The Role of the Nutritionist in a Multidisciplinary Bariatric Surgery Team

  • Luigi SchiavoEmail author
  • Vincenzo Pilone
  • Gianluca Rossetti
  • Antonio Iannelli
Letter to the Editor

Bariatric surgery (BS) is the most effective long-term solution for the treatment and control of morbid obesity. However, the nutritional deficiencies and malnutrition associated with BS present major challenges for patients and clinicians. Herein, we use clinical experience and evidence-based recommendations to review the role of a nutritionist in a multidisciplinary bariatric team before surgery and in postoperative follow-up.

Although data is lacking from randomized controlled trials, large prospective studies or meta-analysis supporting mandated pre-BS weight loss, we recommend a preoperative diet to reduce body weight, liver volume, and intraabdominal fat; identify and correct micronutrients deficiencies (MD); transform the quality of diets and eating habits post-surgery [1].

Obese patients scheduled for BS often have an enlarged steatotic liver that may render the surgical procedure technically challenging, resulting in longer operative times, increased risk of intraoperative...


Compliance with Ethical Standards

Conflict of Interest Statement

The authors declare that they have no conflict of interest.

Statement of Informed Consent

This is a Letter to the Editor in which we do not directly involve human beings.

Statement of Human and Animal Rights

This is a Letter to the Editor in which we do not directly involve human beings or animals.


  1. 1.
    Schiavo L, Sans A, Scalera G, et al. Why preoperative weight loss in preparation for bariatric surgery is important. Obes Surg. 2016;26(11):2790–2.CrossRefGoogle Scholar
  2. 2.
    Iannelli A, Schneck AS, Hébuterne X, et al. Gastric pouch resizing for Roux-en-Y gastric bypass failure in patients with a dilated pouch. Surg Obes Relat Dis. 2013;9(2):260–7.CrossRefGoogle Scholar
  3. 3.
    Iannelli A, Martini F, Schneck AS, et al. Preoperative 4-week supplementation with omega-3 polyunsaturated fatty acids reduces liver volume and facilitates bariatric surgery in morbidly obese patients. Obes Surg. 2013;23(11):1761–5.CrossRefGoogle Scholar
  4. 4.
    Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304–11.CrossRefGoogle Scholar
  5. 5.
    Lewis MC, Phillips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast very low-calorie diet. Obes Surg. 2006;16(6):697–701.CrossRefGoogle Scholar
  6. 6.
    Kim JJ, Rogers AM, Ballem N, et al. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis. 2016;12(5):955–9.CrossRefGoogle Scholar
  7. 7.
    Schiavo L, Pilone V, Rossetti G, et al. A 4-week preoperative ketogenic micronutrient-enriched diet is effective in reducing body weight, left hepatic lobe volume, and micronutrient deficiencies in patients undergoing bariatric surgery: a prospective pilot study. Obes Surg. 2018;28(8):2215–24.CrossRefGoogle Scholar
  8. 8.
    Albanese A, Prevedello L, Markovich M, et al. Pre-operative very low-calorie ketogenic diet (VLCKD) vs. very low-calorie diet (VLCD): surgical impact. Obes Surg. 2018;
  9. 9.
    Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.CrossRefGoogle Scholar
  10. 10.
    Schiavo L, Scalera G, Pilone V, et al. Micronutrient deficiencies in patients candidate for bariatric surgery: a prospective, preoperative trial of screening, diagnosis, and treatment. Int J Vitam Nutr Res. 2015;85(5–6):340–7.CrossRefGoogle Scholar
  11. 11.
    Ben-Porat T, Elazary R, Yuval JB, et al. Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively? Surg Obes Relat Dis. 2015;11(5):1029–36.CrossRefGoogle Scholar
  12. 12.
    Schiavo L, Scalera G, Pilone V, et al. A comparative study examining the impact of a protein-enriched vs normal protein postoperative diet on body composition and resting metabolic rate in obese patients after sleeve gastrectomy. Obes Surg. 2017;27(4):881–8.CrossRefGoogle Scholar
  13. 13.
    Schiavo L, Scalera G, Pilone V, et al. Fat mass, fat-free mass, and resting metabolic rate in weight-stable sleeve gastrectomy patients compared with weight-stable nonoperated patients. Surg Obes Relat Dis. 2017;13(10):1692–9.CrossRefGoogle Scholar
  14. 14.
    Ravussin E, Lillioja S, Knowler WC, et al. Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med. 1988;318(8):467–72.CrossRefGoogle Scholar
  15. 15.
    Ramadan M, Loureiro M, Laughlan K, et al. Risk of dumping syndrome after sleeve gastrectomy and roux-en-Y gastric bypass: early results of a multicentre prospective study. Gastroenterol Res Pract. 2016;2016:2570237.CrossRefGoogle Scholar
  16. 16.
    Cadegiani FA, Silva OS. Acarbose promotes remission of both early and late dumping syndromes in post-bariatric patients. Diabetes Metab Syndr Obes. 2016;9:443–6.CrossRefGoogle Scholar
  17. 17.
    Li-Ling J, Irving M. Therapeutic value of octreotide for patients with severe dumping syndrome--a review of randomised controlled trials. Postgrad Med J. 2001;77(909):441–2.CrossRefGoogle Scholar
  18. 18.
    Eisenberg D, Azagury DE, Ghiassi S, et al. ASMBS position statement on postprandial hyperinsulinemic hypoglycemia after bariatric surgery. Surg Obes Relat Dis. 2017;13(3):371–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency SurgeryUniversity Hospital San Giovanni di Dio e Ruggi d’AragonaSalernoItaly
  2. 2.Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”University of SalernoSalernoItaly
  3. 3.Bariatric Surgery and Metabolic Disease UnitBeato Matteo Clinic InstituteVigevanoItaly
  4. 4.Université Côte d’AzurNiceFrance
  5. 5.Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation UnitArchet 2 HospitalNiceFrance
  6. 6.U1065, Team 8 “Hepatic complications of obesity”InsermNiceFrance

Personalised recommendations