Page 122 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

122 Chapter 6
Discussion
The aim of this study was to identify the behavioral and psychological factors that are associated with suboptimal weight loss in post-bariatric surgery patients. This study, through bivariate analyses, found an association between suboptimal weight loss and the following behavioral factors: disordered eating behaviors, negative body-image avoidant behavior and less weight loss in the first six months. Besides, this study suggests that suboptimal weight loss is associated with two psychological factors, namely impulsivity and depressive symptoms. In addition, with regard to behavioral and psychological factors, an association between suboptimal weight loss and previous psychological treatment was found. Finally, in our multiple back- ward regression analysis we found that pre-operative super-obesity, eating disorder pathology and a longer follow-up period seems to be associated with suboptimal weight loss.
In this study, weight loss was suboptimal in 19% of the participants. This finding isconsistentwithpreviousresearch[6,7,24].Ourresultssupportfindingsfromprevious research that post-operative eating disorder pathology (such as concerns about weight, body image, eating pattern and loss of control over eating) are associated with suboptimal weight loss after bariatric surgery (BS) [15, 18 - 20, 52]. Weight loss after BS depends on the adoption of a personalized healthy eating pattern that takes into account both individual and psychological factors influencing dietary adherence [53]. Most empirical support can be found for the specific association between post-operative, self-reported, loss of control (LOC) over eating and suboptimal weight loss [22, 54]. The subjective sense of LOC over eating has significant impact on weight. The possible explanation can be that global caloric intake is probably higher when there is a LOC over eating and less weight loss can therefore be expected [22]. Post-operative disordered eating behaviors are also likely to compromise the adherence to dietary plans [53, 55].
In the present study we found that successful weight loss in the first six months is associated to successful weight loss during the follow-up period; this is in accordance with the literature [9]. A possible explanation could be that the ability to adjust to the required BS recommendations directly after surgery is linked to the ability to main- tain the required behavioral adjustments. However, the evidence is insufficient as a basis for firm conclusions. We are not aware of any research whether early adherence to post-operative conditions predicts later outcome.
We found that body-image avoidant behavior is associated with suboptimal weight loss after BS. The core feature of eating disorder pathology in the bariatric population, is over-evaluation of weight and shape [26]. The study by Grilo and colleagues (2005) found that body image avoidant behavior is significantly associated