Nutritional Considerations Following Bariatric Surgery
Christopher Larson Key Points
- • Bariatric surgery is an effective treatment for obesity.
- • The two most common bariatric surgical procedures are the sleeve gastrectomy and the Roux-en-Y gastric bypass.
- • Postsurgical bariatric patients are advised to adhere to dietary guidelines to ensure proper healing and safe weight loss.
- • Lifelong follow-up and vitamin and mineral supplementation are necessary to help avoid weight regain and potential nutritional deficiencies.
Keywords Bariatric surgery • Roux-en-Y gastric bypass • Sleeve gastrectomy • Nutritional deficiencies
Obesity is expected to remain a prevalent and costly disease in the United States and worldwide for the foreseeable future. By 2030 it is estimated that over 50% of the population of the USA will be obese (BMI >30 kg/m2) and 11% will be considered severely obese (BMI >40 kg/m2) . Traditional approaches to weight management such as dietary modification, increasing exercise, lifestyle and behavioral interventions, as well as nonsurgical options like pharmaceuticals may help patients achieve modest weight loss but significant and sustained weight loss is rare. In those patients for whom medical management proves inadequate, bariatric surgery may be considered. The procedure has been consistently shown to help obese patients achieve significant and sustained weight loss with concurrent improvement of obesity-related comorbid medical conditions and quality of life. Bariatric surgery is often referred as a “tool” to assist patients in achieving their weight-loss goals, reducing or eliminating obesity-related comorbid conditions, and improving quality of life. A 2016 study of over 1000 weight loss surgery patients demonstrated durability of weight loss and improvement in diabetes, high blood pressure, and sleep apnea after 10 years .
C. Larson, P.A.-C., R.D.N. (*)
© Springer International Publishing AG 2017
N.J. Temple et al. (eds.), Nutrition Guide for Physicians and Related Healthcare Professionals, Nutrition and Health, DOI 10.1007/978-3-319-49929-1_36
The 1991 National Institutes of Health criteria for consideration of bariatric surgery includes patients with a BMI of >35 with associated medical problems or a BMI of >40 kg/m2. The American Society for Metabolic and Bariatric Surgery (ASMBS) has recommended that bariatric surgery be considered for patients with a BMI of 30-35 kg/m2 for whom other treatments have not resulted in sustained weight loss or improvement in comorbid medical conditions.
It is generally accepted that adequate nutritional evaluation and dietary guidance is vital to any comprehensive approach to the perioperative care of the bariatric surgical patient. Most bariatric surgical programs and insurance providers require that surgical candidates provide evidence of previous medically supervised weight loss attempts. In addition, a minimum of 3 months of nutrition and lifestyle education with a registered dietitian and behavioral health specialist in preparation for life after bariatric surgery is required. Before surgery many programs have adopted a low-calorie, full liquid, or meal replacement type diet (usually lasting from 2 to 4 weeks), ostensibly to reduce the size of the liver and improve surgical access. The potential for long-term nutritional deficiencies and weight regain are well established and underscore the need for lifelong surveillance. This chapter provides clinical guidance on nutritional considerations following bariatric surgery.