[6 min read] Medical nutrition therapy after bariatric surgery

Bariatric surgery is life-changing treatment for people with morbid obesity and its associated metabolic conditions. To ensure successful recovery and long-term weight loss, patients must be prepared to implement significant lifestyle changes such as adopting a new healthful eating plan, eating habits, and increasing physical activity (1).

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Having the knowledge of appropriate eating guidelines and familiarity with common nutrition-related problems will help primary care physicians to better counsel their patients, while coordinated multidisciplinary team care maximises the benefits and health outcomes for patients during life after surgery (2).

Texture progression

Immediately after bariatric surgery, a patient’s diet progresses in stages beginning with clear liquids, to pureed/blended foods, and then back onto solids (3). The length of each phase depends on the type of surgery performed and any side effects experienced by the patient, such as food intolerances, acid reflux, and nausea. Unsurprisingly, it is difficult for patients to maintain an adequate nutrient and fluid intake in the early stages after surgery, and it is recommended that patients use nutrient supplements and high-protein supplement drinks or powders to patients during this period. By following a staged approach, patients may be eased back into eating solid foods with minimal complications (4).

Eating and lifestyle

Bariatric surgery should be viewed as a tool that works best in conjunction with healthful diet and lifestyle changes to facilitate sustainable weight loss and improved health. Examples of eating behaviours that physicians should encourage include:

  • Eat small meals, more frequently: patients need to eat frequently throughout the day to meet their nutritional needs. For example, they may eat between four and six meals instead of three large ones.
  • Separate food and fluid intake: due to limited stomach capacity, drinking while eating may overfill the stomach and cause discomfort and sometimes vomiting, Patients should avoid drinking anything 15-30 minutes around a meal.
  • Eat slowly: encourage patients to chew their food well, have rest breaks in between swallows and eliminate distractions such as television at meal times.

Vitamin and mineral supplementation

Some procedures, like gastric bypass or sleeve gastrectomy, changes the way the body absorbs nutrients. Patients will therefore need to be on vitamin and mineral supplements for life to reduce the risk of nutritional deficiencies (5, 6). These typically include a multivitamin, vitamin B12, calcium, vitamin D, and iron. It is also vital that patients have regular blood tests so that nutritional deficiencies can be detected and treated promptly.

Lynette Law, Accredited Practising Dietitian

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References

  1. Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, et al. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr. 2017;8(2):382-94.
  2. Shannon C, Gervasoni A, Williams T. The bariatric surgery patient Nutrition considerations. Australian Family Physician. 2013;42:547-52.
  3. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1(0 1):S1-27.
  4. Bettini S, Belligoli A, Fabris R, Busetto L. Diet approach before and after bariatric surgery. Rev Endocr Metab Disord. 2020;21(3):297-306.
  5. Ha J, Kwon Y, Kwon J-W, Kim D, Park S-H, Hwang J, et al. Micronutrient status in bariatric surgery patients receiving postoperative supplementation per guidelines: Insights from a systematic review and meta-analysis of longitudinal studies. Obesity Reviews. 2021;22(7):e13249.
  6. Malone M. Recommended Nutritional Supplements for Bariatric Surgery Patients. The Annals of pharmacotherapy. 2008;42:1851-8.

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