Page 113 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 6 113
causes of suboptimal weight loss are thought to be multi-factorial and include -along- side technical, surgery-related factors- demographic, behavioral and psychological factors [9-16]. Being a male, age over 40 and a body mass index (BMI) over 50 kg/m2 (super obesity) at time of surgery are found to be firmly associated with suboptimal weight loss [7, 10, 13, 17].
Previous studies of patient factors have focused on pre-operative factors, and little attention has been paid to the impact of psychological and behavioral factors during the period after surgery [9]. With regard to those post-operative factors, the literature is more inconclusive [18]. Dietary changes that patients must commit to after surgery may be associated with post-operative weight loss, but there is insuf- ficient evidence for firm conclusions, and further research is needed [9]. The litera- ture suggests that eating disorder pathology after surgery is more closely related to weight loss than pre-operative eating disorder pathology [19, 20]. Disordered eating behaviors after surgery such as loss of control over eating, grazing and stress eating are associated with poorer weight loss [16, 18, 21]. Most empirical support has been found for the association between loss of control over eating and poorer weight loss [18; 22]. Besides post-operative eating disorder pathology, more weight loss in the first six months has been identified as a positive predictor of later weight loss [9]. The association between post-operative weight loss and the presence of psycho- pathology, like depression, is still unclear [9]. Some studies have found no difference in weight loss between patients with and without the existence of post-operative a psychiatric disorder, while others have found a correlation between a post-operative depressive disorder and suboptimal weight loss [9, 23, 24].
Due to a limited amount of research, the literature is inconclusive about the asso- ciation between weight loss after BS and a negative body image [25]. The study by Grilo and colleagues (2005) found that both checking and avoidance behaviors are significantly associated with the over-evaluation of weight and shape, a core feature of eating disorder pathology in general and in the bariatric population [26]. According to Ortega and colleagues (2012), a main predictor of psychopathology after BS is negative body image. A negative body image is associated with poorer mental health and higher symptoms of depression [27, 28]. The symptoms of depression may lead to disordered eating behaviour (e.g., LOC over eating and grazing), which may lead to weight regain
Impulsivity is another psychological factor associated with suboptimal weight loss after BS [15]. Impulsivity is a multi-faceted construct, and in our study we focused on impulsivity as a personality trait. Impulsivity, measured using self-report questionnaires, is considered to be a stable personality trait considers the tendency for disinhibited or spontaneous behavior without adequate forethought or conside- ration of the consequences [29]. Several facets of impulsivity, such as heightened