Transcript Bariatric Surgery

Carly Pabon
NTR 573
Spring 2014
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The different types of bariatric surgery, their
prevalence, and effectiveness.
Qualifications for bariatric surgery.
Recommended diets prior to and following
surgery.
Role of a Registered Dietitian throughout
process.
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Bariatric Surgery
◦ Category of weight loss surgeries
◦ Change your stomach and digestive system by
limiting how much food you eat and the nutrients
you can absorb.
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Most effective and long lasting treatment for
morbid obesity and related conditions,
resulting in significant weight loss.
Over 200,000 people have bariatric surgery
each year in the United States.
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Roux-en-Y Gastric Bypass (RYGB)
◦ Comprises 80% of all weight loss surgery in U.S.
◦ Decreases how food is absorbed
◦ Stomach, duodenum, and upper intestine have no
contact with food
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Adjustable Gastric Band (AGB)
◦ Second most common weight loss surgery
◦ A band restricts the opening from throat to stomach
creating a pouch
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Biliopancreatic Diversion with a duodenal
switch (BPD)
◦ Accounts for >5% of all weight loss surgery
◦ Removes large part of stomach
◦ Reroutes food away from small intestine
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Vertical Sleeve Gastrectomy
◦ Not as common
◦ Large portion of the stomach is removed
http://www.meditourcz.com/wp-content/uploads/2012/06/bariatric-surgeries.jpg
Surgery Type
Mean EWL
1 Year
EWL
5 Years
EWL
10 Years
EWL
AGB
50%
50%
50%
N/A
RYGB
68%
64%
58%
52%
BPD
79%
71.8%
73.3%
77%
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BMI > 40 or >100 lbs
overweight
BMI > 35 with 2 or
more obesity-related
comorbidities
Inability to lose weight
over a period of time
with weight loss efforts
Adults (18 and over)
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BMI > 40
Adult height
Serious obesity-related
health problems that
will improve with
surgery
Failure to lose weight
after 6 months of
effort
Children (Under 18)
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Modify diet 1-2 weeks prior to surgery
Decrease fatty, sugary, and high
carbohydrate foods
Avoid alcohol
Increase protein
Why?
◦ Improve surgical outcome/recovery time
◦ Prepare for muscle and tissue repair
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At least 1-2 days post-surgery
Sip 2-3 oz of fluid at a time
◦ Non-caffeinated
◦ Non carbonated
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No more that ½ cup total
per meal
Plain/flavored water
Broth
Unsweetened juices
Sugar free gelatin
Milk
Strained cream soup
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Day 3 to 4 weeks
No more than ¾ cup total per meal
Consistency of thick paste with no chunks
Lean/soft meats
Fruits
Beans
Yogurts
Soft vegetables Hot cereals
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4-8 weeks
Meals should be ¾ cup-1 cup total
Foods that can be mashed with a fork
Ground/finely diced
meats
Canned/soft, fresh
fruit
Cooked vegetables
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8 weeks and beyond
No more than 1 cup total per meal
Meat should be no more than 2 oz
Avoid
Popcorn
Nuts
Meats with gristle
Granola
Soda
Bread
Stringy
fruits/vegetables
Dried fruits
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Poor absorption can lead to vitamin and
mineral deficiencies
Adult multivitamin
Calcium citrate
Vitamin B12
B-Complex Vitamin
Vitamin D
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Strictures
Hernias
Dumping syndrome
Constipation
Nausea/vomiting
Blocked opening of stomach pouch
Weight gain or weight loss failure
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Exercise
Eat small meals
Take recommended
supplements
Eat and drink slowly
Drink between meals
What are the
benefits?
Resolves:
Dyslipidemia
Hypercholesterolemia
Metabolic Syndrome
Type 2 Diabetes
GERD
Hypertension
Reduces the risk of
cardiovascular disease by
82%
30-40% reduction in 10-year
mortality
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http://nutritioncaremanual.org/vault/editor/Docs/GastricSurger
yNutritionTherapy_FINAL.pdf
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Pre-Operative
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Post-Operative
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Educate patient on associated nutritional therapy
Perform nutrition assessment
Set dietary goals
Assist patient in preparing for transition diet after
surgery
◦ Counseling during early transition post surgery and
periodically after
◦ Minimize risk of nutritional deficiencies
◦ Assist patient during transition diet
◦ Address possible side effects (ex. Dumping syndrome)
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Pre-Surgery
◦ Excessive oral intake related to inability to limit or
refuse foods despite repeated attempts to modify
eating habits as evidenced by large portions of
calorically dense foods recorded in food diary.
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Post-Surgery
◦ Food and knowledge deficit related to lack of prior
exposure to information as evidenced by
demonstrating an inability to apply food and
nutrition-related information.
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Nguyen, N.T, H Masoomi, C.P Magno, X.M.T Nguyen, K Laugenour, and J Lane.
"Trends in Use of Bariatric Surgery, 2003-2008." Journal of the American College of
Surgeons. 213.2 (2011): 261-266. Print.
Evidence-based Nutrition Practice Guideline on bariatric surgery published at
http://andevidencelibrary.com/topic.cfm?cat=1406and copyrighted by the
Academy of Nutrition and Dietetics.
http://www.dukehealth.org/services/weight_loss_surgery/care_guides/bariatr
ic_surgery_diet_manual/the_recommended_diet_following_bariatric_surgery
http://www.mayoclinic.org/tests-procedures/bariatric-surgery/indepth/gastric-bypass-diet/art-20048472
http://www.saintclares.org/assets/Uploads/Bariatrics_Images/SaintClaresPostBaria
tricSurgeryDietProgression.pdf
http://www.nationalbariatriclink.org/pre-bariatric-surgery-diet.html
American Society for Metabolic & Bariatric Surgery http://www.asmbs.org
National Institutes of Health: National Institute of Diabetes and Digestive and
Kidney Diseases
http://win.niddk.nih.gov/publications/PDFs/Bariatric_Surgery_508.pdf
Kulick, D, L Hark, and D Deen. "The Bariatric Surgery Patient: a Growing Role for
Registered Dietitians." Journal of the American Dietetic Association. 110.4 (2010):
593-9. Print.
http://gastro.oxfordjournals.org/content/early/2013/08/10/gastro.got023.full
http://www.ncbi.nlm.nih.gov/pubmed/20496124
http://www.gastricsleeve.org/tag/vsg-complications/