Page 143 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 7 143
Part III
Eating disorders and obesity
In Part III, the focus shifts to the presence of eating disorder pathology in patients who are morbidly obese. In particular, the focus of this part of the thesis is the occur- rence of eating disorder pathology in patients opting for bariatric surgery.
The finding that, for the treatment of morbid obesity, non-surgical interventions are usually ineffective (Wimmelmann, Dela, & Mortensen, 2014), has far-reach- ing implications. First, bariatric surgery, an invasive surgical procedure requiring lifelong adherence to lifestyle and dietary recommendations, is suggested as most effective weight loss method. Furthermore, it means that, for morbidly obese patients, a successful treatment on eating disorder pathology will not lead to sustained weight loss. These two aspects affect eating disorder treatment for morbidly obese patients, first, accepting the excess weight, at least to an important extent, needs to be a treat- ment goal. Second, as morbidly obese patients increasingly opt for bariatric surgery, to offer appropriate interventions, the eating disorder therapists need to under- stand how weight loss surgery can affect eating behavior. The brief report in Part III concerns an evaluation of the multidisciplinary group-based program which Novar- um offered to bariatric patient awaiting surgery, over several years.
When confronted with a demand for specialized psychological help related to suboptimal outcome after bariatric surgery, examining suboptimal post-operative weight loss in more detail is essential. What percentage of patients do actually experience suboptimal weight loss? And, within a bariatric population, can we identify possible psychological variables associated with suboptimal weight loss? Previous research on psychological and behavioral factors associated with surgical outcome focused mainly on pre-operative characteristics, and less is known of factors (re) occurring after surgery (Hindle, De la Piedad Garcia, & Brennan, 2017). Literature suggests that with regard to disturbed eating behavior, post-operative occurrence of pathology has a stronger association with the degree of post-operative weight loss than the presence of pre-operative eating disorder pathology, although findings are still inconclusive (Meany, Conceição, & Mitchell, 2014). The aim of the cross-sectional study presented in Part III is to develop a better understanding of the association of post-operative behavioral and psychological factors with suboptimal weight loss.