Page 10 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

10 Chapter 1
cated in a real world setting for all referred inpatients and outpatients, with all staff members delivering CBT-E interventions. Besides clinical outcome, direct treatment costs of CBT-E and treatment-as-usual were compared.
In Part II of this thesis, findings of two consecutive cohort studies are presented; Chapter 3 presents findings on differential (cost-)effectiveness of treatment-as-usual and CBT-E for inpatients and outpatients with a body mass index (kg/m2) over 17.5. Chapter 4 then presents findings on differential (cost-)effectiveness of CBT-E Under- weight and treatment-as-usual on inpatients and outpatients with anorexia nervosa.
Around the time when I started working at Novarum, in 2003, bariatric surgery (mainly gastric banding) started becoming treatment of first choice for morbidly obese patients, and we saw the first bariatric patients seeking specialized psycho- logical help. Despite the fact that they did lose excess weight, they had developed post-operative binge eating and started to regain weight, or their daily functioning was still affected by a poor body image. Although bariatric surgery is beneficial for a significant number of severe obese individuals, and ameliorates the physical risks associated with obesity, in those days, we as eating disorder therapists struggled to come to terms with the surgery. We wondered to what extent the behavioral and psychological factors associated with loss of control over eating, reported by a considerable number of morbidly obese individuals, might benefit from a surgical procedure targeted at the somatic aspects of obesity and were somewhat doubtful about the long-term success of bariatric surgery for at least a subgroup of severe obese patients.
Part III of this thesis gives an account of our search to optimize clinical benefits and post-operative mental well-being by increasing understanding of the psychological and behavioral factors related to both suboptimal weight loss and to post-operative (re)development of eating disorder pathology.
Before the different chapters and the accompanying hypotheses are described in more detail, a brief overview of both the prevalence of eating disorders and (morbid) obesity will be given. This is followed by a description of efficacy and effectiveness of recommended psychological therapies for eating disorders and obesity.
Prevalence and treatment of eating disorders
The eating disorder section in the American Psychiatric Association DSM-5 edition includes the following classifications: anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorders (American Psychiatric Association, 2013). Eating disorders affect both mental and physical well-being of