MNT for Bariatric Surgery Flashcards
____ ____ is a surgical procedure performed on the stomach or intestines to induce weight loss
Bariatric surgery
What are the two ways to qualify for bariatric surgery?
-BMI greater than 40
-BMI greater than 35 with a comorbidity such as diabetes, sleep apnea, hypertension, or hyperlipidemia
What are some nutrition concerns of bariatric surgery?
-Intractable N/V
-Dumping syndrome (GB)
-Dehydration
-Protein malnutrition
-Micronutrient deficiencies
-Weight loss failure or regain
What are some considerations for bariatric surgery?
-Must understand the risks and benefits
-Motivation and ability to adhere to long-term lifestyle changes
-No active substance abuse
-Psychological illness (binge eating/bulimia)
-Pregnancy (should wait12-18 months post-op)
What are the four common bariatric surgery options?
-Gastric Bypass
-Sleeve gastrectomy
-Adjustable gastric band (out of date)
-Biliopancreatic diversion (high incidence of nutrient deficiencies)
The gastric bypass is ____ and ____
Restrictive and malabsorptive
The sleeve gastrectomy is ____
Restrictive
The adjustable gastric band is ____ and ____
Restrictive and adjustable
There is a long term average loss of ____-____% excess weight with gastric bypass
60-80
There is a long term average loss of ____% of excess weight with the sleeve
50%
Bariatric surgery can also improve comorbidities such as…
-Diabetes
-Hypertension
-GERD
-Reduction in medication
-Quality of life
The gastric bypass is also known as _____ ____ ____
Roux-en-Y gastric bypass
With gastric bypass, a small gastric pouch (about ____ mL) is created by a stable partition
30
With gastric bypass, the ___ ___ is attached to the gastric pouch via a narrow anastomosis (about 2 cm)
Distal jejunum
With gastric bypass, food bypasses the…
-Distal stomach
-Duodenum
-Proximal jejunum
Weight loss from gastric bypass is caused by…
-Restricted intake
-Decreased hunger
-Malabsorption
-Possible decrease in ghrelin production
Advantages of the gastric bypass:
-Gold standard of weight loss surgery
-Restrictive and malabsorptive
-Usual weight loss is 60-80% excess body weight in the first 2 years
Disadvantages of gastric bypass:
-Gastrointestinal rerouting
-Portion of the digestive tract is bypassed, which may result in nutritional deficiencies
-“Dumping syndrome” can occur
-Difficult to reverse
-More cuts= more changes of leaks
Gastric bypass complications:
-Dumping syndrome
-Leaks
-Blood clots
-Bleeding
-Ulcers
-Wound infections
-Bowel obstruction
-Internal hernias
-Organ failure
-Sepsis
-Death
Advantages of the sleeve gastrectomy:
-Continuity of gastrointestinal tract
-No rerouting
-Decrease in hunger by removing fundus and therefore ghrelin production
-Usually achieve loss of 50% excess body weight at 2 years
Disadvantages of the sleeve gastrectomy:
-Pouch can stretch
-Complicatications
Complications of sleeve gastrectomy:
-Reflux
-Leaks
-Sepsis
-Nausea
-Vomiting
-Bleeding
-Blood clots
-Vitamin deficiencies
-Death
If someone has a very high BMI, which procedure is recommended?
Gastric bypass
If someone is a type 2 diabetic on insulin, which procedure is recommended?
Gastric bypass
If someone has GERD, ulcers, or Barrett’s, which procedure is recommended?
Gastric bypass
If someone is a smoker, which procedure is recommended?
Sleeve
If someone has had chronic NSAID use, which procedure is recommended?
Sleeve
If someone has had previous hernia repairs, which procedure is recommended?
Sleeve
What are some contraindications for bariatric surgery?
-Previous Nissen Fundoplication
-Previous stomach surgery
-Cirrhosis
-Portal hypertension
-Not cleared by psych
-Very complication medical history that would make any surgery too high risk
What are the most common nutritional concerns post-op?
