Top Ten Things You Need to
Know About Bariatric Surgery
Patients
Laura Dyck, M.S., R.D., LDN
Comprehensive Weight Management
Center,
Kingsport, TN
Top Ten Things You Need to Know
About Bariatric Surgery Patients
1) Who qualifies?
2) Surgery options
3) Who benefits?
4) Who may NOT be
a good candidate?
5) How safe is the
surgery?
6) Where should I
refer candidates
for surgery?
7) Post-Op diet
8) Supplements/Lab
Monitoring
9) Post-Op exercise
10) Other potential
issues related to
bariatric surgery
1) Who Qualifies?


BMI of 35-39.9
with co-morbid
conditions OR >40
without co- morbid
conditions
Documented failed
attempts at weight
loss
Weight
Class
BMI
(kg/m2)
Normal
Weight
18.5-24.9
Overweight
25.0-29.9
Obesity
(Class I)
30.0-34.9
Obesity
(Class II)
Morbid
Obesity
(Class III)
35.039.9
>40.0
Who Qualifies?





Able to comprehend, and motivated
for, lifelong lifestyle changes
Committed to lifelong medical
monitoring
Willing to give up tobacco, NSAIDs
Age range (typical) ~18 - 65 years
Able to obtain psychological
clearance for surgery.
Who Qualifies?


Many insurances cover surgery
(Medicare and Medicaid do cover)Must complete insurance company
requirements (medical weight
management, weight loss
requirements, etc.)
PCP and/or FNP may provide
medical weight management
(designated number of consecutive
monthly appts., solely to discuss
diet, exercise and behavior change)
2) Common Surgical Options for
Weight Loss



Restrictive- Gastric banding & sleeve
gastrectomy (sleeve can be Part One
of 2 part procedure)
Malabsorptive- Biliopancreatic
diversion & biliopancreatic diversion
with duodenal switch
Combination- Roux-en-Y gastric
bypass
Common Surgical Options for Weight
Loss- Gastric Banding
Images Courtesy of Ethicon
Common Surgical Options for Weight
Loss- Sleeve Gastrectomy
Image Courtesy of Ethicon
Common Surgical Options for Weight
Loss- Gastric Bypass
Image Courtesy of Ethicon
Common Surgical Options for Weight
Loss- Comparison
Gastric
Banding
Sleeve
Gastrectomy
Gastric
Bypass
35-50 %
Weight Loss*
50-70 %
Weight Loss*
70-75 %
Weight Loss*
In 2-3 years
In 12 months
In 9-12 months
*%ages refer to “Excess
Weight” Lost
Common Surgical Options for Weight
Loss- Which is Best?

Depends on many individual
factors:





How much weight to lose?
Which is safest given body shape/size?
Compliance with dietary changes?
Work/family schedule?
Geographic location?
3) Who Benefits?
Obese patients with:
GBP1
Sleeve2
Band1
1) Diabetes
Resolved 83.7%
R- 56%
R- 47.8%
2) Hypertension
Resolved 67.5%
R- 49%
R- 43.2%
3) High Cholesterol
Improved 94.9%
R- 43%
I- 78.3%
4) Sleep Apnea
Resolved 80.4%
R- 60%
R 94.6%
Improvements/Resolution also seen with:
-GERD3
-Depression4
-Osteoarthritis/Joint Pain4
-Stress Urinary Incontinence4
-Menstrual dysfunction d/t PCOS5
-Ovulation and Fertility Restored5
-Quality of Life/Increased Activity1
4) Who may NOT be a Good
Candidate for Surgery?




Have other untreated medical
conditions that may have caused
obesity
Psychological or cognitive
limitations that jeopardize informed
consent and cooperation with long
term follow-up
Immobility
Medical issues that make surgery
too risky
Who may NOT be a Good Candidate
for Surgery?





Unwilling to give up tobacco &
NSAIDs
Hepatic cirrhosis with impaired liver
function
Active Drug/Alcohol Abuse
Not willing to/motivated to make
lifelong lifestyle changes
Patient is pregnant
5) How Safe is Surgery?
Bariatric surgery holds no more risk
than gallbladder or hip replacement
surgery- the risks of surgery are
lower than long term risks of living
with obesity (increasing risks of
dying due to heart disease,
diabetes, etc. daily)6
How Safe is Surgery?
Bariatric surgery is now endorsed
by the:




American Heart Association
American Diabetes Association
International Diabetes Federation
American Association of Clinical
Endocrinologists
Risks and Complications







Dumping Syndrome (a blessing & a
curse!)
Bleeding
Infections
Complications with anesthesia
Blood clots
Injury to stomach, esophagus,
surrounding organs
Leaks or blockages at site where tissue
has been sewn or stapled
6) Where should I refer candidates for
surgery?
Look for a:
Bariatric Surgery Center of
Excellence
Where should I refer candidates for
surgery?
The American Society for Metabolic
and Bariatric Surgery (ASMBS) +
the American College of Surgeons
(ACS)=
Metabolic and Bariatric Surgery
Accreditation and Quality
Improvement Program
(MBSAQIP)
Holding a Center of Excellence
Designation Means Centers Are:




Accountable for the quality and
safety of surgery in their center
Participating in ongoing data
collection/analysis
Going through a site
inspection/approval process every 3
years
Stressing safety, proficiency and
volume
Holding a Center of Excellence
Designation Means Centers Are:



