Page 146 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

146 Chapter 7
(e) Finally, bariatric patients may expect that once they have lost a significant amount of excess weight, their body dissatisfaction will improve, meaning that one important maintaining factor related to over-eating, i.e. body dissatisfaction, will disappear. Consequently, acquiring skills aimed at uncontrolled over-eating prior to surgery, may be, in their opinion, irrelevant.
The body of knowledge on the pathogenesis of (morbid) obesity is still incom- plete. For instance why obesity seems resistant to psychological methods of treat- ment (Cooper et al., 2010) is still not understood. Across the different disciplines involved in obesity research (e.g. medicine, psychology, sociology), there are still gaps in understanding why some individuals are vulnerable for developing (morbid) obesity and others are not. In addition, with regard to bariatric surgery, why some individuals experience disturbed eating behaviour (re)emerging after surgery, while others do not (Meany, Conceição, & Mitchell, 2014) it is not yet understood. This current lack of understanding might be a barrier in understanding factors moder- ating treatment outcome of an intervention like bariatric surgery. More generally speaking, understanding pathogenesis of morbid obesity may be a precondition for developing effective strategies aimed at the psychological and behavioral aspects associated with severe obesity.
Limitations
The exact temporal sequence in which post-operative factors associated with suboptimal weight loss occur is not known and is rather difficult to establish. This could be viewed as a limitation as it makes understanding possible causal pathways more difficult (Hindle, De la Piedad Garcia, & Brennan, 2017). For example, the direction of the found association of reported depressive symptoms and suboptimal weight loss is unclear; did the mood drop in response to poorer weight loss or has there been a depressed mood prior to the suboptimal weight loss? To be able to offer appropriate interventions, understanding causal pathways is relevant. Another limi- tation relates to the difficulty of assessing eating disorder pathology, especially loss of control over eating, in individuals who are (morbidly) obese (Meany, Conceição, & Mitchell, 2014; van Riel et al., 2020). In a population of patients who have undergone bariatric surgery, a procedure which limits food intake, proper assessment of pres- ence and severity of eating disorder pathology is even more complicated (Meany, Conceição, & Mitchell, 2014).