Page 31 - When surgery alone won’t cut it - Valerie Maureen Monpellier

INTRODUCTION
The Roux-en-Y gastric bypass (RYGB) is currently the most popular type of bariatric surgery 1-3. It results in long-term weight loss; improvement of obesity related comor- bidities and it positively affects quality of life (QoL) 3-5. Percentage excess weight loss (%EWL) is generally used to describe weight loss after RYGB 6. The average patient reaches an EWL of 60-70%; in 10-20% of the patients EWL is below 50%, which has been claimed as unsuccessful weight loss by some authors 6,7. Now that the RYGB has proven to be a successful and safe treatment for morbid obesity, further research should focus on the questions why not all patients lose a substantial amount of weight and why some patients relapse.
Some factors influencing weight loss are age, race, the presence of diabetes mellitus and gastrointestinal hormone levels 8-10. In addition to these “medical” factors, cogni- tive and behavioral factors might influence the results of bariatric surgery. Cognitive mechanisms related to the behavior of obese patients might sabotage successful weight loss and its maintenance 11. Also, co-morbid psychopathology, like depression and (binge) eating disorders, could influence weight loss 10,11.
Obese patients frequently report negative perceptions towards their own body, a negative body image, and related cognitive-behavioral consequences 12-16, such as severe avoidance of social situations and low self-esteem, leading to a low QoL 12-14. Experts argue that psychological problems, a lack of physical activity and non-com- pliance to life-style change have a negative impact on weight loss after RYGB 1,17. Though these “moderators” have been studied before, systematic reviews and me- ta-analyses are scarce. Moreover, previous reviews generally include different types of bariatric surgery, while it cannot be ruled out that weight loss is differently influenced by the type of surgery 5. The aim of this study is to review and analyze the cogni- tive, behavioral and psychopathology related moderators of weight loss after primary RYGB.
MATERIALS AND METHODS
Search strategy
The search strategy was developed with an information specialist. The search was carried out using the following electronic databases: Pubmed, Embase, Cochrane and Psycinfo. Searches were performed until 31th of January 2016. The following terms were used for the search: gastric bypass, bariatric surgery, compliance, phys- ical activity, psychopathology, depressive disorder, eating disorder, binge eating dis- order, body image, quality of life and outcome. Reference lists of systematic reviews were hand searched for additional publications. Subsequently titles and abstract were screened for eligibility. Case control studies, cohort studies, cross-sectional and ran- domized controlled trials were included. If it was unclear if the article was suitable
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