Behavioral Interventions After Bariatric Surgery.

Purpose of Review: Bariatric surgery is the most effective and durable treatment for severe obesity. Postoperative behavioral weight management approaches are available for optimizing weight change for both short- and long-term outcomes. Recent Findings: Varying settings such as groups and telemedicine along with techniques such as cognitive behavioral therapy have been assessed in the post-bariatric surgery population. The assessment and application of these programs have been limited due to methodological, financial, and attrition-related constraints. Summary: This review aims to summarize the current evidence for different postoperative behavioral interventions on postoperative outcomes, specifically highlighting weight loss. Future opportunities for study include mechanisms for overcoming some of the barriers to implementing these programs in clinical, non-research settings.

Comparison of Bariatric Branded Chewable Multivitamin/Multimineral Formulations to the 2016 American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines.

Postoperative vitamin and mineral supplementation are integral components of the management of the weight loss surgery patient. Supplements differ in type, amount, and salt form. No recent publication has compared bariatric branded commercially available products with current practice guidelines. Registered dietitians belonging to the New England Bariatric Dietitians LinkedIn group were surveyed to identify their recommendation practices. These results were then used to compare and discuss in a comprehensive fashion the most widely recommended bariatric branded chewable supplements to the 2016 American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines.

Weight Loss Prior to Bariatric Surgery and 30-Day Mortality, Readmission, Reoperation, and Intervention: an MBSAQIP Analysis of 349,016 Cases.

INTRODUCTION: Despite preoperative weight loss being a common prerequisite to metabolic and bariatric surgery, its relationship to 30-day postoperative outcomes is unclear. The aim of this study was to assess whether preoperative weight loss is associated with 30-day postoperative quality outcomes in adults undergoing metabolic and bariatric surgery. METHODS: Retrospective cohort study assessing adults who underwent Roux-en-Y gastric bypass or sleeve gastrectomy in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use File, years 2015-2017. The relationship between preoperative weight loss and 30-day readmission, reoperation, mortality, intervention, and morbidity was assessed using multivariable logistic regression. RESULTS: Preoperative weight loss, body mass index loss, and percent weight loss were not associated with 30-day postoperative overall readmission, reoperation, mortality, or intervention (p > 0.01). Preoperative percent weight loss was associated with increased incidence of superficial surgical site infections (OR = 1.023, 95% CI 1.009-1.036; p = 0.001) and urinary tract infections (OR = 1.044, 95% CI 1.030-1.059; p < 0.001). CONCLUSION: Weight loss prior to metabolic and bariatric surgery may not be necessary or safe for all patients. Unsafe weight loss prior to surgery may compromise nutrition status and lead to increased infection rates.

American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients.

BACKGROUND: Optimizing postoperative patient outcomes and nutritional status begins preoperatively. Patients should be educated before and after weight loss surgery (WLS) on the expected nutrient deficiencies associated with alterations in physiology. Although surgery can exacerbate preexisting nutrient deficiencies, preoperative screening for vitamin deficiencies has not been the norm in the majority of WLS practices. Screening is important because it is common for patients who present for WLS to have at least 1 vitamin or mineral deficiency preoperatively. OBJECTIVES: The focus of this paper is to update the 2008 American Society for Metabolic and Bariatric Surgery Nutrition in Bariatric Surgery Guidelines with key micronutrient research in laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, biliopancreatic diversion, and biliopancreatic diversion/duodenal switch. METHODS: Four questions regarding recommendations for preoperative and postoperative screening of nutrient deficiencies, preventative supplementation, and repletion of nutrient deficiencies in pre-WLS patients have been applied to specific micronutrients (vitamins B1 and B12; folate; iron; vitamins A, E, and K; calcium; vitamin D; copper; and zinc). RESULTS: Out of the 554 articles identified as meeting preliminary search criteria, 402 were reviewed in detail. There are 92 recommendations in this update, 79 new recommendations and an additional 13 that have not changed since 2008. Each recommendation has a corresponding graded level of evidence, from grade A through D. CONCLUSIONS: Data continue to suggest that the prevalence of micronutrient deficiencies is increasing, while monitoring of patients at follow-up is decreasing. This document should be viewed as a guideline for a reasonable approach to patient nutritional care based on the most recent research, scientific evidence, resources, and information available. It is the responsibility of the registered dietitian nutritionist and WLS program to determine individual variations as they relate to patient nutritional care.

Impact of Spanish-language information sessions on Spanish-speaking patients seeking bariatric surgery.

BACKGROUND: Bariatric centers frequently provide preoperative educational programs to inform patients about the risks and benefits of weight loss surgery. However, most programs are conducted in English, which may create barriers to effective treatment and access to care for non-English speaking populations. To address this concern, we instituted a comprehensive Spanish-language education program consisting of preoperative information and group nutrition classes conducted entirely in, and supported with Spanish-language materials. OBJECTIVES: The primary aim was to examine the effect of this intervention on Spanish-speaking patients' decision to undergo surgery in a pilot study. SETTING: University Hospital/Community Health Center, United States. METHODS: Three cohorts of patients seeking bariatric surgery between January 1, 2011 and March 31, 2012 were identified: 1) primary English speakers attending English-language programs ("English-English"); 2) primary Spanish speakers attending Spanish-language programs ("Spanish-Spanish"); and 3) primary Spanish speakers attending English-speaking programs with the assistance of a Spanish-to-English translator ("Spanish-English"). RESULTS: 26% of the English-English cohort ultimately underwent surgery compared with only 12% of the Spanish-Spanish cohort (P = .009). Compared with the English-English group, time to surgery was 35 days longer for the Spanish-Spanish and 185 days longer for the Spanish-English group (both P< .001). CONCLUSION: Spanish-speaking patients were less likely to undergo bariatric surgery regardless of the language in which educational sessions are provided. For those choosing surgery, providing Spanish-language sessions can shorten time to surgery. A barrier to effective obesity treatment may exist for Spanish speakers, which may be only partially overcome by providing support in Spanish.

Nutrition and metabolic support recommendations for the bariatric patient.

Managing the metabolic needs of the patient with obesity is a challenge unto itself without the added demands of accounting for an altered gastrointestinal tract. Nevertheless, with about 200,000 bariatric procedures being performed annually in the United States, clinicians must be prepared to manage the critically ill bariatric surgery patient. This article reviews the recent literature relating to nutrient needs and metabolic support for the bariatric patient. Bariatric patients are at risk for several micronutrient deficiencies, including vitamins D and B12, calcium, and iron; some bariatric procedures affect macronutrient needs as well. Literature on nutrition support guidelines for the bariatric population is limited. However, with an understanding of the anatomical and physiological effects of bariatric surgery, recent guidelines for critically ill patients with obesity can be applied to the bariatric surgery population. The unique needs of the bariatric population, such as susceptibility to micronutrient deficiencies and specialized access routes, must be considered to provide safe and efficacious nutrition support. Further research is necessary to develop specific nutrition support recommendations for the bariatric population.