Page 158 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

158 Chapter 8
Findings of both presented studies may both boost implementing specialized treatments; for normal weight eating disorder patients, cost-effectiveness favors CBT-E compared to treatment-as-usual; for anorexia nervosa patients, the improved weight gain and a comparative lower dropout rate during the CBT-E period, are important benefits. The found higher costs are reasonable and justify a broader use of CBT-E.
Part III
Eating disorders and obesity
Psychological factors associated with clinical outcome of weight loss surgery
In Part III, the focus shifts to the occurrence of eating disorder pathology in morbidly obese patients opting for bariatric surgery. As non-surgical interven- tions aimed at morbid obesity are usually ineffective in the long run, weight loss surgery, an invasive surgical procedure requiring lifelong adherence to lifestyle and dietary recommendations, has been suggested as the most effective method to lose weight (Wimmelmann, Dela, & Mortensen, 2014). Although the majority of patients achieves a successful degree of excess weight loss after surgery, literature suggests that 20-30% of patients experience suboptimal weight loss (Livhits et al., 2011). Several demographic factors are associated with this poorer weight loss; being male, having a lower socioeconomic status, having super obesity (body mass index ≥ 50 kg /m2) at time of surgery, and a relatively older age (Livhits et al., 2011; Wimmelmann et al., 2014). With regard to psychological factors, the following associations are found; (1) post-operatively reported disturbed eating behaviors, (2) poor adherence to post- operative treatment plan and (3) poor psychological functioning (Hindle, De la Piedad Garcia & Brennan, 2017).
Chapter 5 examines clinical outcome and possible benefits of a multimodal group-based therapy offered at Novarum to bariatric patients prior to surgery. Based on the frequently reported disturbed eating behavior by severely obese patients (De Zwaan 2001; Wilson & Fairburn, 2007), our clinical impression was that offering strat- egies aimed at establishing regular eating and 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.
Chapter 6 presents a cross-sectional study examining the association between post-operative behavioral and psychological factors and suboptimal weight loss in a sample of 140 participants who have had bariatric surgery (malabsorptive procedures or combined restrictive malabsorptive procedures). We hypothesized that reported