Nutritional Management of the Bariatric Patient: Diets and Deficiencies

Abstract

Surgical treatment of obesity is associated with marked weight loss, resolution of weight-related comorbid conditions, and enhanced longevity. However, bariatric surgery has not been perfected and complications are unavoidable. Patients may gain back some or all of their weight or develop debilitating pain, bleeding, nausea, and vomiting. A new field of “bariatric endoscopy” has been developed to correct anatomical problems that are associated with these surgical complications. In addition, endoscopic procedures for primary treatment of obesity are being evaluated, which may obviate the need for bariatric surgery under some circumstances. Despite the enthusiasm for the endoscopic approach to revisional interventions and primary obesity treatment, it is clear that long-term patient success depends on many factors. This includes the appropriate nutrition evaluation and treatment of the patient both before and after endoscopic intervention.

This chapter focuses on the nutritional management of the bariatric patient with attention to nutritional management after traditional surgery and endoscopic weight loss procedures, and common nutritional deficiencies. Generally speaking, the principles that have been developed for nutritional management of the postsurgical bariatric patient are applicable to the post-endoscopic bariatric patient. Pre-procedure nutritional preparation is a key to success as well. Patients should understand that procedural intervention is just a start, and that durable weight loss depends on modifying current dietary habits. Lack of attention to nutritional issues can be associated with high rates of recidivism for weight regain, as well as symptoms of nausea, vomiting, macro- and micronutrient deficiencies, and dumping syndrome.