Tuesday, November 9, 2010
With the ever-increasing number of patients undergoing bariatric surgery, it is not surprising that professional organisations around the world are publishing a slew of recommendations and guidelines on how best to manage these patients.
The 20-page guideline, authored by a panel led by David Heber (University of California), focusses on the immediate postoperative period and long-term endocrine and nutritional management of the post-bariatric surgery patient.
As expected, the key challenges are to prevent complications, weight regain, and progression of obesity-associated comorbidities.
As the panel notes, bariatric surgery is by no means a guarantee of successful weight loss or maintenance and all patients require care from a multidisciplinary team including an experienced primary care physician, endocrinologist, or gastroenterologist (I would add a general internist to this list) and must consider enrolling postoperatively in a comprehensive program for nutrition and lifestyle management.
The guidelines also point out that while nutritional risks are greatest with malabsorbtive procedures (e.g. Roux-en-Y gastric bypass), the risk for weight regain are highest for purely restrictive procedures (e.g. adjustable gastric banding).
Nutritional education and clinical management to prevent and detect nutritional deficiencies are recommended for all patients undergoing bariatric surgery (including those with purely restrictive procedures) and should focus on adequate protein, vitamin, and mineral intake.
The guidelines contain particularly comprehensive sections dealing with the causes of weight regain, management of patients with diabetes mellitus, and issues related to bone health, gout, gastrointestinal problems, and eating behaviour.
All clinicians involved in this rapidly evolving field of medicine will likely find these latest guidelines a quick and worthwhile read.
Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, & Still C (2010). Endocrine and nutritional management of the post-bariatric surgery patient: an endocrine society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 95 (11), 4823-43 PMID: 21051578