Page 19 - When surgery alone won’t cut it - Valerie Maureen Monpellier
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PSYCHOLOGICAL PROBLEMS
As described briefly before, obesity in general has a negative impact on social and psychological well-being 19,23-25. The most common psychological problems in obese persons are low self-esteem, depressive symptoms, eating disorders and a negative body image 23-29. It seems that psychological problems are even more prevalent in the obese population who is seeking surgical treatment 28,30,31. In daily practice, it is assumed that the best weight loss (maintenance) after bariatric surgery is achieved by patients who have no psychological problems and who are willing to change their physical activity and eating habits after surgery. Therefore, psychological assessment is a standard part of screening for bariatric surgery 18,83. Nonetheless the scientific evidence for these assumptions is not very strong.
Studies assessing the effect of psychological problems on weight change after bar- iatric surgery show conflicting results. Depressive symptoms are known to negatively affect body weight in the obese population 24,28,29,84. But there are only few studies in the bariatric population, that have shown a relationship between depression and worse weight loss results 79,85. For eating disorders, the effects on weight loss are also inconclusive. Several studies have shown a negative effect of eating disorders on weight loss after bariatric surgery 86,87. Others conclude that patients with an eating disorder will lose more weight compared to patients without an eating disorder 79. The effect of a negative body image on weight loss in the bariatric population has only been analysed in two studies. One found that a more negative body image was related to less weight loss 88. While the other study, using the same questionnaire, found no correlation 89. Body image is related a range of problems such as avoid- ance of social situations, low self-esteem and even depression in the obese popula- tion 23,24,27,28. There seems to be sufficient evidence that lack of physical activity and non-compliance to follow-up after surgery have a negative impact on weight outcome after bariatric surgery 3,90-93.
More and better knowledge of the effect of these psychological and behavioural fac- tors on weight change after surgery is important for a least two reasons. Firstly, be- cause these factors can be influenced by, for example cognitive behavioural therapy, and thereby outcome after bariatric surgery may be improved. Secondly, because some of these factors, like eating disorders, are frequently seen as a contra-indication for bariatric surgery and a common reason for delaying or even refusal of an operation worldwide 3. This means that these patients do not get a treatment, which can have a significant positive impact on their long-term health, mortality and HRQoL. With a better understanding of the actual influence of these factors on weight change, selec- tion for bariatric surgery and treatment of patients who undergo a bariatric procedure can be improved.
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