Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Abstract

Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

“…Although we included previously published guidelines in our literature review, we graded those recommendations as being expert opinion unless we had reviewed the original articles cited by the authors. Just prior to submission, “Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures ‐ 2019 update were published so were included.” 4 …”

“…Detailed preoperative care recommendations are listed in Table 2. A specialist dietitian, skilled in bariatric nutrition, should undertake a detailed dietary and nutritional assessment 1–5,13,51 . Essential preoperative blood tests include screening for nutritional deficiencies, diabetes, dyslipidaemia and renal function 2–4,9,10,12–14,52–54 .…”

“…Bariatric surgery is recognized as the most clinically and cost‐effective treatment option for people with severe and complex obesity 1 . All bariatric surgery procedures impact on nutrition to varying degrees and can potentially cause clinically significant deficiencies of micronutrients 2–4 …”

“…This is an update and review of those guidelines. Since the 2014 guidelines, a number of other nutritional guidelines for the care of people who undergo bariatric surgery have been published 3,4,7–11 . However, not all have been specifically related to micronutrition, had dietetic involvement and included either primary care or patient representatives.…”

Patient adherence to multivitamin supplementation after bariatric surgery: a narrative review

“…Multivitamin supplements (MVSs) are routinely recommended lifelong to prevent vitamin deficiencies (4,(6)(7)(8)(9)(10) . However, vitamin deficiencies are quite common after bariatric surgery despite the use of MVS, which can lead to serious long-term complications (3,(11)(12)(13) .…”