Page 125 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 6 125
ment reported greater psychopathology and more loss of control over eating than those who did not seek treatment [61]. In addition, people who are disappointed after BS could be more inclined to participate in an online survey of weight loss after BS than participants who lost more weight after surgery. Only post-operative data were obtained. Due to the lack of pre-operative data, it remains unclear whether the observed differences were already present before surgery or whether they developed after surgery. Therefore, a causal relationship cannot be claimed. A limitation of this study is the lack of information about the weight trajectory after BS; due to this lack of information, it is unknown whether participants in the suboptimal weight group initially lost weight and may have regained weight over time. Another limitation to consider is that different types of malabsorptive procedures and combined restric- tive malabsorptive procedures were included. These procedures can differ in efficacy [4]. However, the majority of the participants had a gastric bypass. Furthermore, all data were collected through self-report measures. Self-report questionnaires can be inaccurate because of response distortions and retrospective recall [39]. In particu- lar self-report on pre-operative weight, 6 months post-operative weight and current weight is prone for inaccuracy. In addition, not all the measurements used were validated for this specific population. Despite these limitations, the current find- ings show that psychological and behavioral factors are associated with suboptimal weight loss, which is of importance to optimize the effect of BS.
Conclusion
In this study several post-operative psychological and behavioral factors of eating disorder pathology, impulsivity and depressive symptoms were associated with suboptimal weight loss.
The early identification of postoperative factors, such as loss of control over eating or depression, that negatively impact successful weight loss and for which there are evidence-based treatments, will probably improve the overall efficacy of bariatric surgery [21]. Pre-operative and frequent post-operative monitoring of these psychological and behavioral factors are therefore needed.
Because gradual weight regain and suboptimal weight loss are associated with the number of years since surgery, it is important to have a long follow-up period during which patients are monitored. During follow-up, it can be useful to help patients to achieve early weight loss by helping them to adjust to postoperative recommenda- tions relating to diet, physical activity, medical care and support group attendance.