Bariatric Surgery

Carly PabonNTR 573

Spring 2014

The different types of bariatric surgery, their prevalence, and effectiveness.

Qualifications for bariatric surgery. Recommended diets prior to and following

surgery. Role of a Registered Dietitian throughout

process.

Learning Objectives

Bariatric Surgery◦ Category of weight loss surgeries ◦ Change your stomach and digestive system by

limiting how much food you eat and the nutrients you can absorb.

Most effective and long lasting treatment for morbid obesity and related conditions, resulting in significant weight loss.

Over 200,000 people have bariatric surgery each year in the United States.

Introduction

Roux-en-Y Gastric Bypass (RYGB)◦ Comprises 80% of all weight loss surgery in U.S.◦ Decreases how food is absorbed◦ Stomach, duodenum, and upper intestine have no

contact with food

Adjustable Gastric Band (AGB)◦ Second most common weight loss surgery◦ A band restricts the opening from throat to stomach

creating a pouch

Types of Surgery

Biliopancreatic Diversion with a duodenal switch (BPD)◦ Accounts for >5% of all weight loss surgery◦ Removes large part of stomach◦ Reroutes food away from small intestine

Vertical Sleeve Gastrectomy◦ Not as common◦ Large portion of the stomach is removed

Types of Surgery

http://www.meditourcz.com/wp-content/uploads/2012/06/bariatric-surgeries.jpg

Surgery Type Mean EWL 1 Year EWL

5 Years EWL

10 Years EWL

AGB 50% 50% 50% N/A

RYGB 68% 64% 58% 52%

BPD 79% 71.8% 73.3% 77%

Excess Weight Loss by Surgery

 

Eligibility

Adults (18 and over) Children (Under 18)

BMI > 40 or >100 lbs overweight

BMI > 35 with 2 or more obesity-related comorbidities

Inability to lose weight over a period of time with weight loss efforts

BMI > 40 Adult height Serious obesity-

related health problems that will improve with surgery

Failure to lose weight after 6 months of effort

Modify diet 1-2 weeks prior to surgery Decrease fatty, sugary, and high

carbohydrate foods Avoid alcohol Increase protein Why?

◦ Improve surgical outcome/recovery time◦ Prepare for muscle and tissue repair

Pre-Surgery Diet

Post-Surgery Diet

At least 1-2 days post-surgery Sip 2-3 oz of fluid at a time

◦ Non-caffeinated◦ Non carbonated

No more that ½ cup total per meal

Phase One: Liquids

Plain/flavored water Broth Unsweetened juices

Sugar free gelatin Milk Strained cream soup

Day 3 to 4 weeks No more than ¾ cup total per meal Consistency of thick paste with no chunks

Phase Two: Pureed

Lean/soft meats Beans Yogurts

Fruits Soft vegetables Hot cereals

4-8 weeks Meals should be ¾ cup-1 cup total Foods that can be mashed with a fork

Phase Three: Soft Foods

Ground/finely diced meats

Canned/soft, fresh fruit

Cooked vegetables

8 weeks and beyond No more than 1 cup total per meal Meat should be no more than 2 oz

Avoid

Phase Four: Solid Foods

Popcorn Nuts Meats with gristle Granola

Soda Bread Stringy fruits/vegetables Dried fruits

Poor absorption can lead to vitamin and mineral deficiencies

Adult multivitamin Calcium citrate Vitamin B12 B-Complex Vitamin Vitamin D

Vitamin and Mineral Supplements

Strictures Hernias Dumping syndrome Constipation Nausea/vomiting Blocked opening of stomach pouch Weight gain or weight loss failure

Side Effects & Complications

Exercise Eat small meals Take recommended

supplements Eat and drink slowly Drink between meals

Lifestyle Changes

What are the benefits?

Resolves:Dyslipidemia

HypercholesterolemiaMetabolic SyndromeType 2 DiabetesGERDHypertension

Reduces the risk of cardiovascular disease by 82%

30-40% reduction in 10-year mortality

http://nutritioncaremanual.org/vault/editor/Docs/GastricSurgeryNutritionTherapy_FINAL.pdf

Pre-Operative◦ Educate patient on associated nutritional therapy◦ Perform nutrition assessment◦ Set dietary goals◦ Assist patient in preparing for transition diet after surgery

Post-Operative◦ Counseling during early transition post surgery and

periodically after◦ Minimize risk of nutritional deficiencies◦ Assist patient during transition diet◦ Address possible side effects (ex. Dumping syndrome)

What is the role of the RD?

 Pre-Surgery◦ Excessive oral intake  related to inability to limit

or refuse foods despite repeated attempts to modify eating habits as evidenced by large portions of calorically dense foods recorded in food diary.

Post-Surgery◦ Food and knowledge deficit related to lack of prior

exposure to information as evidenced by demonstrating an inability to apply food and nutrition-related information.

PES Statements

Nguyen, N.T, H Masoomi, C.P Magno, X.M.T Nguyen, K Laugenour, and J Lane. "Trends in Use of Bariatric Surgery, 2003-2008." Journal of the American College of Surgeons. 213.2 (2011): 261-266. Print.

Evidence-based Nutrition Practice Guideline on bariatric surgery published at http://andevidencelibrary.com/topic.cfm?cat=1406and copyrighted by the Academy of Nutrition and Dietetics.

http://www.dukehealth.org/services/weight_loss_surgery/care_guides/bariatric_surgery_diet_manual/the_recommended_diet_following_bariatric_surgery

http://www.mayoclinic.org/tests-procedures/bariatric-surgery/in-depth/gastric-bypass-diet/art-20048472

http://www.saintclares.org/assets/Uploads/Bariatrics_Images/SaintClaresPostBariatricSurgeryDietProgression.pdf

http://www.nationalbariatriclink.org/pre-bariatric-surgery-diet.html American Society for Metabolic & Bariatric Surgery http://www.asmbs.org National Institutes of Health: National Institute of Diabetes and Digestive and Kidney

Diseases http://win.niddk.nih.gov/publications/PDFs/Bariatric_Surgery_508.pdf Kulick, D, L Hark, and D Deen. "The Bariatric Surgery Patient: a Growing Role for

Registered Dietitians." Journal of the American Dietetic Association. 110.4 (2010): 593-9. Print.

http://gastro.oxfordjournals.org/content/early/2013/08/10/gastro.got023.full http://www.ncbi.nlm.nih.gov/pubmed/20496124 http://www.gastricsleeve.org/tag/vsg-complications/

References