An Overview of Nutrition for Bariatric Surgery
Due to overall food restriction and/or malabsorption, protein status is a continual concern for all bariatric patients, but especially for the bariatric athlete. In order to preserve and maintain muscle mass, it is crucial to encourage a high-protein diet along with high-quality protein supplements to assist the bariatric athlete in meeting recommended protein needs.3
As with all athletes, hydration before, during, and after physical activity is necessary to prevent dehydration. Sweat and decreased pouch size can hinder bariatric athletes from consuming enough fluid and sodium to replace those lost in sweat during physical activity. To combat dehydration, RDNs should encourage bariatric athletes to choose foods high in both energy and water content, such as Greek yogurt with fruit. RDNs should also encourage patients to consume salty foods after intense exercise to replace sodium losses from sweat.
Bariatric athletes have increased nutrient requirements, and thus are at greater risk of developing deficiencies if adequate intake and vitamin/mineral supplementation are not ensured. Iron deficiency is especially common among bariatric female athletes of childbearing age. A multivitamin with iron or separate iron supplement, along with a high-iron diet, is recommended.
Before beginning to exercise postoperatively, it is necessary for the patient to receive medical clearance. Bariatric patients are instructed to conduct aerobic exercise for 150 minutes per week, with a long-term goal of 300 minutes per week.6,7 In order to help preserve muscle mass, they are also directed to add strength training 2 to 3 times per week.6,7
Bariatric patients are cautioned to avoid pregnancy during the first 18 months after undergoing their procedure. This time frame allows the patient to reach weight loss goals and for their weight to become stabilized. At 18 months post-procedure, regular textures are now tolerable, and patients are able to adhere to their vitamin/mineral schedule, resulting in nutrition-related laboratory values within normal ranges.
The pregnant bariatric patient requires their laboratory values to be reviewed every trimester for possible nutrient depletions, as this patient population is at increased risk of nutrient deficiency. It is often advised that pregnant bariatric patients continue using bariatric specific vitamins rather than an over-the-counter prenatal vitamin. This recommendation is due to the maximal absorption and increased potency of bariatric-specific products sourced from reputable companies.
One of the most challenging patient populations to monitor following bariatric surgery are those receiving hemodialysis. To avoid nephrotoxicity, the bariatric dietitian and renal team must collaborate in order to ensure the patient’s nutritional needs are met. Their daily vitamin and mineral schedule must be altered from the standard bariatric regimen secondary to the danger of renal overload of fat-soluble vitamins and magnesium, as well as the loss of water-soluble vitamins during hemodialysis. As with all hemodialysis patients, their sodium, potassium, and phosphorus levels must be closely monitored. Nutritional recommendations for these patients do not follow the standard guidelines created by ASMBS, but are based on the individual patient’s laboratory values. Supplement titrations are to be referred to their nephrologist and renal dietitian.
As RDNs, our goal is to assist patients in leading healthier lives through improved dietary techniques and lifestyle changes. Bariatric surgery can be a beneficial tool to aid patients in achieving their weight loss goals and improving their overall health. However, this life-altering surgery is multifaceted, and the most challenging work must be completed by patients themselves. Key points for the bariatric dietitian to enforce with patients include monitoring micronutrient deficiencies, emphasizing portion control, and meeting protein and fluid requirements.
It is essential for bariatric dietitians to educate patients on the specifics of pre- and post-bariatric surgery nutritional guidelines. Even above the indispensable piece of nutrition education, a dietitian must exemplify empathy, encouragement, and emotional support throughout the rigorous bariatric surgery journey.
- Mechanick JI, Youdim A, Jones DB, 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. Endocr Pract. 2013;19(2):337-72. doi: 10.4158/EP12437.GL.
- Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008 ;4(5 Suppl):S73-108. doi: 10.1016/j.soard.2008.03.002.
- Raftopoulos I, Bernstein B, O'Hara K, Ruby JA, Chhatrala R, Carty J. Protein intake compliance of morbidly obese patients undergoing bariatric surgery and its effect on weight loss and biochemical parameters. Surg Obes Relat Dis. 2011; 7(6): 733-742. doi:10.1016/j.soard.2011.07.008
- Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013; 9.S159-191. doi:10.1002/oby.20461.
- Thibault R, Huber O, Azagury DE, Pichard C. Twelve key nutritional issues in bariatric surgery. Clin Nutr. 2016;35(1):12-7. doi:10.1016/j.clnu.2015.02.012.
- Sherf Dagan S, Goldenshluger A, Globus I, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Advances Nutr. 2017;8(2): 382-394. doi:10.3945/an.116.014258.
- Adapted from U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008. Available at: http://www.health.gov/paguidelines. Accessed August 6, 2015.