In 2008, bariatric surgeons in the United States performed about 220,000 weight loss procedures, about 10 times more than were performed in 1998, according to the National Anemia Action Council. Although bariatric surgery may allow severely obese patients to lose significant amounts of weight, the risk of nutritional deficiencies, inadequate weight loss and weight regain require nutritional care before and after the procedure.
How It Works
Patients more than 100 lbs. overweight may benefit from bariatric or weight loss surgery. Depending on your individual needs, your surgeon may recommend one of three types of procedures: restrictive, malabsorptive or a combination procedure. Restrictive procedures, including vertical banded gastroplasty and adjustable gastric banding, reduce the size of the stomach and limit the amount of food eaten in one sitting. Malabsorptive procedures, such as biliopancreatic diversion, block calories and some nutrients from absorbing efficiently. Combination procedures such as gastric bypass or Roux-en-Y surgery restrict the size of the stomach and reroute the digestive system to cause some malabsorption.
Significance
Bariatric surgery patients must make permanent changes to their diets and lifestyles to lose weight and maintain their health. While the procedures help to speed weight loss, the changes to the digestive system place patients at risk for nutrition deficiencies. Patients need additional protein, at least 60 to 80 g per day, to avoid losing lean muscle mass while losing weight rapidly. Vitamin and mineral deficiencies, especially in iron, calcium, folate and vitamin B12, occur due to the restricted food intake as well as malabsorption. Other nutritional issues bariatric sugery patients may experience include flare-ups of eating disorders, inability to follow dietary guidelines and psychological issues. If left untreated, nutritional deficiencies may result in hair loss, brittle bones, weakness, fatigue, anemia and neurological problems, all of which become worse over time.
Medical Follow-Up
Bariatric surgeons follow their postoperative patients closely during the first year to identify nutritional deficiencies and weight loss problems quickly. A typical follow-up program requires office visits at the end of the first, third, sixth and 12th month after the procedure. At each visit, the surgeon assesses and evaluates indicators of the patient's progress, including weight, body mass index or BMI, blood pressure and laboratory tests. Based on the results of laboratory tests for individual nutrients, the surgeon may change the patient's dosages of commonly prescribed nutritional supplements, including multivitamins, calcium with vitamin D, B vitamins, iron and protein.
Nutritionist Follow-Up
About 10 percent of bariatric surgery patients fail to lose enough weight or regain the weight after an initial loss, according to the Weight-Control Information Network. Frequent snacking, eating high-calorie foods and lack of exercise contribute to these problems. A nutritionist or dietitian can provide valuable education and assessment that may help prevent or correct nutritional issues after surgery. Nutritional care begins before surgery by assessing the patient's intake, health status, nutritional knowledge and readiness for change, says Linda Aills, R.D., lead researcher in a study published in the September 2008 issue of "Surgery for Obesity and Related Diseases." By assessing the whole person, the nutritionist can identify potential challenges and strengths. Education about postoperative food plans and nutrition supplements begins early in the process and continues after the procedure. Typical follow-up visits might include assessing intake and compliance with the plan; addressing symptoms such as nausea, vomiting and diarrhea; suggesting ways to add nutrient-rich foods; and assessing weight loss progress.
Support
Patients must make long-term behavioral changes after bariatric surgery, including eating differently, taking supplements every day, exercising more and avoiding habits such as grazing or over-eating. Morbidly obese individuals often have difficulty making these changes because they also deal with long-term psychiatric issues, such as binge eating, depression, post-traumatic stress disorder and low self-esteem, says Judy Dowd, R.D., in a 2005 article published in "Diabetes Spectrum." In addition to counseling for these issues, patients benefit from support groups that provide successful role models and reinforcement of positive changes necessary for compliance with the diet plan.
References
- ASMBS: ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patients
- "Diabetes Spectrum:" Nutrition Management After Gastric Bypass Surgery
- National Anemia Action Council: Avoiding Anemia and Nutritional Deficiencies Following Bariatric Surgery
- Weight-Control Information Network: Bariatric Surgery for Severe Obesity
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