Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice

Abstract

Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients’ medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.

Nutritional status prior to bariatric surgery for severe obesity: a review

“…Regardless of the type of planned surgery, all BS candidates should be submitted to a comprehensive nutritional, medical and health-related behavior assessment prior to surgery, followed by suitable counseling and intervention. Patients planning to undergo BS must be also provided with appropriate knowledge about the surgical treatment for weight loss [31,32]. Preoperative screening of baseline nutritional deficiencies should be performed (Table I) [33] and adequate nutritional supplementation, based on micronutrient laboratory tests results, should be recommended [16].…”

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

“…Even then, nutritional counselling is safe, requires minimal resources, helps to create a rapport with the bariatric team and prepares the patient for necessary lifestyle modifications required around and after the surgery. It is an important adjunct to comprehensive bariatric care and is recommended by most guidelines[ 33 , 136 , 200 ].…”

“…Estimation of serum vitamin B12 and folate levels are recommended before surgery[ 33 , 223 ]. Low vitamin B12 should be treated by parenteral administration in megaloblastic anemia, neuropathy, or in presence of other deficiency symptoms[ 33 , 200 , 223 - 225 ]. A systemic review by Smelt et al [ 226 ] suggested that daily oral administration of 350 μg of vitamin B12 corrects low levels in most cases.…”

“…The authors inferred that the likelihood of achieving 5% weight loss was highest with a three week 700-1050 kcal diet, comprising of moderate carbohydrate, high protein and low or moderate fat. Though both LCD and VLCD cause preoperative weight loss the utility of such a strategy in improving perioperative outcome has not been validated[ 200 ]. The recommendation for preoperative weight loss to reduce liver size in order to improve the technical aspects of surgery was downgraded due to inconsistent evidence in the AACE/TOS/ASMBS/OMA/ASA guidelines published in 2019[ 33 ].…”

Nutritional Interventions for Patients with Severe Obesity Seeking Bariatric Surgery

“…Suboptimal postoperative weight results are often attributed to a return to maladaptive lifestyle behaviors, poor adherence to the postoperative diet, inadequate follow-up support with the dietitian, or low patient knowledge, rather than surgical or metabolic reasons [ 5 , 6 , 7 ]. Therefore, pre- and postoperative nutritional intervention programs should be studied, and, if successful, be implemented into clinical practice [ 8 , 9 ].…”