Page 136 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 8 - Discussion
The main goal of this thesis was to study which psychological factors relate to weight loss after bariatric surgery. In the first part of the thesis we focused on the effect of compliance to follow-up, physical activity, psychopathology, depressive disorders, eating disorders, HRQoL and body image on weight loss after primary RYGB. The current literature regarding the effect of these factors was studied via a systematic review and meta-analysis (chapter 2). Then the effect of physical activity and eating style on weight loss and weight regain up to 48 months after RYGB was analysed (chapter 3). Additionally, the relationship between weight loss and HRQoL was stud- ied, comparing an obesity-specific and a generic questionnaire for the evaluation of HRQoL (chapter 4).
Excess skin, BCS and body image were the main focus in the second part of the thesis. We compared patients with a desire for BCS, with patients who already had BCS and patients without a desire for BCS. First, we assessed the relationship be- tween body image, weight loss and depressive symptoms in the three patient groups (chapter 5). Social economic status, complaints of overhanging skin, satisfaction with the body and qualification for BCS reimbursement according to Dutch weight criteria were also compared between these groups (chapter 6). In the last chapter we de- scribe the development of a new screening tool for the reimbursement of BCS: the Dutch Reboc Tool (chapter 7).
SUMMARY OF FINDINGS
As a base for this thesis and to provide an overview of the available literature, the first study was a systematic review and meta-analysis assessing the effect of compliance, physical activity, depressive symptoms, binge eating, body image and HRQoL on weight loss after RYGB. The meta-analysis showed us that weight loss was signifi- cantly higher in compliant patients compared to non-compliant patients. And that active patients also had a higher weight loss, the difference was almost 7%, com- pared to non-active patients. This effect of physical activity seemed to become more pronounced on long-term follow-up after RYGB.
Contrary to common believe, binge eating and depressive symptoms did not signifi- cantly affect weight loss. Twelve studies assessing depressive symptoms before and after surgery were included; EWL was not significantly different in the patients with symptoms (66.9%) compared to patients without symptoms (65.4%). For binge eat- ing mean EWL was even higher in patients who reported binge eater before surgery (61.3%) compared to the patients who did not report binge eating (58.7%). From these results we can conclude that compliance to follow-up and physical activity should be focus of counselling in bariatric patients. Psychological issues like binge eating and depression might not be suitable to disqualify patients for bariatric surgery. The systematic review also showed that research regarding HRQoL and body image was sparse; for both there were only two studies assessing the effect on weight loss.
136