ASMBS guidelines
ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient

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Nutrition care

The Dietitian's role is a vital component of the bariatric surgery process. Nutrition assessment and dietary management in surgical weight loss have been shown to be an important correlate with success [1], [2]. A comprehensive nutrition assessment should be conducted preoperatively by a dietitian, physician, and/or well-informed, qualified multidisciplinary team to identify the patient's nutritional and educational needs. It is essential to determine any pre-existing nutritional deficiencies,

Importance of multivitamin and mineral supplementation

It is common knowledge that a comprehensive bariatric program includes nutritional supplementation guidance, routine monitoring of the patient's physical/mental well-being, laboratory values, and frequent counseling to reinforce nutrition education, behavior modification, and principles of responsible self-care. As the popularity of surgical interventions for morbid obesity continues to grow, concern is increasing regarding the long-term effects of nutritional deficiencies. Nutritional

Etiology of potential deficiency

Thorough mastication of food is an important first step in the overall digestion process to compensate for the reduced grinding capacity of the pouch. Breaking food into smaller particles and moistening it with saliva will facilitate a bolus of animal protein to pass from the esophagus into the pouch or through the band. In normal digestion, hydrochloric acid converts the inactive proteolytic enzyme pepsinogen (secreted in the middle of the stomach) into its active form, pepsin. This allows the

Diet and texture progression

The purpose of nutrition care after surgical weight loss procedures is twofold. First, adequate energy and nutrients are required to support tissue healing after surgery and to support the preservation of lean body mass during extreme weight loss. Second, the foods and beverages consumed after surgery must minimize reflux, early satiety, and dumping syndrome while maximizing weight loss and, ultimately, weight maintenance. Many surgical weight loss programs encourage the use of a multiphase

Conclusion

It was the intent of this paper to serve as an educational tool for not only dietitians, but all those providers working with patients with severe obesity. Current research and expert opinion were reviewed to provide an overview of the elements that are important to the nutritional care of the bariatric patient. While the extent of this paper has been broad, the Allied Health Executive Council of the American Society for Metabolic and Bariatric Surgery realizes there are many areas for future

Disclosures

J. Blankenship is on the Medical Advisory Board for BariMD and the Advisory Board for Celebrate Vitamins. L. Aills, C. Buffington, M. Furtado, and J. Parrott claim no commercial associations that might be a conflict of interest in relation to this article.

Acknowledgments

We would like to thank Dr. Harvey Sugerman for allowing the use of the following manuscript cited in the book titled “Managing Morbid Obesity” as the starting point for this paper: Blankenship J, Wolfe BM. Nutrition and Roux-en-Y Gastric Bypass Surgery, In: Sugerman HJ, Nguyen NT, eds. Management of morbid obesity. New York: Taylor & Francis; 2006. We thank our senior advisors, Scott Shikora, M.D., F.A.C.S., and Bill Gourash, N.P.-C., for their advice and support. We also thank the American

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