Page 147 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 7 147
Suggestions for further research
To broaden the evidence base on pre-operative and post-operative factors associ- ated with clinical outcome after surgery, and in order to understand possible causal pathways, patients should be assessed prior to surgery and should be assessed frequently, during a long follow up period, after surgery. With a better understanding of those factors and of possible causal pathways, further research can focus on developing effective, targeted interventions for potentially changeable factors like disturbed eating behavior, increased avoidance behavior due to a poor body image and for depressive symptoms.
Recommendations for clinical practice
Understanding in which phase of the bariatric surgical process, psychological interventions aimed at disturbed eating behavior, are best offered is relevant. As findings indicate that pre-operative disturbed eating behaviors can remit after surgery, and other findings indicate that maladaptive eating patterns can emerge after surgery while not being present pre-operatively (Meany, Conceição, & Mitchell, 2014), the effectiveness of offering pre-operative eating disorder interventions can be questioned, particularly as literature suggests that pre-operative treatment aimed at behavioral change has limited effect. Therefore, it might be recommended to offer treatment aimed at eating disorder pathology only post-operatively.
The finding that post-operative disturbed eating disorder behavior is associated with suboptimal weight loss opposed to the presence of pre-operative eating pathology (Livhits et al., 2011) has increased the awareness that post-operative close monitoring, during a considerable length of time, of possible (re)occurrence of a maladaptive eating pattern and of psychopathology like depressive symptoms or alcoholism is
highly relevant.
In the recent European guideline on bariatric surgery, a multidisciplinary post-operative follow up is recommended, although a minimal duration of this follow up period is not mentioned (Di Lorenzo et al., 2020). With regard to regular monitoring in order to detect disturbed eating behavior or psychological problems after surgery, no recommendations are made. The guideline only includes the rather general recommendation of “post-operative nutritional and behavioral advice to be provided” (Di Lorenzo et al., 2020).