scholarly journals Diet approach before and after bariatric surgery

2020 ◽  
Vol 21 (3) ◽  
pp. 297-306
Author(s):  
Silvia Bettini ◽  
Anna Belligoli ◽  
Roberto Fabris ◽  
Luca Busetto
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Severe Obesity ◽  
Eating Habits ◽  
Normal Weight ◽  
Nutritional Management ◽  
Micronutrient Deficiencies ◽  
Ketogenic Diets ◽  
Comorbidity Burden ◽  
Bariatric Patients

Abstract Bariatric surgery (BS) is today the most effective therapy for inducing long-term weight loss and for reducing comorbidity burden and mortality in patients with severe obesity. On the other hand, BS may be associated to new clinical problems, complications and side effects, in particular in the nutritional domain. Therefore, the nutritional management of the bariatric patients requires specific nutritional skills. In this paper, a brief overview of the nutritional management of the bariatric patients will be provided from pre-operative to post-operative phase. Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery. At present, evidences from randomized and retrospective studies do not support the hypothesis that pre-operative weight loss could improve weight loss after BS surgery, and the insurance-mandated policy of a preoperative weight loss as a pre-requisite for admission to surgery is not supported by medical evidence. On the contrary, some studies suggest that a modest weight loss of 5–10% in the immediate preoperative period could facilitate surgery and reduce the risk of complications. Very low calories diet (VLCD) and very low calories ketogenic diets (VLCKD) are the most frequently used methods for the induction of a pre-operative weight loss today. After surgery, nutritional counselling is recommended in order to facilitate the adaptation of the eating habits to the new gastro-intestinal physiology. Nutritional deficits may arise according to the type of bariatric procedure and they should be prevented, diagnosed and eventually treated. Finally, specific nutritional problems, like dumping syndrome and reactive hypoglycaemia, can occur and should be managed largely by nutritional manipulation. In conclusion, the nutritional management of the bariatric patients requires specific nutritional skills and the intervention of experienced nutritionists and dieticians.

scholarly journals Spontaneous Neural Activity Changes after Bariatric Surgery: a resting-state fMRI study

2021 ◽  
Author(s):  
Yashar Zeighami ◽  
Sylvain Iceta ◽  
Mahsa Dadar ◽  
Mélissa Pelletier ◽  
Mélanie Nadeau ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Visual Cortex ◽  
Neural Activity ◽  
Dorsolateral Prefrontal Cortex ◽  
Severe Obesity ◽  
Normal Weight ◽  
Post Surgery ◽  
Spontaneous Neural Activity ◽  
Dorsolateral Prefrontal

1.AbstractBackgroundMetabolic disorders associated with obesity could lead to alterations in brain structure and function. Whether these changes can be reversed after weight loss is unclear. Bariatric surgery provides a unique opportunity to address these questions because it induces marked weight loss and metabolic improvements which in turn may impact the brain in a longitudinal fashion. Previous studies found widespread changes in grey matter (GM) and white matter (WM) after bariatric surgery. However, findings regarding changes in spontaneous neural activity following surgery, as assessed with the fractional amplitude of low frequency fluctuations (fALFF) and regional homogeneity of neural activity (ReHo), are scarce and heterogenous. In this study, we used a longitudinal design to examine the changes in spontaneous neural activity after bariatric surgery (comparing pre- to post-surgery), and to determine whether these changes are related to cardiometabolic variables.MethodsThe study included 57 participants with severe obesity (mean BMI=43.1±4.3kg/m2) who underwent sleeve gastrectomy (SG), biliopancreatic diversion with duodenal switch (BPD), or Roux-en-Y gastric bypass (RYGB), scanned prior to bariatric surgery and at follow-up visits of 4 months (N=36), 12 months (N=29), and 24 months (N=14) after surgery. We examined fALFF and ReHo measures across 1022 cortical and subcortical regions (based on combined Schaeffer-Xiao parcellations) using a linear mixed effect model. Voxel-based morphometry (VBM) based on T1-weighted images was also used to measure GM density in the same regions. We also used an independent sample from the Human Connectome Project (HCP) to assess regional differences between individuals who had normal-weight (N=46) or severe obesity (N=46).ResultsWe found a global increase in the fALFF signal with greater increase within dorsolateral prefrontal cortex, precuneus, inferior temporal gyrus, and visual cortex. This effect was more significant 4 months after surgery. The increase within dorsolateral prefrontal cortex, temporal gyrus, and visual cortex was more limited after 12 months and only present in the visual cortex after 24 months. These increases in neural activity measured by fALFF were also significantly associated with the increase in GM density following surgery. Furthermore, the increase in neural activity was significantly related to post-surgery weight loss and improvement in cardiometabolic variables, such as insulin resistance index and blood pressure. In the independent HCP sample, normal-weight participants had higher global and regional fALFF signals, mainly in dorsolateral/medial frontal cortex, precuneus and middle/inferior temporal gyrus compared to the obese participants. These BMI-related differences in fALFF were associated with the increase in fALFF 4 months post-surgery especially in regions involved in control, default mode and dorsal attention networks.ConclusionsBariatric surgery-induced weight loss and improvement in metabolic factors are associated with widespread global and regional increases in neural activity, as measured by fALFF signal. These findings alongside the higher fALFF signal in normal-weight participants compared to participants with severe obesity in an independent dataset suggest an early recovery in the neural activity signal level after the surgery.

