Nutritional Management in Bariatric Surgery Patients

Abstract

The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon’s work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.

Neurohormonal Changes in the Gut–Brain Axis and Underlying Neuroendocrine Mechanisms following Bariatric Surgery

“…In addition, the use of probiotic supplementation after BS has shown a beneficial modulation in the gut microbiome profile, a promotion of the absorption of micronutrients and an improvement in inflammatory markers; however, these changes seem to be transient [ 410 , 414 ]. Gut microbiome composition is important for the metabolic benefits observed after BS, and maintaining a healthy nutritional status is vital after BS, as it has been found that microbiome abundance is decreased in nutrient deficiency often caused by BS [ 415 ]. Recently, Quilliot et al highlighted the best practice for nutritional care and the need for adequate vitamins (such as D and B12) and mineral supplementation after BS [ 416 ].…”

Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: A controlled clinical study

“…Regarding dietary habits and eating behaviour, an improvement in most of the investigated food aspects was observed, especially for the Gastroplasty group. The benefits of dietary advice and pre‐operative weight loss include the education in postoperative dietary restrictions, the reduction of perioperative morbidity and the reduction of liver size and operating room time 34,35 . As the most frequent cause of failure in gastroplasty surgery is due to unhealthy eating behaviour and the compulsion for palatable foods that might be present before the surgery, 36 it is important to assess and identify the different eating behaviours and continue to encourage change in eating habits.…”

“…The benefits of dietary advice and preoperative weight loss include the education in postoperative dietary restrictions, the reduction of perioperative morbidity and the reduction of liver size and operating room time. 34,35 As the most frequent cause of failure in gastroplasty surgery is due to unhealthy eating behaviour and the compulsion for palatable foods that might be present before the surgery, 36 it is important to assess and identify the different eating behaviours and continue to encourage change in eating habits. Additionally, the use of distractors (television, computer or cell phone) during meals decreased in both groups, which is also a positive aspect since this habits influence the amount of calories consumed.…”

Weight Maintenance after Dietary Weight Loss: Systematic Review and Meta-Analysis on the Effectiveness of Behavioural Intensive Intervention

“…There are several studies on weight-maintenance strategies after weight loss [ 33 ], and a recent narrative review provided an overview of the most commonly used [ 34 ], such as (1) a low-caloric and low-fat diet [ 33 ] even if the macronutrients composition does not seem to influence the outcomes [ 35 ]; (2) physical activity, which, coupled with dietary intervention, gives better results than diet alone [ 36 ] but, unfortunately, does not find good long-term adherence [ 37 ]; (3) the use of drugs (orlistat, liraglutide, naltrexone/bupropion, and phentermine/topiramate), which can supplement lifestyle intervention in patients with a BMI > 30 kg/m 2 or >27 kg/m 2 with comorbidities [ 38 ]; and (4) bariatric surgery, which is currently considered the most effective therapy for long-term weight loss and for reducing comorbidities and mortality due to severe and complicated obesity but requires a careful nutritional surveillance to prevent and correct the frequent nutritional deficiencies [ 39 ]. Among other strategies, the following should be mentioned: acupuncture, acting on the mechanisms of appetite, if only in assisting other treatments [ 40 ]; continuous contact between the patient and health professionals, [ 41 ] and sharing with a group, including on social networks [ 41 ].…”