Page 102 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

102 Chapter 5
Introduction
In this brief report we provide an overview of an outpatient multidisciplinary group based treatment, offered in collaboration with a general hospital between 2004 and 2009, to morbidly obese patients awaiting bariatric surgery.
Obesity is defined as abnormal or excessive fat accumulation that may impair health (World health Organization, 2020). Worldwide, the prevalence of morbid obesity (having a body mass index over 40 kg/m2) is estimated at 0.64% in men and 1.6% in women (NCD Risk Factor Collaboration, 2016). In 2014, 18.4% of the world’s obese adults lived in high-income English-speaking countries, these countries contained an even larger share of the world’s severely obese people (27.1%), followed by 13.9% in the Middle East and north Africa (NCD Risk Factor Collaboration, 2016). In the Netherlands, in 2018, one percent of the population aged 20 years or older, was morbidly obese (Centraal Bureau voor de Statistiek, 2018).
Obesity affects mental wellbeing as well; obesity is firmly associated with an increased risk of depression (Luppino et al., 2010) and it is suggested that 30% of individuals seeking weight control treatment might be diagnosed with a binge eating disorder (De Zwaan, 2001). In individuals opting for bariatric surgery, findings suggest a preoperative prevalence of psychiatric disorders between 20-60%, mainly consisting of affective, anxiety and / or eating disorders (Wimmelmann et al., 2014).
For morbid obesity, as non-surgical interventions are usually ineffective in the long run, bariatric surgery is an increasing popular treatment option, already in 2004. Bariatric surgery is a treatment option for people with a body mass index over 40 kg/m2, or over 35 kg/m2 with other significant comorbid disease that could be improved if they lost weight, e.g. type 2 diabetes or high blood pressure. Bariatric surgery is the option of choice for adults with a body mass index over 50 kg/m2 when other interventions have not been effective (National Institute for Health and Care Excellence, 2014). Since early 2000, the number of bariatric procedures for morbidly obese individuals has been steadily increasing. In the Netherlands, the number of surgical procedures increased from around 800 in 2003 (Buchwald & Williams, 2004) to 6807 in 2013 (Agrisani et al., 2015) and has currently stabilized at 12.000 proce- dures a year. Earlier on, surgical weight loss procedures mainly concerned gastric banding, later, partly due to limited effectiveness, non-adjustable procedures like gastric bypass surgery became procedures of first choice.
It is estimated that successful long-term weight loss after gastric banding surgery was achieved by approximately 48% of patients (Tice, Walsh, Petersen & Feldman, 2008); for non-adjustable procedures, successful weight loss is estimated at 70-80% (Livhits et al., 2012).