Page 133 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

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In Part III, the focus shifted to eating disorder pathology as found in individu- als with morbid obesity (i.e. having a body mass index over 40 kg/ m2), specifically, to the recommended treatment for morbid obesity, weight loss surgery (National Institute for Health and Care Excellence, 2014). Obesity is not included in the DSM-5 eating disorder section as obesity itself is not necessarily caused by a psychologi- cal dysfunction (Hoek & van Elburg, 2014). Disturbed eating behavior is, however, regularly reported by individuals who are severely obese (De Zwaan 2001; Wilson & Fairburn, 2007). The prevalence of a binge eating disorder in the population of obese individuals seeking weight control treatment is estimated to be 30% (de Zwaan, 2001; Meany, Conceição, & Mitchell, 2014). Consequently, developing effective interven- tions for those reported disturbed eating behaviors, may benefit from knowledge on eating disorder pathology.
As non-surgical interventions aimed at morbid obesity are usually ineffective in the long run, weight loss surgery has been suggested to be the most effective meth- od to lose weight (Wimmelmann, Dela, & Mortensen, 2014). Although the majority of patients achieves a successful degree of excess weight loss after surgery, 20-30% experience suboptimal weight loss (Livhits et al., 2011). Several psychological and behavioral factors are assumed to be associated with this (Hindle, De la Piedad Garcia, & Brennan, 2017). In the cross-sectional study presented in Part III, possible associations of psychological and behavioral variables and suboptimal weight loss were examined in a sample of 140 patients who have had weight loss surgery. Part III also includes a brief report about an evaluation of the multidisciplinary group-based program which Novarum offered to bariatric patients awaiting surgery, over several years. Besides examining clinical outcome of the interventions offered, a discussion of the rationale behind the offered pre-surgical program is offered.
The main objective of Part I is to contribute to the body of knowledge on the efficacy of psychological treatments for anorexia nervosa. In Chapter 2, by conducting a meta-analysis, we systematically assess whether specialized treatments are superior to non-specialized, control treatments. In Part II, the main objective is to examine the effectiveness and the cost-effectiveness of cognitive behavioral therapy-enhanced, an empirically supported treatment, in a real-world setting, offering treatment to adult patients with anorexia nervosa, bulimia, binge eating disorder and other specified feeding or eating disorders. The main objective in part III is to develop a better understanding of the association between psychological and behavioral factors and clinical outcome after bariatric surgery.