Page 47 - When surgery alone won’t cut it - Valerie Maureen Monpellier

concluded that depression disorders have a positive effect of weight loss, mediated by the positive effect on QOL 87. A somewhat surprising finding is that in four out of six studies with a negative effect of depression on weight loss, depressive symptoms was assessed postoperatively 34,36,44,57. Depression has been linked to changes in eat- ing behavior in the obese population before 11,12. Thus, it might be that post-operative occurrence of depression has effect on bodyweight. Follow-up of RYGB patients and timely treatment of post-operative depression might be the most important in this population.
Although the number of studies that could be included in the meta-analysis were suffi- cient, the findings of this study are somewhat restricted by the number of publications with sufficient weight loss data. Most studies were conducted in the past decade and %EWL was generally used as a weight loss variable, however this outcome measure- ment was not available in a substantial number of studies. The recently published guideline on reporting outcome after bariatric surgery should avoid this problem in future meta-analysis 18.
The variance in assessment and definition of the moderators might have contributed to the fact that there was no difference in weight loss in the analysis of depressive and binge eating symptoms. And although in six studies weight loss was not influenced by the presence of psychological/psychiatric problems 46,48-50,52,53. Because of the vari- ations in psychological evaluation a meta-analysis could not be conducted. The most recent guideline does state that psychosocial evaluation before bariatric surgery is essential, however the best method to conduct this assessment is yet to be identified 1. Thus, our results do give good insight in current everyday practice.
In the future, more effort should be made for consensus on psychological screening of bariatric patients 1. It seems that current screening is mostly conducted with ques- tionnaires and without structured interviews. This could lead to the fact that patient might now be included in the depressive symptoms group, but do not actually have a depression. The same is possible for binge eating symptomatology. When accurate diagnosis of psychological issues is conducted, then definitive conclusions of the impact on weight loss can be made.
In this consensus there also should be attention for what psychologists’ call: positive faking. Patients who are screened for bariatric surgery, usually know the contra-indi- cations and might behave differently to “get” the surgery.
CONCLUSION
A decade ago van Hout et al. stated that more research was needed to fully under- stand the influence of patient related factors on weight loss 88. This study shows that
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