Page 139 - When surgery alone won’t cut it - Valerie Maureen Monpellier

months after RYGB. In addition, no relation could be found between preoperative behaviour and weight regain 36 or 48 months after RYGB.
In conclusion, there is not much evidence for a negative effect of preoperative, self-re- ported physical activity, eating style behaviour, depressive symptoms and binge eat- ing on postoperative weight loss in patients undergoing bariatric surgery. Patients should not be denied access to bariatric surgery based on the outcome of only a questionnaire, since, we did not find any indications that there an absolute cut-off predicts which patients will fail after bariatric surgery. Normally psychological assess- ment is preferably done via structured interviews, because they are more valid and reliable than questionnaires. The outcome of screening of the pre-bariatric patients should also be based on a complete picture of the patient via a thorough screening by a multidisciplinary team, including a mental health professional. In this screening questionnaires can be helpful. Screening of bariatric patients remains to be important, also because participation in mental health treatment before bariatric surgery can improve weight loss results 8.
Which assessments a team should use, is in important topic for future research. The review showed great variance in instruments of assessment and definition of psy- chological issues and/or symptoms and thus, probably also a great variation in ac- ceptance of patients for bariatric surgery. This is caused by the fact that there is no consensus or guideline for psychological evaluation of the pre-bariatric patient 5, 9, 10. More effort should be made to develop such a guideline or consensus.
CHANGE IN BEHAVIOUR
In chapter 2, we showed that patients with better compliance and higher physical activity had more weight loss. For both these parameters it seemed that the weight loss was even higher when follow-up after surgery was longer, but populations were too small to do a meta-analysis for the long-term follow-up.
Regular physical activity improves health and maintains body weight, and is advised to all bariatric patients 9-12. In our population, (chapter 3), the patients who were more active 15, 24 and 36 months after surgery had a higher weight loss. This has been shown before, also when looking at preoperative change in physical activity 13,14. For eating style, the opposite was true: overall patients who reported an increase in emo- tional, external or restrained eating from baseline (before surgery) to follow-up had less weight loss. For emotional eating this association was significant at all follow-up moments, from 15 to 48 months. Restrained eating was negatively associated with weight loss up to 36 months follow-up. External eating was only related to weight loss at 24 months follow-up.
Additionally, chapter 3 showed that patients who had higher restrained eating at 139