Page 103 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 5 103
Due to mixed findings on surgery effects and due to high comorbidity of complex psychopathology in their bariatric population, in 2004 collaboration was sought by the departments of bariatric surgery and medical psychology of an Amsterdam based general hospital, with Novarum, a specialized eating disorder center. This collabora- tion consisted of offering the bariatric patients of this hospital specialized psycho- logical help aimed at disturbed eating behavior, prior to surgery. Around that time, Novarum was already treating morbidly obese patients with an eating disorder, and amongst patients seeking treatment, there were already patients who had undergone bariatric surgery and were struggling with the (re)appearance of disturbed eating disorder behavior.
By offering all their bariatric patients pre-operative behavioral and weight management interventions aimed at establishing a regular eating pattern, regardless of whether they were diagnosed with an eating disorder or not, it was assumed that the effect of bariatric surgery would be enhanced (Garcia-van den Berg, Van Es & De Vries, 2005). If patients were not willing to enter psychological treatment, they were obliged to lose a fixed amount of weight, as determined by the operating surgeon, prior to surgery. Thus, the bariatric patients of this hospital were accepted for bari- atric surgery after either completing psychological treatment and acquiring skills to control over-eating, or after having lost the required amount of weight.
Method
Participants
Between 2004 and 2009, around three hundred bariatric patients, all over 18 years of age, were seen at Novarum to assess whether patients were (1) motivated and (2) eligible for psychological group therapy treatment. The main exclusion criteri- um was language difficulties. A considerable percentage of assessed patients met the exclusion criterium of poor literacy: in a pilot study, 68.4% (39/57) of referred patients were excluded (Van den Berg, Peen, Van Empelen, & Dekker, 2014). After the start of the first therapy groups, a known history of antisocial behavior became an additional exclusion criterium. Motivated patients who were regarded non-eligible for group therapy, were offered a limited number of individual support sessions.