However, as regular readers will recall, I am also the first to point out that surgery is not a ‘stand-alone’ procedure, but rather, requires intense and probably life-long follow-up to prevent nutritional and psychological complications that may emerge even years after surgery.
This problem is again emphasized by a recent study by McGrice and Porter, from Melbourne, Australia, published in OBESITY SURGERY.
They invited 215 patients to complete validated Food Frequency Questionnaire 12 months following adjustable gastric banding.
Although only bout 25% of patients responded, those who did, reported daily energy intakes ranging between just 270 (???) to over 3000 Calories, with an average of about 1200 Cal/day.
Not surprisingly, many patients failed to meet even the minimum recommendations for macronutrient intake.
The average fibre intake was only 14 g/day (current recommendations are 25 g for women and 30 g for men) and the average diet contained 36% total fat (almost half of which was saturated fat) compared to the recommendations of 20-25%.
From these findings the authors conclude that:
“Patients’ dietary intakes vary significantly 1 year post-laparoscopic adjustable band surgery, with many patients not meeting recommendations. These results suggest that patients decrease their total energy intake; however, eating habits may not improve as they consume a diet high in saturated fat. It is recommended that all patients receive dietary education about diet quality post-laparoscopic adjustable gastric band surgery to assist them in improving their diet quality as well as quantity for optimal health and weight loss.”
Critics will immediately point out the important limitations of this study including the rather low response rate and the rather ‘iffy’ reliability of one-time questionnaires.
But, unless we assume that only people with post-surgical nutritional issues responded to this questionnaire, we must assume that there are severe nutritional issues in a considerable number of patients one year after surgery.
Although this study is limited to patients undergoing gastric banding, we have yet to see data on long-term nutrition intake in patients undergoing other types of bariatric surgery.
Certainly this study (despite its limitations), if nothing else, should serve as a reminder that we need to pay long-term attention to dietary intake with periodic and ongoing assessment of nutritional status in patients undergoing bariatric surgery.
In fact, I would not be surprised if those who lose the most weight (and by surgical standards, would be considered to have the greatest ‘success’), are the ones at highest risk for nutritional problems.
If you have experienced nutritional problems or deficiencies post-surgery, I’d certainly love to hear your story.
McGrice MA, & Porter JA (2012). What are Gastric Banding Patients Eating One Year Post-Surgery? Obesity surgery PMID: 22923340