What Are Patients Eating One Year After Gastric Banding?
Wednesday, August 29, 2012
There is no doubt that, for severe obesity, bariatric surgery is currently the most effective treatment with well-documented benefits on a wide range of health problems and quality of life.
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.
AMS
Edmonton, Alberta
McGrice MA, & Porter JA (2012). What are Gastric Banding Patients Eating One Year Post-Surgery? Obesity surgery PMID: 22923340
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Wednesday, August 29, 2012
For people who receive this surgery, there is usually a lot of positive reinforcement from friends and the medical team about how much weight is lost and all the health and quality of life benefits because of the weight loss. It would be a natural consequence that there would be more of a focus on restricting calories than ensuring nutritional requirements are met. As you say, bariatric surgery is a risk factor for nutritional deficiencies and long term follow up is warranted.
Wednesday, August 29, 2012
Dr. Sharma, are you aware of any qualitative studies along the same lines as this one? Being able to capture participants’ feelings on this subject could shed some valuable light on this phenomenon. It’s possible that some of them are adhering to low carb and paleo diets, for example. I assume that in Australia, bariatric surgery patients are provided with counseling before and after the surgery; is this correct? Also, I find it interesting that the response rate would be so low.
Wednesday, August 29, 2012
I’m really glad that you’re thinking about this issue. Fat people need proper and adequate nutrition just like everyone else does, and not only does weight loss surgery limit the number of calories people can eat, it impairs absorption of micronutrients. The deficiencies it causes will have an increasing impact over the years and over the decades. I shudder to think of the health problems that a young person who has the surgery might develop in 20, 30 or 40 years.
I find the studies that seem to show health benefits unconvincing. The followups are too short and they lose track of too many people. I strongly doubt that the people who they continue to track are typical.
Thursday, August 30, 2012
I had a RNY done privately with Dr. Christou just over 33 months ago. At the one year mark, i can only guess that my diet was pretty good, overall. I was concerned about getting enough protein, I was taking my supplements and I had not introduced a lot of sugar back into my diet. Currently I rank my diet as poor. I am making very poor choices about food quality and quantity and I often will choose to eat junk food instead of healthynfood due to the limited “real estate”. In addition, processed food is much easier for my pouch to handle and therefore I can eat more. I am chronically deficient in vitamin A and have become allergic to vit A supplements. I find my food thoughts and cravings to be as strong as ever.
I have had minimal follow up with my GP with only checking bLoodwork periodically. I have met with a psychologist and a RD, but found it ineffectual since they had no idea what I had gone through. Since follow up is throughnthe surgeon, and my surgeon lives a 5 hour flight away, I have had no follow up with his office. I contacted a local surgeon about joining his group, and he was not receptive to the idea.
I Would estimate my calorie intake to be in the 3000 range. My only saving grace is that I deliver mail for almost 4 hours a day walking over 15 km each day.
Friday, August 31, 2012
Gastric banding January 15 2008, weight dropped from 425 to 190 lbs in 24 months; coughing and swallowing issues lead to gastroscopy, discovery of extensive Barrettes and emptying of the band in 2010; weight regain to 340 lbs by 2012. Simplistic nutritional counseling, no treatment of binge eating disorder or addition-like response to sugar; leading to depression; suicide attempt; job difficulties and loss; medication treatment of depression moderately effective; no low cost trauma therapy available or in-patient treatment for binge eating disorder or addiction-like response to sugar (cravings, etc.). My conclusion: failure of the medical profession to help, ending up leaving me worse off than pretreatment condition; the ethics of gastric banding in Canada at paid cosmetic surgery clinics highly suspect. Bottom line: Canada is unprepared to treat obesity effectively.
Sunday, September 2, 2012
Hi Arya, thank you for bringing attention to this issue. The experiences from your readers are not unusual, and show that there needs to be a better process for post-operative care for patients undergoing bariatric surgery.