scholarly journals Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

2021 ◽  
Author(s):  
Arnaud Liagre ◽  
Francesco Martini ◽  
Radwan Kassir ◽  
Gildas Juglard ◽  
Celine Hamid ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Severe Obesity ◽  
Postoperative Mortality ◽  
One Anastomosis Gastric Bypass ◽  
Sustained Weight Loss ◽  
Biliopancreatic Limb ◽  
Percentage Excess Weight Loss

Abstract Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract

Abstract 16013: Evidence for Improvement in NYHA Class and Freedom From Hospitalization in Bariatric Surgery Patients With an Established Diagnosis of Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael W Foster ◽  
Sara E Badenhausen ◽  
Colleen Tewksbury ◽  
Noel N Williams ◽  
J Eduardo Rame ◽  
...  
Keyword(s):  
Heart Failure ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Medical Record ◽  
Median Time ◽  
Severe Obesity ◽  
Nyha Class ◽  
High Volume ◽  
Metabolic And Bariatric Surgery

Introduction: Heart failure patients with severe obesity endure significant morbidity and frequent hospitalizations. Bariatric surgery is proven to provide durable weight loss for those with severe obesity, but the clinical impact and safety of these procedures among patients with heart failure has not been well-demonstrated. Methods: We conducted a medical record query of patients who have a previous diagnosis of heart failure (HFpEF and HFrEF) and underwent subsequent Roux-En-Y gastric bypass or laparoscopic sleeve gastrectomy at a high-volume metabolic and bariatric surgery center. We compared clinical, demographic, and echocardiographic data captured just prior to the bariatric procedure to the most recent data available in the medical record for each patient. Results: There were 50 patients (88% had HFpEF) included in this study. Time from HF diagnosis to most recent follow-up ranged from 0.2 to 20.3 years (median 6.7 years) and there was no recorded mortality. The median time from HF diagnosis to surgery was 2.3 years and median time from surgery to recent follow-up was 2.9 years. Post-operative median decrease in BMI was 8.8 kg/m 2 , HF hospitalizations were 0.4 per patient year (PPY) to 0.15 PPY, p=0.008, and median NYHA Class was II pre-op and I post-op, p=0.048). LVEF, LVESD, and LVEDD were not significantly changed post-operatively (Table 1). Conclusion: Weight loss following bariatric surgery for patients with HF led to improvements in NYHA Class, fewer hospitalizations for HF, and was not associated with perioperative mortality. It is reasonable to consider bariatric surgery for this patient population, but further prospective investigation is warranted.

