Page 18 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 1 - Introduction
Health-related Quality of Life
Health-related quality of life (HRQoL) was recently defined as a key outcome measure after bariatric surgery by the American Society of Metabolic and Bariatric surgery (ASMBS) 65. In general, HRQoL improves significantly after bariatric surgery, even up to 10 years postoperatively 23,43,69. However, there is a great variance in the effect of bariatric surgery on HRQoL 65,70. This variance seems to be caused by two factors. First, there is no specific questionnaire to assess HRQoL in the bariatric patient and thus numerous questionnaires are used 65,70. Since all these questionnaires measure different aspects of HRQoL, this is likely to influence outcomes. Second, (improve- ment of) HRQoL appears to be related to weight loss 71-74. So, if studies differ in mean weight loss, the effect of bariatric surgery on HRQoL might also be different.
IMPROVING WEIGHT OUTCOME
Even though bariatric surgery is currently the most effective treatment for morbid obesity, weight outcome varies greatly between patients and the reasons for this are unclear. Unsuccessful weight loss after bariatric surgery is usually defined as an EWL below 50% or a TWL below 20% 6,7,67. There is no uniform definition for weight regain, used definitions range from “any weight regain” to weight regain up to a BMI > 35 kg/m2 75. Insufficient weight loss or significant weight regain occurs in 20-30% of the population, leading to secondary and/or tertiary bariatric procedures in up to 25% of the patients 5-7. Weight regain in turn negatively impacts comorbidities and HRQoL 7,69,76. It is essential to identify which factors determine weight outcome after surgery, so that weight loss can be improved and weight regain can be avoided. Most previous research has concentrated on factors that do relate to weight outcome, but cannot (easily) be influenced, such as age, race, presence of co-morbidities, genetics and gastrointestinal hormone levels 77-81. Surgical factors, like the length of biliary limbs, do not seem to effect long-term weight loss 82. To further improve weight loss and/or reduce weight regain it seems more logical to focus on factors that can be influenced: patient related factors. This will also allow a shift of focus from the total population to the specific patients that need extra guidance.
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