Page 140 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 8 - Discussion
3-year follow-up had higher weight regain 3 years after surgery. And patients with more emotional eating at 4 years follow-up had higher weight regain 4 years after surgery.
It is important to note that we could not interpret the data from chapter 3 in a causal way. It could be that an increase in physical activity or decrease in emotional eating is causal to an increase in weight loss, but the association might as well be the other way around. Further research should focus on the causal relationship and study effect of psychological problems (like depression) that arise on the mid to long-term after surgery. In the review four out of six studies showing a negative effect of depression on weight loss, depressive symptoms were assessed postoperatively 24-27. Depression has been linked to changes in eating behaviour in the obese population before 28,29. It might be that post-operative (re-) occurrence of depression does negatively affect bodyweight, like in the obese 1,2,30,31. Whether this is also related to more emotional or restrained eating and negative body image is unknown in the bariatric population, but these factors are related in the obese population 1,2,28,30,32,33. Follow-up of bariatric patients and timely assessment and treatment of post-operative psychological prob- lems thus seems important.
We can conclude that there is a relationship between the change in physical activity and eating style after surgery with weight loss results. Previous research links insuffi- cient weight loss and weight regain to low psychical activity and non-compliance to eating advice 15. And an exercise regime or postoperative counselling in addition to bariatric surgery seems to have a positive effect on weight loss and other outcome parameters, like psychological problems 16-20. This is in line with our results. It was surprising that patients experienced less restrained eating after surgery and especially that more restrained eating was related to less weight loss. It seems that self-report- ed restrained eating reflects intentions to restrain intake instead of actual restrained eating [39].
Guidelines for treatment of bariatric patient’s advice multidisciplinary counselling on nutrition, physical activity and psychological issues 5, 9, 10. Patients themselves also describe that to achieve and maintain outcome after surgery, they needed to achieve lifelong changes, which are mostly difficult to accomplish 21. Strangely enough, mul- tidisciplinary counselling is usually not a standard part of treatment in bariatric clinics 22, 23. Since it seems that physical activity and eating style influence weight loss and weight regain, we think it is important that counselling in bariatric surgery patients should focus on all factors that induce or maintain obesity to improve outcome after surgery.
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