results. The review also showed that there is great variety in psychological evaluation of bariatric patients.
Based on these results we conducted the studies in the clinical population. In chapter 3 the relationship between self-reported eating style and physical activity with weight change up to 4 years after surgery was studied in a primary RYGB population of 4,569 patients. Eating style and physical activity before bariatric surgery were not indicative
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