Page 145 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 7 145
Lack of understanding the pathogenesis of obesity hinders the development of persona- lized and effective behavioral interventions for bariatric patients
Unlike with people with eating disorders, sustained behavior change in individu- als with obesity is remarkably difficult to achieve (Cooper et al., 2010), and is one of main reasons for non-surgical interventions usually being ineffective in the long run (Wimmelmann, Dela, & Mortensen, 2014). The finding that behavior change is very difficult to achieve has far-reaching implications, especially when behavioral factors do seem to be associated with suboptimal surgical outcome. One of these implica- tions touches on the rationale of offering bariatric patients peri-surgical behavioral interventions in order to enhance surgical outcome, while the understanding is that behavioral change is particularly difficult to achieve. Pessimistically, a rather poor treatment response could be argued to be incorporated from the start, however, on the other hand, around 80% of bariatric patients does benefit from bariatric surgery. Several factors, particularly associated with the bariatric population, further chal- lenge the already modest effects of behavioral interventions:
(a) Of the bariatric patients referred for psychological treatment in our pilot studies, a considerable number was regarded as ‘not eligible for psychological treatment’ due to poor literacy and / or language difficulties. An association between socioeconomic status and literacy can be assumed, so probably a considerable number of bariatric patients may have a lower socioeconomic status. Literature suggests an association between lower socioeconomic status and suboptimal weight loss (Livhits et al., 2011). In addition, as findings in the field of anxiety and depression disorders suggest, lower socioeconomic status appears to be
also associated with poorer treatment response to psychological treatments
(Finegan, Firth, Wojnarowski, & Delgadillo, 2018).
(b) Bariatric patients, regularly do not enter pre-operative psychological treatment
out of free choice. A considerable number of participants follow treatment because operating hospitals require participation in order to proceed with surgery. Being doubtful beforehand whether treatment is necessary and suitable, might be negatively associated with treatment outcome. Literature suggests a negative association between a low motivation to change and treatment response (Dray & Wade, 2012).
(c) When bariatric patients, rightfully, expect the surgical procedure itself to be helpful in gaining control over eating, they may be less motivated to participate in pre-operative treatment aimed at behavioral change.
(d) In addition, when one has decided that a somatic intervention best suits the problem of one’s excess weight, rather than behavioural interventions, possible benefits of those behavioural interventions may already be suboptimal from the start.