Page 32 - When surgery alone won’t cut it - Valerie Maureen Monpellier
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Chapter 2
for inclusion in the review, the whole paper was obtained and assessed. The search was performed by one reviewer (VM) and inclusion was double checked by a second reviewer (EA).
Eligibility criteria
Studies were only included if the study population consisted of adult patients un- dergoing RYGB for morbid obesity and when weight loss was the outcome. When studies described results of multiple types of bariatric surgery, the study was only included if results of the RYGB patients were presented separately. Studies were in- cluded when one or more of the following moderators was assessed: compliance to follow-up, physical activity, general psychopathology, depressive disorders, binge eating disorder, general eating disorder, quality of life and body image. Only articles published in academic journals in English were included.
Data extraction
The following data were extracted from the included papers: number of patients, gen- der, age, study design, follow-up time and weight loss data. Since up to recently there was no guideline for reporting weight loss after bariatric surgery all available weight loss data was selected and or calculated in accordance with current guide- lines: height, bodyweight and Body Mass Index (BMI) before and after RYGB, %EWL, % excess BMI loss (%EBMIL), % total weight loss (%TWL) 18. If insufficient data was provided in the article the author was contacted at least three times for additional data. In addition, all data regarding the moderator of interest was acquired: methods of assessment of moderator and timing of assessment.
In current practice there is no guideline on how to evaluate behavioral and psycho- logical factors in bariatric patients 18,19. Therefore, all papers assessing one or more of the moderators were included, independently from the methods of assessment. Thus, moderators could either be evaluated via direct measurement of physical activity or compliance to follow-up, via validated or non-validated questionnaires or via clinical interviews.
RESULTS
Search results
After removing duplicates, 3825 articles were identified, with hand searches of the (systematic) reviews 9 articles were added (Figure 1). Titles of 3834 articles were reviewed, 3477 were excluded. Abstracts of 357 records were reviewed, and 108 full- text articles were read. A total of 61 articles were included in this review, 20 studies reported the effect of multiple moderators (Table 1).
For the following moderators there was sufficient data to be included in the review: compliance, physical activity, psychological evaluation, depressive symptoms and
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