Page 154 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Summary - English
orientation and overweight preoccupation. This might be explained by the fact that BCS improves only certain aspects of body image.
In all patients (even the patients without a desire for BCS) a more positive body image was related to less depressive symptoms. This shows that body image is an important parameter in the bariatric population.
In the population with a desire for BCS, body image was even one of the mediators of the relationship between % total weight loss (TWL) and depressive symptoms. Mean- ing that a higher %TWL was related to less depressive symptoms, via more positive feelings of attractiveness and higher body-area satisfaction.
The research in chapter 6 was conducted in the same population as chapter 5. How- ever, now we focused on differences between these patient groups regarding social economic status, qualification for reimbursement of BCS, complaints of overhanging skin and satisfaction with one’s body.
To qualify for reimbursement by health insurance companies in the Netherlands pa- tients have to meet the following qualifications: (a) have to be at least 18 months past bariatric surgery, (b) should have a stable weight for at least 12 months, (c) should have a BMI below 35 kg/m2. They should also have a skin excess grade 3 accord- ing to the Pittsburgh Rating Scale (PRS) or a serious impairment of bodily function. However, research has shown that rating with the PRS has great variability. Moreover, psychological complaints are not part of the current criteria, and physical complaints are not assessed objectively.
Chapter 6 showed that patients with a desire were most often unemployed and more often had an income below the Dutch median income. This might reflect the fact that patients with a bad financial status / low education are unable to stand up for them- selves and try to get a reimbursement.
Patients who desired BCS had more body parts affected by overhanging skin and more often rated the overhanging skin with a the highest PRS grade (meaning more excess skin) compared to patients without a desire. There were no significant dif- ferences between the three groups regarding the percentage of patients who met the Dutch weight qualifications for reimbursement (i.e., BMI < 35kg/m2 and a stable weight).
Striking was that almost 40% of the patients who had a desire for BCS never consult- ed a plastic surgeon, although many of these patients did meet the weight criteria. The results of this chapter showed that there are two issues regarding reimbursement of BCS. The first issue (what we also see in daily practice) is that with the current Dutch criteria there seems to be great variation in reimbursement. The second issue is that only a few patients consult the plastic surgeon because they assume that they will not get reimbursed. Patients should be better educated on the guidelines.
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