Page 144 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

144 Chapter 7
Main findings
One of the main findings in the brief report is that bariatric participants appeared to benefit less from the multidisciplinary group-based program compared to non-bariatric participants. Although the findings of two pilot studies discussed in the brief report need validation, they suggest that patients opting for surgery did lose less weight and their poor body image improved less, compared to patients who did not opt for surgery. Second, when entering treatment, no differences were found between patients who did and those who did not opt for surgery, neither with regard to the degree of obesity, nor with regard to reported negative body image or reported psychological and / or somatic distress.
The brief report described how, in the early days of bariatric surgery, the main strategy of Novarum was to offer all bariatric patients pre-operative treatment inter- ventions, originally developed for binge eating disorders, regardless of whether or not patients were actually diagnosed with a binge eating disorder. Based on the frequently reported disturbed eating behavior by severely obese patients (De Zwaan 2001; Wilson & Fairburn, 2007), our clinical impression was that offering strategies aimed at establishing regular eating and aimed at gaining control over over-eating, made sense. We assumed that acquiring those skills would help patients to adjust to the required dietary restrictions after surgery, and would therefore enhance surgical outcome. Our findings that bariatric patients appeared to benefit less from treatment compared to non-bariatric patients may, however, be seen in line with recent litera- ture stating that behavioral interventions are best offered after surgery. On the other hand, whether bariatric patients who have been offered pre-operative behavioral interventions had a better surgical outcome, compared to bariatric patients who did not receive such pre-operative treatment was not examined.
In Chapter 6, it was found that in a Dutch sample of 140 obese men and women who had undergone bariatric surgery (malabsorptive procedures or combined restrictive malabsorptive procedures), 19% of patients reported suboptimal weight loss. This percentage is in line with the literature (Livhits et al., 2011). These findings suggest that patients experiencing suboptimal weight loss reported more post-oper- ative symptoms of eating disorder pathology, more loss of control over eating and reported more avoidant behavior due to poor body image, compared to patients who experienced successful weight loss. Furthermore, in comparison, patients who expe- rienced suboptimal weight loss, reported higher scores on an impulsivity self-report and reported more depressive symptoms. With regard to non-psychological factors, having a body mass index > 50 kg/m2 at time of surgery, and a longer follow-up peri- od after surgery were associated with poorer weight loss. On the other hand, being able to lose more weight loss in the early period after surgery was associated with better weight outcome later on.