scholarly journals Nutritional Deficiencies Associated to Bariatric Surgery

2013 ◽  
Vol 20 (2) ◽  
pp. 157-164 ◽  
Author(s):  
Cornelia Zetu ◽  
Rubin Munteanu ◽  
Raluca Parasca ◽  
Constantin Ionescu-Tîrgovişte
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Nutritional Deficiencies ◽  
Micronutrient Deficiencies ◽  
Epidemic Disease ◽  
Surgical Options ◽  
Clinical Signs And Symptoms ◽  
Fat Soluble Vitamins

Abstract Obesity is an epidemic disease, increasingly addressed through surgical options for weight loss. Benefits of these surgical procedures, such as weight loss and improvement of obesity-related co-morbidities, are well established. However, postoperative complications do occur. Deficiencies in micronutrients, which include water and fat-soluble vitamins and minerals, are common after bariatric surgery. Recognition of the clinical signs and symptoms of micronutrient deficiencies is important to minimize long-term adverse effects.

scholarly journals Eating Habits of Children Born after Maternal Bariatric Surgery

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2577
Author(s):  
Karolien Van De Maele ◽  
Charlotte De Geyter ◽  
Yvan Vandenplas ◽  
Inge Gies ◽  
Roland Devlieger
Keyword(s):  
Bariatric Surgery ◽  
Eating Behaviors ◽  
Eating Habits ◽  
Vegetable Consumption ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Control Group ◽  
Cross Sectional ◽  
Meal Skipping ◽  
Unhealthy Eating

Mothers who underwent bariatric surgery (BS) before pregnancy have worrisome eating habits, but little is known about the eating habits of their offspring. EFFECTOR is a cross-sectional, long-term follow-up study of 4–11-year-old children born from mothers that underwent bariatric surgery before pregnancy (n = 36), mothers with overweight/obesity (OW/OB) in a control group (n = 71), and mothers with a normal weight (NW) in a second control group (n = 35). Data on anthropometry and on eating habits obtained through a Food Frequency Questionnaire were collected prospectively. The children’s body mass index (BMI) scores significantly correlated with maternal pre-pregnancy BMI. The prevalence of overweight and obesity was the highest in children of the BS group (38.9% vs. 15.5% for children of the OW/OB group and 5.7% for those of the NW group; p = 0.004). Meal-skipping behavior was comparable between the groups. There was no difference in fruit and vegetable consumption. The BS group consumed more low-calorie sweetened beverages compared to the NW group (p = 0.01) but less fruit juice compared to the NW and OW/OB groups (p = 0.01). Our results may indicate a sugar-avoiding behavior in children of the BS group, fitting dietary maternal habits in a strategy to prevent dumping syndrome. In conclusion, maternal pre-pregnancy bariatric surgery does not alter unhealthy eating behaviors and the risk of development of overweight during childhood in their children.

scholarly journals Bariatric Surgery: Remission of Inflammation, Cardiometabolic Benefits, and Common Adverse Effects

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Fatimo Biobaku ◽  
Husam Ghanim ◽  
Scott V Monte ◽  
Joseph A Caruana ◽  
Paresh Dandona
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Adverse Effects ◽  
Chronic Inflammation ◽  
Large Scale ◽  
Severe Obesity ◽  
Neurological Complications ◽  
The Common ◽  
Underlying Mechanisms ◽  
Remission Of Comorbidities

Abstract Obesity is associated with increased mortality as a result of several comorbidities which occur in tandem with the obese state. Chronic inflammation is well documented in obesity, and evidence from numerous studies support the notion that the increased inflammation in individuals with obesity accentuates the comorbidities seen in this condition. The remission of comorbidities such as metabolic, cardiovascular, and neurological complications occurs following bariatric procedures. Bariatric surgery significantly reduces mortality and results in remarkable weight loss and reversal in several obesity-related comorbidities. There is indisputable evidence that the resolution of inflammation that occurs after bariatric surgery mitigates some of these comorbidities. With the increasing use of bariatric surgery for the treatment of severe obesity, it is pivotal to elucidate the underlying mechanisms responsible for the notable improvements seen after the procedure. This review summarizes underlying mechanisms responsible for the remission of obesity-related abnormalities and discusses the common adverse effects of bariatric surgery. Well-stratified, large-scale studies are still needed for a proper evaluation of these underlying mechanisms.

