Bariatric Surgery

Question 1

What are the trends of obesity?

Answer 1

Rates have been increasing over the years
There are 100M more females than males obese
25% of the Canadian population are obese

Question 2

What is bariatric surgery and its purpose?

Answer 2

The surgical treatment of obesity

To promote significant weight loss and assist/improve weight-related comorbidities and promote health

Question 3

What are the indications for bariatric surgery?

Answer 3

BMI > 40 (even if person is "healthy")
BMI > 35 with health issues
Person has to accept risks of surgery
Failure to non-surgcal weight loss
Person must be motivated to make lifestyle changes after the surgery

Question 4

What are the contraindications to bariatric surgery?

Answer 4

drugs, alcohol use
psychiatric illness
cirrhosis
pulmonary HTN
severe cardiac and respiratory disease

Question 5

What are the 2 categories and 4 types of surgery?

Answer 5

Restrictive & restrictive + malabsorptive

Adjustable gastric band: reversible, part of the stomach is restricted, no done anymore

Vertical sleeve gastrectomy: 70-80% of stomach is removed, PYLORIC SPHINCTER IS INTACT, irreversible

Roux-en-Y gastric bypass (RYGB): a pouch is created - a section of the stomach is removed but still kept in the stomach due to enzymes and gastric juices, NO PYLORIC SPHINCTER

BPD-DS (switch): best resolution for diabetes, little absorption, requires a lot of commitment and change after surgery (compliance with taking pills)

Question 6

What is the rate of weight loss?

Answer 6

• most significant: first 6 months

- can last up to 12 months

Question 7

What are the 3 mechanisms of weight loss (3 things that allow for weight loss after surgery)?

Answer 7

1. gastric restriction
2. common limb length (shorter absorption area - RYGB & BPD-DS)
3. gut hormones (low ghrelin and high leptin)

Question 8

What are the nutrition guidelines pre-op?

Answer 8

VLCD for 2 weeks before surgery
800-900 calories
low carb, high protein, moderate fat
(want to induce ketosis to reduce the size of the liver)

Question 9

What are the nutrition guidelines post-op?

Answer 9

Texture progression:
1-3 days: clear fluids
5 weeks: full fluids/puree
5 weeks+: solids

Portion progression:
start with 1/2 cup then increase to 1 cup

Question 10

What is dumping syndrome?

Answer 10

contents of the stomach can easily slip into the intestines (usually happens with simple sugars)

Question 11

What vitamins and minerals are specially affected after a bariatric surgery and why?

Answer 11

B12 - because of reduced intrinsic factors

iron & calcium due to lower absorption due to lower gastric acids released

Question 12

In what case does primary PEM occur? Secondary PEM?

Answer 12

primary: due to decreased oral intake/volume restriction
secondary: due to malabsorption

Question 13

What are the protein recommendations for the surgeries?

Answer 13

All: 1–1.5 g/kg/IBW

Most restrictive one (BDP-DS): 1.5-2 g/kg/IBW

Question 14

Why is it important to breakdown food completely in the mouth before swallowing?

Answer 14

because after surgery, the stomach is very tight and cannot grind and squeeze the food anymore

Question 15

What are some of the required dietary modifications after surgery?

Answer 15

limit liquid calories (low caffeine, low sugar, low kcal)
1. protein 2. vegetables 3. grains
decrease processed foods
decrease high fat foods

Question 16

When should you drink in comparison to meal times?

Answer 16

15min before meal or 30 min after