Page 159 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 8 159
post-operative eating disorder pathology was associated with suboptimal weight loss, as the presence of eating disorder pathology may interfere with the ability to adhere to the recommended postsurgical eating pattern.
Main findings
In Chapter 5, one of the main findings is that patients opting for surgery appeared to benefit less from the treatment offered. Preliminary findings indicate that they did lose less weight and their poor body image improved less, compared to morbid- ly obese group participants who did not opt for surgery. When entering treatment, no differences were found between referred patients who did and those who did not want to undergo bariatric surgery, neither with regard to the degree of obesity, nor with regard to reported negative body image or reported psychological and / or somatic distress.
Chapter 6 reported that, in the examined sample, 19% of patients reported suboptimal weight loss. The findings suggest that patients experiencing suboptimal weight loss reported more symptoms of eating disorder psychopathology, reported
more loss of control over eating and more avoidant behavior due to a poor body image, compared to patients who experienced successful weight loss. Furthermore, in comparison, patients who experienced suboptimal weight loss, reported higher scores on an impulsivity self-report and reported more depressive symptoms. With regard to non-psychological factors, having a body mass index over 50 kg/m2 at time of surgery, and a longer follow-up period after surgery were associated with poorer weight loss. On the other hand, being able to lose more weight loss in the early period after surgery, was associated with better weight outcome later on. Our hypothesis that reported post-operative eating disorder pathology appears to be associated with suboptimal weight loss, was confirmed.
Our findings that bariatric patients appear to profit less from treatment compared to non-bariatric patients may be seen in line with recent literature stating that behavioral interventions are best offered after surgery (Meany, Conceição, & Mitchell, 2014). As literature suggests that both pre-operative disturbed eating behaviors can remit due to surgery, and that maladaptive eating patterns can emerge after surgery while not being present pre-operatively (Meany, Conceição, & Mitchell, 2014), it may be recom- mended offering treatment aimed at eating disorder pathology only post operatively.
Post-operative close monitoring of possible (re)occurrence of a maladaptive eating pattern and or psychopathology like depressive symptoms during a consider- able length of time is very relevant.