Page 104 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

104 Chapter 5
Intervention
The 24-week group based treatment consisted of around eight male and female patients. Within the treatment groups, patients awaiting bariatric surgery were mixed with morbidly obese patients seeking psychological help for their disturbed eating behavior, but who did not opt for bariatric surgery; it was assumed that clinical outcome of a homogenous bariatric patient group may be negatively affected by a shared ambivalence towards non-surgical, behavioral interventions. So mixing bariatric patients with non-bariatric, morbidly obese patients was thought to be favorable for bariatric patients.
The intensive outpatient program consisted of a guided meal and three therapy modules; (1) a weight management module, aimed at establishing a long-lasting, regular eating pattern, improving the quality of daily diet and reducing overall energy intake, (2) a cognitive behavioral therapy module, aimed at acquiring skills for uncontrolled overeating and improving poor body image (Fairburn, 1995; Werkboek Eetbui- stoornis, 2002), and (3) an exercise module, aimed at increasing physical activity. During the guided meals, exposure interventions with regard to dietary rules and rate of eating were offered. After completing treatment, bariatric patients were offered an
additional psychoeducation group focusing on the upcoming operation.
Remarks on clinical outcome
Two brief accounts of findings on clinical outcome were presented in earlier Dutch language articles (Olthof et al., 2010; Van den Berg et al., 2014). In these two pilot studies, clinical outcome of several treatment groups taking place between 2006 and 2009, was examined. At baseline, no differences were found between bariatric and non-bariatric patients with regard to the degree of morbid obesity, with regard to reported depressive symptoms on the Beck Depression Inventory (Van der Does, 2002), with regard to reported psychological problems & somatization (Symptom Checklist, Arrindell & Ettema, 1986) or with regard to the level of reported avoidance behaviors due to a poor body image (Body Image Avoidance Questionnaire; Rosen, Srebnik, Saltzberg & Wendt, 1991).
Although in both pilot studies, bariatric and non-bariatric patients did lose weight, in both studies, opting for bariatric surgery was associated with less weight loss. With regard to reported body image, findings suggested that bariatric patients reported a smaller decrease of avoidance behaviors compared to non-bariatric patients at end-of-treatment. Over the years, the dropout rate was high: of the examined
therapy groups, 50% of patients dropped out before the end of treatment.