Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: ) presurgery nutritional evaluation and presurgery diet and supplementation;) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and ) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.
This work was supported by grant no. 3-000-8480 from the Israel Ministry of Health Chief Scientist, the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson.
Bariatric surgery, resulting in significant weight reduction, was associated with a significant decrease in low back and radicular pain as well as a marked increase in the L4-L5 intervertebral disc height. Reduction in body weight after bariatric surgery in morbidly obese patients is associated with a significant radiographical increase in the L4-L5 disc space height as well as a significant clinical improvement in axial back and radicular leg pain.
Many bariatric operations are associated with reduced food tolerance and frequent vomiting, which may cause nutritional deficiencies and influence quality of life. However, the impact of different bariatric procedures on quality of eating and food tolerance has not yet been studied enough. Two hundred and eighteen participants filled a quality of eating questionnaire, at three different time periods after bariatric operation: short-term (3-6 months, n = 63), medium-term (6-12 months, n = 69) and long-term follow-up (over 12 months, n = 86). The participants underwent the following procedures: 99 patients have had Roux-en-Y gastric bypass (RYGB), 49 laparoscopic gastric banding (LAGB), 56 sleeve gastrectomy (SG), and 14 biliopancreatic diversion with duodenal switch (BPD-DS). At short-term period score achieved for all section of the questionnaire was similar for all operations. The total score of the questionnaire at the medium-term group was 20.27 ± 3.57, 14.47 ± 5.92, 22.27 ± 4.66, and 20.91 ± 3.26 (p < 0.001) and the total score for the long-term group of was 21.56 ± 5.16, 15.5 ± 3.75, 20.45 ± 4.9, and 24.2 ± 2.16 (p < 0.001) for RYGB, LAGB, SG, and BPD-DS, respectively. In a linear regression model we found that LAGB patients had a significantly lower total score compared to all other procedures (p < 0.001). Every 1% of %EWL was associated with a total score decrease in 0.045 points (p = 0.009). Impaired quality of eating and food intolerance is common following many types of bariatric procedures. However, the difficulties diminish as time passes after operation and can be affected by the type of procedure. Patients undergoing LAGB have significantly greater limitations and difficulties to ingest variety of foods.
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