Page 163 - When surgery alone won’t cut it - Valerie Maureen Monpellier

VALORISATION ADDENDUM
This thesis has shown that a large majority of the post-bariatric patients will develop excess skin after bariatric surgery. This excess skin can significantly influence patient well-being by causing medical, physical and psychological problems. Body contour- ing surgery (BCS) is the only available treatment for excess skin. It improves body image, health-related quality of life (HRQoL) and weight loss maintenance. However, decision making regarding reimbursement of BCS in the Netherlands is based on a guideline that is not objective and does not consider all complaints caused by excess skin. This leads to unfair reimbursement: some patients with mild complaints will be reimbursed, while others with significant complaints will not. This valorization adden- dum will focus on improving the reimbursement pathway for post-bariatric BCS in the Netherlands.
RELEVANCE
In the Netherlands, more than 10.000 patients a year undergo bariatric surgery 1. This thesis demonstrated that 63 - 80% of these patients will develop excess skin and desire BCS. Thus, in the Netherlands, there are around 6,000 ‘new’ post-bariatric patients a year who desire BCS.
We showed that because of the excess skin patients experience medical issues like intertrigo (68%); functional complaints (78%) such as hindrance in daily activities; and psychological issues (59%) such as depressive feelings and shame. These com- plaints were reflected in the lower HRQoL in patients with a desire for BCS compared to patients without a desire for BCS. Patients who desired BCS also had a more neg- ative body image and reported more depressive symptoms. Moreover, we showed a relationship between body image, weight loss and depressive symptoms: a higher weight loss resulted in less depressive symptoms, medicated by more positive feel- ings of attractiveness and higher body-area satisfaction.
In addition, other studies have shown that post-bariatric patients who have under- gone BCS have an improved functional status, HRQoL and body image 2-5. More importantly, these patients had better long-term weight loss maintenance compared to patients who did not have BCS 6, 7. The latter is especially important, since weight regain is an issue that is getting more and more attention in the post-bariatric pop- ulation. It is estimated that about 20-30% of the population will develop significant weight regain 8-12. Although the cause of weight regain is considered to be multifac- torial, a negative body image is generally not included as a cause 8, 13, 14. However, this thesis showed that body image is an importance construct for all post-bariatric patients. Even in the population who did not want BCS, a more negative body image
163