Requiring a multidisciplinary team
for appropriate patient care
Hosting monthly support group
meetings for patients
Dedicated to long term follow-up
(Patients should be followed by
their bariatric surgeon for LIFE!)
QUIZ TIME!
Which foods will I need to avoid after
gastric bypass surgery?
a.
b.
c.
d.
Alcohol
Carbonated beverages
Sugar
All of the above
Which foods will I need to avoid after
gastric bypass surgery?
a.
b.
c.
d.
Alcohol
Carbonated beverages
Sugar
All of the above
After surgery I will need to:
a.
b.
c.
d.
Chew my food thoroughly
Take 30-60 minutes to eat a meal
Eat and drink at the same time
a&b
After surgery I will need to:
a.
b.
c.
d.
Chew my food thoroughly
Take 30-60 minutes to eat a meal
Eat and drink at the same time
a&b
Xylitol, Lactitol and Sorbitol found in
foods are classified as:
a.
b.
c.
d.
Sugar
Sugar Alcohols
Fat
Preservatives
Xylitol, Lactitol and Sorbitol found in
foods are classified as:
a.
b.
c.
d.
Sugar
Sugar Alcohols
Fat
Preservatives
Chewing gum is not allowed. If you do
chew it and swallow it you might have
which complication?
a.
b.
c.
d.
Ulcer formation
Headache
Diarrhea
Outlet obstruction of your gastric
pouch
Chewing gum is not allowed. If you do
chew it and swallow it you might have
which complication?
a.
b.
c.
d.
Ulcer formation
Headache
Diarrhea
Outlet obstruction of your
gastric pouch
Dumping Syndrome after gastric bypass
(and possibly sleeve gastrectomy) can occur
by eating foods high in:
a.
b.
c.
d.
Fat
Sugar
Sugar Alcohols
All of the above
Dumping Syndrome after gastric bypass
(and possibly sleeve gastrectomy) can occur
by eating foods high in:
a.
b.
c.
d.
Fat
Sugar
Sugar Alcohols
All of the above
7) Post-Op Diet



“Phases” are slowly progressed
through for ~8-12 weeks after
surgery
Diet for life is a low fat, sugar free,
balanced diet with smaller serving
sizes
60-75 grams of Protein/day
Post-Op Diet
 STOP
when full- otherwise, will lead to
N/V
 CHEW WELL- otherwise, will lead to
N/V
 Dumping Syndrome with high fat
and/or high sugar foods after Gastric
Bypass (and mild dumping is possible
after sleeve gastrectomy)
Post-Op Diet



Separate foods/fluids by at least 30
minutes
Fluid goals: 6-8 cups/day, SF, noncarbonated, caffeine free, noncaloric
Avoid Alcohol- ESPECIALLY GBP
patients
8) Post-Op Supplements/Lab
Monitoring

Sleeve Gastrectomy/Gastric Banding



MVI/Mineral Supplement daily
Calcium Citrate- 1200-1500 mg/day
Gastric Bypass




MVI/Mineral Supplement daily
Vitamin B12- 500 mcg/day sublingual or
1000mcg IM injection/month
Calcium Citrate- 1200-1500 mg/day
Iron (for menstruating women or if directed by
MD or FNP)- 200-325 mg of Ferrous Sulfate
daily
Post-Op Labs to Monitor/Check






CMP (electrolytes, albumin, etc.)
CBC
Serum B12 (especially with GBP)
Ferritin/Iron Profile
Lipid Panel
25-hydroxyvitamin D or ionized
Calcium
9) Post-Op Exercise
Is an absolute MUST!!!


Patients should gradually work up
to goal of 45 minutes- 1 hour of
exercise most days of the week.
Should have education preoperatively and resources, if needed
Post-Op Exercise


Support groups are great places to
build on exercise knowledge
Utilize community resources (parks,
rec centers, senior’s centers, gyms,
Med Fit Center, etc) and nationally
offered resources (National Institute
on Aging, Go4Life Exercise and
Physical Activity Books/DVD)
10) Other Potential Issues Related to
Bariatric Surgery







Ulcers/Reflux (Don’t smoke/Avoid
NSAIDs)
Incisional hernias (especially if open
procedure)
Loose skin
Hypoglycemia
Strictures
Addiction Transfer Syndrome
Weight Regain (~10% regain is normal)
References
1.
2.
3.
4.
5.
6.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric
surgery. A systematic review and meta-analysis. JAMA.
2004;292:1724-1737.
EES summary of data contained in review article:
Brethauer SA, Hammel JP, Schauer PR. Systematic review
of sleeve gastrectomy as staging and primary bariatric
procedure. Surg Obes Relat Dis. 2009;5:469-475.
Wittgrove A, Clark G. Laparoscopic gastric bypass, Rouxen-Y---500 patients: technique and results, with 3-60
month follow-up. Obes Surg. 2000;10(3):233-239.
Schauer P, Ikramuddin S, Gourash W, et al. Outcomes
after laparoscopic roux-en-Y gastric bypass for morbid
obesity. Ann Surg. 2000;232(4):515-529.
Eid GM, Cottam DR, Velcu LM, et al. Effective treatment of
polycystic ovarian syndrome with roux-en-Y gastric byapss.
Surg Obes Related Dis. 2005;2:77-80.
The Longitudinal Assessment of Bariatric Surgery (LABS)
Consortium. N Engl J Med. 2009;361:445-454.
QUESTIONS?