Page 141 - When surgery alone won’t cut it - Valerie Maureen Monpellier

HEALTH RELATED QUALITY OF LIFE
In bariatric surgery, most studies report outcome in terms of complication rate and weight loss 34. Recently, the American Society for Metabolic and Bariatric Surgery (ASMBS) has defined HRQoL as one of the key outcomes in bariatric surgery; they advise to use a generic and a disease specific instrument to measure HRQoL 35. There is also a core outcome set for bariatric surgery: an agreed minimum set of outcomes developed by patients and experts 34,36. HRQoL is part of this core outcome. Because of the differences in HRQoL questionnaire used, the ASMBS questioned whether the effect of bariatric surgery on HRQoOL was indeed positive and to what extent 35,37.
Using a large patient cohort and good follow-up rates we showed that all aspects of HRQoL improve greatly after RYGB (chapter 4). The improvement of HRQoL seems to follow the same curve as the weight loss: it reaches a plateau after 1-2 years and then decreases, but never below the HRQoL scores before surgery 38-40. Like in the obese population undergoing non-surgical treatment, evaluating change in HRQoL with the RAND-36 and the IWQOL-lite showed that HRQoL measured by a specific “obesity” questionnaire was more related to the weight (loss) 41. The fact that a higher weight loss was related to higher HRQoL on both scales shows the importance of maximizing weight loss after bariatric surgery. Especially, since a review assessing HRQoL after non-surgical weight loss showed that mental quality of life did not improve 40.
HRQoL is defined as the functional effect of a medical condition and/or its conse- quent therapy upon a patient 42. Thus, the purpose of HRQoL measurement is to quantify the degree to which the medical condition or its treatment impacts the in- dividual’s life in a valid and reproducible way. Although the IWQOL-lite is an obesity specific questionnaire, it was not created specifically for the changes that occur in patients after bariatric surgery 43. Ideally, to quantify the degree to which bariatric surgery impacts the patients’ life, we need a more specific questionnaire 44. In this questionnaire not only the general psychological topics, like social problems, eating problems, self-esteem and depressive symptoms should be included, but also topics regarding the complications and/or negative side-effects that can occur after surgery, like excess skin and body image.
BODY IMAGE
Similar to studies conducted with obese patients, this thesis supports the importance of body image in all patients undergoing bariatric surgery. There were some distinct differences when comparing patients who desired BCS and patients who did not. Patients with a desire for BCS were more concerned about shape and, they were less satisfied with their body. But, they also were more focused on their appearance,
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