Obesity Surgery

, Volume 20, Issue 12, pp 1654–1659 | Cite as

Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient

  • Mitsi H. LizerEmail author
  • Heather Papageorgeon
  • Troy M. Glembot
Clinical Report


The purpose of this study was to describe vitamin and nutrient supplement practices and assess medication dosage formulations utilized in patients hospitalized with a history of bariatric surgery. Retrospective pilot study was conducted from January 1, 2006 through December 31, 2007 in patients with a past history of bariatric surgery. Demographic data, vitamin and nutrient supplements, and medication dosage formulations were evaluated upon admission. This was compared to published guidelines. Compliance with the following supplementation was categorized: daily multivitamin, calcium, iron, vitamin B-12, and folic acid. The frequency of non-immediate-release and enteric-coated medication dosage forms was also examined. Discrepancies were identified as lack of one of the supplements or if an inappropriate dosage formulation was ordered. Of 133 admissions, 117 (88%) had a history of a malabsorptive procedure and at least one discrepancy was found. Only 33.3% of admissions were ordered a multivitamin, 5.1% were ordered supplemental vitamin B-12, and 7.7% received a calcium supplement. Additional folic acid was ordered in 11.1% and iron ordered in 12.0%. Inappropriate medication formulations were ordered in 61.5% of patients; 34.7% included non-immediate-release formulations, 25.0% enteric-coated formulations, and 40.3% both non-immediate-release and enteric-coated. Upon discharge from the institution, 50% had inappropriate formulations continued. Patients with a history of bariatric surgery may not have their vitamin and nutrient needs met upon hospitalization. Prior bariatric surgery is not consistently taken into consideration when ordering medications. Healthcare providers need to be cognizant of vitamin regimens to recommend as well as medication dosage formulations to avoid.


Bariatric surgery Dosage formulations Dosage forms Vitamin replacement Nutrient replacement Roux-en-Y 


  1. 1.
    Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMedGoogle Scholar
  3. 3.
    American Gastroenterological Association Clinical Practice Committee. AGA technical review on obesity. Gastroenterology. 2002;123:882–932.CrossRefGoogle Scholar
  4. 4.
    Steinbrook R. Surgery for severe obesity. NEJM. 2004;350:1075–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surgery for Obesity and Related Diseases. 2008;4:S109–84. doi: 10.1016/j.soard.2008.08.009.CrossRefPubMedGoogle Scholar
  6. 6.
    Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17:1150–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal complications of bariatric surgery. Nutr Clin Pract. 2007;22:29–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Malone M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmacother. 2008;42:1851–8. doi: 10.1345/aph.1L321.CrossRefPubMedGoogle Scholar
  9. 9.
    Fussy SA. The skinny on gastric bypass what pharmacists need to know. US Pharm. 2005;2:HS3–HS12.Google Scholar
  10. 10.
    Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J Health-Syst Pharm. 2006;63:1852–7.CrossRefPubMedGoogle Scholar
  11. 11.
    O’Brien PE, Brown WA, Dixon JB. Obesity, weight loss and bariatric surgery. Med J Aust. 2005;183:310–4.PubMedGoogle Scholar
  12. 12.
    Alvarez-Leite J. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7:569–75.CrossRefPubMedGoogle Scholar
  13. 13.
    Malone M, Alger SA. Medication use patterns after gastric bypass surgery for weight management. Ann Pharmacother. 2005;39:637–42. doi: 10.1345/aph.1E393.CrossRefPubMedGoogle Scholar
  14. 14.
    Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with super obesity. J Gastrointest Surg. 2002;6:195–203.CrossRefPubMedGoogle Scholar
  15. 15.
    Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93. doi: 10.1007/s11695-007-9310-0.CrossRefPubMedGoogle Scholar
  16. 16.
    Malone M. Altered drug disposition in obesity and after bariatric surgery. Nutr Clin Prac. 2003;18:131–5.CrossRefGoogle Scholar
  17. 17.
    Motylev A. The operating room pharmacist and bariatric surgery. US Pharm. 2008;33(12):HS19–27.Google Scholar
  18. 18.
    Seaman JS, Bowers SP, Dixon P, et al. Dissolution of common psychiatric medications in a Roux-en-Y gastric bypass model. Psychosomatics. 2005;46:250–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Mitsi H. Lizer
    • 1
    Email author
  • Heather Papageorgeon
    • 1
  • Troy M. Glembot
    • 2
  1. 1.Shenandoah University School of PharmacyWinchesterUSA
  2. 2.Winchester Bariatric ProgramWinchesterUSA

Personalised recommendations