Page 103 - When surgery alone won’t cut it - Valerie Maureen Monpellier

INTRODUCTION
In 2014 bariatric surgery was performed in 579,517 patients worldwide 1. Bariatric surgery causes massive weight loss, leading to overhanging skin in up to 96% of the patients 2-5. This overhanging skin can result in several problems, ranging from skin conditions to physical discomfort, but also serious psychological issues 2,5-8. Body contouring surgery (BCS) is the only treatment to restore the body’s contour. After BCS patients have improved quality of life, body image and weight loss maintenance 8-15. Despite these positive effects, BCS is not a standard part of the post-bariatric treatment regime and only a minority of the population undergoes BCS 5,8,16. Patients frequently address that they cannot be treated because they do not get reimbursed by the insurance company, although this was barely studied 3,8.
To qualify for reimbursement in the Netherlands, patients must meet the following cri- teria: bariatric procedure over 18 months ago, stable weight for more than 12 months, body mass index (BMI) < 35 kg/m2. In addition, patients should have a serious impair- ment of bodily function in daily life or a grade 3 excess skin in the Pittsburg Rating Scale (PRS), which is graded by the plastic surgeon 17,18. Insurance companies then verify, and sometimes adjust, this grading and finally decide whether a patient will get reimbursed.
It appears that a significant number of the post-bariatric individuals who desire BCS do not undergo a procedure, partly because of the current reimbursement system in the Netherlands. However, exact numbers of patients who desire BCS and who undergo BCS are unknown. In addition, there might be other reasons why patients do not undergo BCS, like the extent of complaints and dissatisfaction with their body. The goal of this study is to gain more insight into the differences between patients who have undergone BCS, patients who desire BCS and patients who do not. This study looks at demographics, overhanging skin, body satisfaction and qualification for reimbursement. Secondly, we will investigate the perceived reasons why patients have not undergone BCS.
METHODS
Standard treatment
Patients were all in treatment at the Nederlandse Obesitas Kliniek (NOK, Dutch Obe- sity Clinic). This is the largest outpatient clinic for bariatric patients in the Netherlands, offering multidisciplinary pre- and postoperative group counselling in combination with bariatric surgery. This study was part of a larger research project on body con- touring surgery in the post-bariatric population 19. The study was approved by the Eth- ical Research Committee of the Faculty of Psychology and Neuroscience, Maastricht University (ECP 06_11_2014).
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