Page 137 - When surgery alone won’t cut it - Valerie Maureen Monpellier

This was insufficient data to conduct a meta-analysis and therefore we could not draw any conclusion regarding these factors.
The next step was to evaluate our own population, starting with the factor that has been shown to improve weight loss: physical activity. And since lifestyle change is the main focus of the treatment at NOK, we also added self-reported eating style to this study. A total of 4,569 patients were included, and, with a follow-up up to 48 months, we could study both weight loss and weight regain. We showed that self-reported physical activity and eating style before surgery were not related to weight loss or weight regain at any of the follow-up moments after primary RYGB. Hence, patients should not be denied surgery based on pre-operative physical activity and eating style.
Looking at the change of physical activity and eating style from before surgery to after surgery, the study showed that patients who became more active after surgery com- pared to before surgery had more weight loss. Patients with more emotional eating af- ter surgery compared to baseline, had less weight loss at all follow-up moments. Pa- tient who reported more external eating at 24 months follow-up showed less weight loss. Thus, patients who change their physical activity and eating style in a positive way, seem to have better weight loss results. Interestingly, there was also less weight loss in patients who reported to eat more restrained. And weight regain at 36 months after RYGB was higher in patient who showed more restrained eating at 36 months. This shows that while patients might have the intention to eat less, they might not. This study also revealed that patients who experienced emotional eating at 48 months had more weight regain.
Then we concentrated on the factors that were scarcely studied before: HRQoL and body image. Both these factors have been associated with weight loss in the obese population 1-3. To evaluate the relationship between HRQoL and weight loss we com- pared the IWQOL-lite (an obesity specific questionnaire) and the RAND-36 (a generic questionnaire) in patients undergoing a primary RYGB. We studied weight and HRQoL before surgery and at 15 and 24 months after surgery. Patient with a higher BMI had a lower HRQoL, not only before but also after RYGB. Moreover, patients who lost more weight, had more improvement of HRQoL on both questionnaires. The correlations between weight (loss) and HRQoL were higher when HRQoL was measured with the IWQOL-lite compared to the RAND-36. These results showed that the reported vari- ance in the effect of RYGB on HRQoL can be explained by both the weight loss of the researched population and the questionnaire used.
There is almost no knowledge about the relationship between body image, excess skin and desire for BCS in post-bariatric patients. This thesis showed that excess skin, desire for BCS and body image are important factors in the bariatric population, which can negatively influence patient well-being. In the studied post-bariatric pop-
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