Page 138 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 8 - Discussion
ulation, a majority had complaints of excess skin and desired BCS. Patients with a more positive body image had fewer depressive symptoms, even within the group of patients without a desire for BCS. Patients with a desire for BCS had a more negative body image and more depressive symptoms compared to patients without a desire for BCS. More interestingly, in these patients the relationship between weight loss and depressive symptoms was partly explained by body image. Patients with more weight loss had fewer depressive symptoms, via a more positive body image.
Patients who desired BCS were younger and more often female, compared to the group that already had BCS and the group that did not want BCS. The patients with a desire also experienced more excess skin and were less satisfied with their body compared to patients without a desire or patients who already had BCS. There were no differences between the three groups with regards to the percentage of patients who met the weight criteria for reimbursement for BCS in the Netherlands.
A large part of the patients who desired BCS never consulted a plastic surgeon for their overhanging skin, although almost half of these patients qualified for reimburse- ment according to the weight loss results. This confirms what we see in daily practice: there is a group of patients who might be reimbursed by their insurance company, but never take the necessary action to get surgery, i.e. consult a general practitioner, bariatric surgeon or plastic surgeon. This is, at least partially, caused by the fact that patients are not educated on the current guidelines. They might also feel unequipped or unsure to stand up for themselves and try to get a reimbursement.
PRE-OPERATIVE PSYCHOLOGICAL FACTORS
To qualify for bariatric surgery, patients have to go through a multidisciplinary screen- ing. According to the IFSO criteria, assessment of motivation to follow-up and adher- ence to, non-specified, behavioural changes is an essential part of this screening 4,5. Guidelines state that non-stabilized psychotic disorders, severe depression, person- ality and eating disorders are a contra-indication for bariatric surgery 4,5. These criteria are based on the idea that these psychological issues have a negative impact on long- term weight loss and complication risk after bariatric surgery and that preoperative behaviour predicts behaviour and weight change after surgery 4,5.
This research in this thesis shows that some common assumptions in the selection of patients for bariatric surgery are not based on facts, even untrue and in need of change. In chapter 2, we showed that weight loss was not influenced by self-report- ed binge eating or depressive symptoms. Several other studies have suggested that there is no effect of depression on weight loss 6,7. For binge eating another review even found a positive effect 6. In chapter 3, we showed that preoperative physical activity and self-reported eating style were also not related to weight loss up to 48
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