Surgery for Obesity and Related Diseases
ASMBS guidelinesASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient
Section snippets
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
References (176)
- et al.
Predicting success after gastric bypass: the role of psychological and behavioral factors
Surgery
(2003) - et al.
Facilitating dietary change: the patient centered counseling model
J Am Diet Assoc
(2001) - et al.
Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity
J Gastrointest Surg
(2006) - et al.
Prevalence of vitaminosis D depletion among morbidly obese patients seeking bypass surgery
Surg Obes Related Dis
(2006) - et al.
Vitamin E, vitamin B-6, vitamin B-12, and folate status of gastric bypass surgery patients
J Am Diet Assoc
(1988) Nutritional and metabolic complications of bariatric surgery
Am J Med Sci
(2006)- et al.
Biliopancreatic diversion for obesity at eighteen years
Surgery
(1996) - et al.
Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery
J Gastrointest Surg
(2004) - et al.
Wernicke's syndrome after bariatric surgery
Clin Nutr
(2000) - et al.
Intestinal adaptation: structure, function and regulation
Semin Pediatr Surg
(2001)
Wernicke encephalopathy—an emerging trend after bariatric surgery
Am J Med
Preoperative thiamin deficiency in obese population undergoing laparoscopic bariatric surgery
Surg Obes Relat Dis
Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity
Rev Med Interne
Wernicke's encephalopathy after gastric bypass that masqueraded as acute psychosis
Curr Surg
Alterations in gastrointestinal physiology after Roux-en-Y gastric bypass
J Am Coll Surg
Vitamin B-12 deficiency after gastric surgery for obesity
Am J Clin Nutr
Are vitamin B-12 and folate deficiency clinically important after Roux-en-Y gastric bypass?
J Gastrointest Surg
Pharmacological therapies for obesity
Gastroenterol Clin North Am
A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band® patients in a single U.S. center with three-year follow-up
Obes Surg
Ghrelin and gastric bypass: is there a hormonal contribution to surgical weight loss?
J Clin Endocrinol Metab
Weight Management
J Am Diet Assoc
Recommendations for reporting weight loss
Obes Surg
Bariatric surgery, a systematic review and meta-analysis
JAMA
Results of the surgical treatment of obesity
Am J Surg
Varying body mass index cutoff points to describe overweight prevalence among U.S. adults: NHANES III (1988 to 1944)
Obes Res
A new handheld device for measuring resting metabolic rate and oxygen consumption
J Am Diet Assoc
Eating disturbances and outcome of gastric bypass surgery: a pilot study
Int J Disord
High risk behavior
Obes Surg
Binge status and quality of life after gastric bypass surgery: a one-year study
Obes Res
Bariatric surgery: the role of the RD in patient assessment and management
SCAN's Pulse, a newsletter of the Sports, Cardiovascular and Wellness Nutrition Practice Group of the American Dietetic Association
National Institutes of Health/National Heart Lung and Blood Institute, North American Association for the Study of Obesity in Adults
Successful weight loss maintenance
Annu Rev Nutr
Disorders of vitamin and mineral metabolism: identifying vitamin deficiencies
AGA technical review of short bowel syndrome and intestinal transplantation
Gastroenterology
Vitamin D deficiency in the morbidly obese
Obes Surg
Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity alter bariatric surgery
Obes Surg
Calcium metabolism in pre and postmenopausal morbidly obese women at baseline and after laparoscopic Roux-en-Y gastric bypass
Obes Surg
Dietary calcium intake and obesity
J Am Board Fam Pract
Dairy augmentation of total and central fat loss in obese subjects
Int J Obes
Vitamin and trace mineral levels after laparoscopic gastric bypass
Obes Surg
Low plasma antioxidants and normal plasma B vitamins and homocysteine in patients with severe obesity
Isr Med Assoc J
Nutrient deficiencies secondary to bariatric surgery
Curr Opin Clin Nutr Metab Care
Nutritional deficiencies following bariatric surgery: what have we learned?
Obes Surg
Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies
Int J Obes
Changes in body composition, metabolic profile, and nutritional status 24 months after gastric banding
Obes Surg
Biliopancreatic diversion
World J Surg
Micronutrient deficiencies after gastric bypass for morbid obesity
Am Surg
Nutrition status seven years after Roux-en-Y gastric bypass surgery
Surgery
Iron absorption and therapy after gastric bypass
Obes Surg
Acute Wernicke's encephalopathy following bariatric surgery: clinical course and MRI correlation
Obes Surg
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