Page 153 - When surgery alone won’t cut it - Valerie Maureen Monpellier

of postoperative weight loss or weight regain in any of the follow-up moments. From this we can conclude that these factors should not be reason to deny patients for bariatric surgery.
This chapter also showed that there is a relationship between weight loss and change in self-reported physical activity and eating style. In general terms, patients who be- came more active and experienced less emotional and restrained eating had better weight loss results. External eating was only related to weight loss at 2-year follow-up. This demonstrates that change of eating style and physical activity after bariatric sur- gery is important to improve weight loss results. And therefore, treatment programs should focus on supporting patients in making these changes.
In chapter 4 the relationship between weight loss and HRQoL was studied. Previ- ous research showed a great variation in HRQoL improvement after bariatric sur- gery. Based on research in the obese population we compared an obesity specific questionnaire, the Impact of Weight on Quality of Life-lite (IWQOL-lite) with a generic HRQoL questionnaire, the RAND-36. HRQoL before surgery was very low. For both questionnaires there was a significant improvement of HRQoL scores up to 2 years after surgery. Before and after surgery a higher BMI was related to lower HRQoL. The more weight the patients lost, the more HRQoL improved. The relationship between weight loss and HRQoL improvement was more apparent with the IWQOL-lite. Thus, bariatric surgery has a positive effect on HRQoL; the variety in HRQoL change is caused by the differences in weight loss and questionnaire used.
The second part of the thesis highlighted the importance of excess skin, body image and desire for body contouring surgery (BCS). In the obese population, a negative body image is very common and related to body weight. Since a large part of the post-bariatric population develops excess skin, body image after bariatric surgery might also be important. Excess skin can only be treated by BCS, a type of surgery in which the excess skin is surgically removed. We were interested in the consequences of this excess skin in relation to the desire for BCS. Especially since reimbursement of BCS is a worldwide problem, and a lot of post-bariatric patients are not able to undergo a body contouring procedure.
In chapter 5 depressive symptoms, body image and weight loss were studied in a post-bariatric population. In this cross-sectional study, we approached patients who had bariatric surgery 2-3 years before. Patients with a desire for BCS were compared with patients who already had BCS and patients without a desire for BCS. A total of 590 patients could be included, the majority of these patients had a desire for BCS (62.4%). Patients with a desire for BCS had a more negative body image compared to patients without a desire for BCS. Surprisingly, the patients who already had BCS were quite comparable to the population who desired BCS, regarding appearance
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