scholarly journals Perioperative Optimization of Patients Undergoing Bariatric Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
C. E. Owers ◽  
Y. Abbas ◽  
R. Ackroyd ◽  
N. Barron ◽  
M. Khan
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Operative Management ◽  
Surgical Patient ◽  
Optimal Management ◽  
Safe Method ◽  
Number Of Patients ◽  
The World ◽  
Obese Population ◽  
Bariatric Patients

Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.

scholarly journals Nutritional Support for Bariatric Surgery Patients: The Skin beyond the Fat

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1565
Author(s):  
Paolo Toninello ◽  
Alvise Montanari ◽  
Franco Bassetto ◽  
Vincenzo Vindigni ◽  
Antonio Paoli
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Postoperative Period ◽  
Body Contouring ◽  
Massive Weight Loss ◽  
Water Soluble ◽  
Nutritional Deficiencies ◽  
Multivitamin Supplementation ◽  
Bariatric Patients ◽  
The Aesthetic

Body contouring surgery after the massive weight loss due to bariatric surgery deals with different kinds of complications. The aim of this review is to analyze the role that some nutrients may play in tissue healing after surgery, thus helping plastic surgeons to improve the aesthetic and health outcomes in massive weight loss patients under a multidisciplinary approach. As a matter of fact, preoperative nutritional deficiencies have been shown for vitamins and minerals in a large percentage of post-bariatric patients. Preoperative deficiencies mainly concern iron, zinc, selenium, and vitamins (both fat-soluble and water-soluble), but also total protein. During the postoperative period, these problems may increase because of the patients’ very low intake of vitamins and minerals after bariatric surgery (below 50% of the recommended dietary allowance) and the patients’ low compliance with the suggested multivitamin supplementation (approximately 60%). In the postoperative period, more attention should be given to nutritional aspects in regard to the length of absorptive area and the percentage of weight loss.

scholarly journals Endoscopic plasma argon coagulation in treatment of weight regain after bariatric surgery: what does the patient think about this?

2014 ◽  
Vol 27 (suppl 1) ◽  
pp. 47-50 ◽  
Author(s):  
Simone Dallegrave MARCHESINI ◽  
Giorgio Alfredo Pedroso BARETTA ◽  
Maria Paula Carlini CAMBI ◽  
João Batista MARCHESINI
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Multidisciplinary Team ◽  
Weight Regain ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
The Internet ◽  
Bariatric Patients ◽  
Second Chance

BACKGROUND: Bariatric surgery, especially Roux-en-Y gastric bypass is an effective treatment for refractory morbid obesity, causing the loss of 75% of initial excess weight. After the surgery, however, weight regain can occur in 10-20% of cases. To help, endoscopic argon plasma coagulation (APC) is used to reduce the anastomotic diameter. Many patients who undergo this treatment, are not always familiar with this procedure and its respective precautions. AIM: The aim of this study was to determine how well the candidate for APC understands the procedure and absorbs the information provided by the multidisciplinary team. METHOD: We prepared a questionnaire with 12 true/false questions to evaluate the knowledge of the patients about the procedure they were to undergo. The questionnaire was administered by the surgeon during consultation in the preoperative period. The patients were invited to fill out the questionnaire. RESULTS: We found out that the majority learned about the procedure through the internet. They knew it was an outpatient treatment, where the anesthesia was similar to that for endoscopy, and that they would have to follow a liquid diet. But none of them knew that the purpose of this diet was to improve local wound healing. CONCLUSION: Bariatric patients who have a second chance to resume weight loss, need continuous guidance. The internet should be used by the multidisciplinary team to promote awareness that APC will not be sufficient for weight loss and weight-loss maintenance in the long term. Furthermore, there is a need to clarify again the harm of drinking alcohol in the process of weight loss, making its curse widely known.

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