Page 22 - When surgery alone won’t cut it - Valerie Maureen Monpellier
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Chapter 1 - Introduction
Outline of this thesis
To sum up, bariatric surgery has proven to be a highly effective treatment for one of the most prevalent health issues in this century: morbid obesity. Bariatric surgery generally has a positive outcome, but not in all patients. About 20-30% of the patients experience insufficient weight loss, or weight regain, and others are seriously affected by overhanging skin. To improve the outcomes after bariatric surgery, it is essential to know which factors influence weight change. Physical and psychological factors that might influence the surgery outcomes are not frequently studied.
The first part of this thesis will focus on the patient related factors as moderators of weight change after surgery. The studies in this part of the thesis are all conducted in patients who have undergone a RYGB without any prior bariatric procedures. This population was chosen because the RYGB is the most popular in the Netherlands and because weight loss can differ between the types of bariatric surgery, especially when patients who undergo secondary or tertiary procedures are included. A system- atic review and meta-analysis will discuss the evidence on the role of compliance to follow-up, physical activity, psychopathology, depressive disorders, eating disorders, HRQoL and body image on weight loss after RYGB (chapter 2). Subsequently, we will use the outcome of this systematic review as a base for a prospective data-analysis to study the effect of moderators on weight loss after RYGB in our own population. We will study weight change up to 4 years after RYGB and assess the relationship with eating style and physical activity (chapter 3). In chapter 4, we will assess the relationship between weight loss and HRQoL using an obesity specific and a generic HRQoL questionnaire.
In the second part of the thesis the emphasis will be on excess skin, BCS and body image. In chapter 5 depressive symptoms, body image and weight loss will be stud- ied in a post-bariatric population, by comparing patients with a desire for BCS with patients who already had BCS and patients without a desire for BCS. The mediating effect of body image on the relationship between weight loss and depressive symp- toms will be studied. In chapter 6 differences between these patient groups regarding social economic status, qualification according to Dutch weight criteria, complaints of overhanging skin and satisfaction with body will be analysed. Perceived reasons why patients have not undergone BCS will also be assessed in this chapter. In chapter 7 a new screening tool for reimbursement of BCS will be developed and tested.
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