title: Bariatric surgery and bariatric psychology: general overview and the Dutch approach.
abstract: BACKGROUND
  Obesity is a chronic, multifactorially caused disease with serious somatic and psychosocial comorbidity as well as economical consequences. In the Netherlands, between 1993 and 1997, the prevalence of morbid obesity was 0.2% for men and 0.6% for women. Although bariatric surgery generally is an effective intervention, it does not lead to equal results in every patient. The long-term efficacy is predominantly determined by compliance to adequate dietary rules in which psychosocial factors can play a major role.
  
  
  METHODS
  Questionnaires were sent to the surgery departments of all hospitals in the Netherlands. Subsequently, a second questionnaire was sent to clinical psychology departments of hospitals which perform bariatric surgery.
  
  
  RESULTS
  In 28 Dutch hospitals (19%), bariatric surgery is being performed, mostly using restrictive procedures. Almost all hospitals have a multidisciplinary selection-process, and all surgeons and psychologists use multiple selection-criteria. Regarding these criteria, there is more consensus between surgeons than between psychologists. In most hospitals, patients are psychologically assessed prior to surgery. However, postoperative assessment is relatively rare, as is preoperative and postoperative psychological treatment.
  
  
  CONCLUSIONS
  In the Netherlands, bariatric surgery is still relatively uncommon and mostly limited to restrictive procedures. Irrespective of BMI and eating behavior, the majority of patients will be offered a restrictive procedure. The involvement by the psychological and/or psychiatric discipline is not optimal yet; especially, postoperative assessment and pre- and postoperative treatment are not frequently performed, in spite of the fact that these programs can enhance the success rate of bariatric surgery.
authors.affiliation: Department of Medical Psychology, Catharina Hospital, Eindhoven, the Netherlands. gerbrand.v.hout@cze.nl
authors.forename: Gerbrand C M
authors.initials: GC
authors.lastname: Van Hout
authors.forename: Anke J
authors.initials: AJ
authors.lastname: Leibbrandt
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jakimowicz
authors.forename: J Frans
authors.initials: JF
authors.lastname: Smulders
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Schoon
authors.forename: Jan P
authors.initials: JP
authors.lastname: Van Spreeuwel
authors.forename: Guus L
authors.initials: GL
authors.lastname: Van Heck
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000379:methods / Q000523:psychology*; D015391:Gastroplasty / Q000379:methods / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery*; D010348:Patient Care Team; D016896:Treatment Outcome