Page 56 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 3
METHODS
Standard treatment
This is a retrospective analysis of prospectively collected data of patients who were treated at the Nederlandse Obesitas Kliniek (NOK, Dutch Obesity Clinic). Data were collected until 22nd February 2017. The NOK is the largest outpatient clinic for bar- iatric surgery in the Netherlands, with eight locations throughout the country. In ad- dition to the bariatric procedure, the treatment program entails group counselling by a multidisciplinary team. Group counselling starts before surgery and is focused on behavioural change. After 15-month follow-up, patients are invited yearly for consul- tation with the whole multidisciplinary team.
Routine assessment (as part of the treatment program) of self-reported physical ac- tivity and eating style was enrolled over the different locations at several time points during 2012 and 2013.
Patients
4,829 Patients who had undergone a primary RYGB between 2012 and 2015 and had a follow-up of 24 months or more were selected from the prospective database. A to- tal of 260 patients (5.6%) patients were excluded because they were lost to follow-up before 12 months post-surgery and/or no results were available for the questionnaires (see below).
Assessments
Physical Activity
Physical activity was evaluated preoperatively (baseline) and at 15, 24, 36 and 48 months after surgery with the Baecke questionnaire 21. This questionnaire has shown good test-retest reliability and validity, and was used in the bariatric population be- fore 14, 21, 22. The Baecke consists of 22 questions assessing physical activity at work, during sports and during leisure time. A total score can be calculated, which ranges from 3 to 15, with higher scores indicating increasing self-reported activity. For this analysis, the scores at baseline and follow-up were used. Based on weight loss pla- teau around 18 months, the maximum change in physical activity (ΔPA) from baseline to 15 or 24 months follow-up was calculated.
Eating style
Eating style was evaluated at the same time points as the physical activity measure- ments, using the Dutch Eating Behaviour Questionnaire (DEBQ) 23. The DEBQ is a widely used questionnaire to measure eating style 23. It consists of 33 questions as- sessing three styles of eating: emotional eating, external eating and restrained eating. Emotional eating means eating in response to negative emotions. External eating re- fers to eating in response to external cues (like seeing food). Restrained eating refers
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