Page 15 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 1 15
affects mental well-being. Obesity is clearly associated with an increased risk of depression, with gender acting as a moderating factor, obese women are more likely to experience a mood disorder (Luppino et al., 2010). Literature suggests that 30% of obese individuals seeking weight control treatment might be diagnosed with a binge eating disorder (de Zwaan, 2001; Meany, Conceição, & Mitchell, 2014). Compared to non-binging obese individuals, obese binge eating disorders patients were found to have a higher prevalence of psychiatric disorders (Hudson, Hiripi, Pope, Jr., & Kessler, 2007). In obese individuals opting for bariatric surgery, findings indicate a pre-operative prevalence of axis I disorders between 27% and 42%, mainly consisting of affective disorders, anxiety disorders and eating disorders (Herpertz et al., 2004). Pre-operative prevalence of axis II disorders, is estimated between 22% and 24% of individuals (Herpertz et al., 2004).
Treating obesity
In 2014, international guidelines recommended multicomponent interventions for the treatment of obesity, weight management programs should include behavior change strategies to increase people’s physical activity levels or decrease inactivity, improve eating behavior, improve the quality of the person’s diet, and reduce energy intake (National Institute for Health and Care Excellence, 2014).
As non-surgical interventions aimed at morbid obesity are usually ineffective in the long run, weight loss surgery has been suggested as the most effective method to lose weight (Wimmelmann, Dela, & Mortensen, 2014). Weight loss surgery is recom- mended for adults with acceptable surgical risk and a BMI over 40, or over 35 when major obesity-related morbidities are involved (National Institute for Health and Care Excellence, 2014). In addition, in the Netherlands, earlier non-surgical weight loss interventions must have proven ineffective in order to apply for bariatric surgery.
Although the majority of patients achieve a successful degree of excess weight loss after surgery, 20-30% of patients experience suboptimal weight loss (Livhits et al., 2011). Factors associated with this poorer weight loss are being male, having a lower socioeconomic status, having super obesity (BMI ≥ 50) at time of surgery, and a relatively older age (Livhits et al., 2011; Wimmelmann et al., 2014). Post operatively, the following areas of functioning are associated with poorer weight loss: (a) reported disturbed eating behaviors, (b) poor adherence to post-operative treatment plan and (c) poor psychological functioning (Hindle, De la Piedad Garcia & Brennan, 2017).
Whether the presence of psychopathology should be considered an impediment to bariatric surgery is controversial (Wimmelmann et al., 2014). In their systemat- ic review, Herpertz et al. (2004) state that, apart from serious psychiatric disorders