Page 46 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 2
difference was even seen up to 5.8 years after surgery. The authors of the previous review suggest that follow-up rates are lower in patients with less weight loss 17. An- other explanation can be that motivated patients have a better compliance to both the consultation as well as the lifestyle adherence, with more weight loss as a con- sequence. For future treatment it is essential to get more insight in how the improve compliance of these patients.
The effect of compliance is in concordance with the higher weight loss in patients who endorse in physical activity after surgery, which is also a form of compliance to postoperative advice. In the general population the positive effect of psychical activity on weight loss and weight maintenance is already well established 81. In our analy- sis the pre-operative BMI difference between the active and non-active patients was less than one BMI point, and still the mean difference in EWL was almost 7%. When comparing all included studies, the effect of PA seems to be more pronounced on long-term. One study with 2-5 years follow-up even showed 15% more weight loss in active patients 39. Although this meta-analysis was only conducted with studies on RYGB, we want to emphasize that previous research has also shown a positive effect of PA on weight loss in patients undergoing different types of bariatric surgery 82. In addition to weight loss, physical activity has shown to have a positive effect on cardiac and pulmonary function and body composition 83-85. As described in previous guidelines, physical activity should be promoted in all post-bariatric patients 1.
Regarding the psychological predictors the results of the meta-analysis are not in concordance with common belief, which generally link psychological issues and eat- ing disorders to less weight loss after surgery 1. Binge eating is present in a significant part of the pre-bariatric surgery population and a common reason for delaying and refusal of surgery 1. However previous reviews did never find a negative effect of binge eating on weight loss after bariatric surgery; one review even found a positive effect 10. This in in concordance with our results, which also show slightly more weight loss in binge eaters. When looking at the individual studies, there is a great variation in as- sessing binge eating symptoms. Seven different questionnaires were used, in only in a few studies a structured interview was conducted. In addition, the groups with long term outcomes were very small, ranging from 10-36 patients 54,55,74. Independently of these possible biases, it seems that pre-operative binge eating symptoms do not have a significant negative influence on weight loss.
To our knowledge no meta-analysis has ever been conducted to assess the effect of depressive symptoms on weight loss after RYGB or any other bariatric procedure. Our results show no difference in weight loss between patients self-reporting depressive symptoms vs patients who do not report symptoms. Several other studies have sug- gested that there is no effect of depression on weight loss 10,86. Herpertz et al. even
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