-Intolerance to certain foods from nausea and vomiting
-Dumping syndrome
-Nutritional deficiencies
-inadequate protein intake
-Weight regain
-“diet mentality”
In preparation for surgery, patients should eat 3 meals per day, focusing on ____ ____ and fruits and vegetables (+1 starch serving per meal, eaten last)
Lean protein
Before surgery, patients should aim for ___ ounces of non-caloric/non-carbonated fluids
64
Before surgery, patients should also begin taking a ____
Multivitamin
Before surgery, patients should also begin ____ ___ and mindful eating habits
Physical activity
7 days prior to surgery, the patient should begin the ____ ___-___ diet
Liquid pre-op
There is usually 6 days of a full liquid diet that consists of…
-Protein shakes
-Clear liquids (sugar free: Jell-O, popsicles, broths, crystal lite, Mio, G2 Gatorade, coffee/tea, milk)
Those on the full liquid diet should limit caffeine to ____ ounces per day
16
On the last day of pre-op, the patient should have ___ ____ only (protein shakes and milk are eliminated)
Clear liquids
Patient should be NPO ____ hours prior to surgery
6
Phase I of the post-op diet consists of ____ and begins the day the patient leaves the hospital (similar to the pre-op liquid diet)
Liquids
The two goals for phase I of the post-op diet are…
-Protein
-Hydration
Those on phase I of the post-op diet should get at least ___-___ g of protein per day
30-40
Those on phase I should also try to sip ____ all day long
Fluids
Acceptable liquids for those on phase I post-op diet:
-Sugar free: water, sports drinks, broths, Jell-O, popsicles, coffee/tea, milk, protein shakes, condensed strained soups with milk
If someone on phase I of the post-op diet has symptoms of low blood sugar, we should treat with a small amount of ____ (like fruit juice or Gatorade)
Sugar
In phase I of post-op, patients shouldn’t…
-Drink through straws
-Chew gum
-Take big gulps of fluid
Phase II of the post-op diet is ___ ___
Soft foods
Those on phase II of the post-op diet should eat ___ meals, focusing on eating protein first
3
___-___ grams of protein per day is the goal for phase II of the post-op diet
60-80
To start, those on phase II should have a ___-___ ounce meal, and slowing increase to ___ ounces
1-2; 4
People in phase II should take small bites, chew thoroughly, and put the fork down between bites to ensure eating ____
Slowly
People on phase II should not drink during or ____ minutes after meals
30
People on phase II should begin a _____ regimen
Vitamin
What are some acceptable foods for phase II of the post-op diet?
-Cottage cheese
-Yogurt
-Eggs
-Crockpot meat
-Fish that flakes
-Thinly sliced lunch meat
-Lean ground beef
-Soups
-Soft cooked/mushy vegetables,
-Applesauce
-Diced peaches
Phase III of the post-op diet is building upon textures to get back to a ___ ___ (i.e crockpot chicken -> baked chicken breast with chicken stock -> grilled chicken breast)
Regular diet
Patients in phase III should focus on nutritionally balanced meals with ____ as the most important macronutrient
Protein
In phase III, patients should keep a ___ ____ to keep track of the amount of protein consumed per day
Food log
Every recovery and progression back to normal food is ____
Individualized
What are some common food intolerances in people after bariatric surgery?
-Tough meat
-Raw vegetables
-Dried fruits and skins
-Carbonated beverages
-Dairy products
-Seeds, nuts, and popcorn
-Sweets (gastric bypass)
After bariatric surgery, people are commonly deficient in vitamin B12 due to…
-Decreased meat intake
-Decreased HCL and pepsin levels
-Decreased intrinsic factor
After bariatric surgery, people are commonly deficient in iron due to…
-Decreased intake of heme iron
-Decreased HCl
-Bypassed duodenum (RYGB)
-Menstruating women are at high risk
After bariatric surgery, people are commonly deficient in calcium due to…
-Decreased intake
-Bypassed duodenum
-Vitamin D deficiency
-Steatorrhea
After bariatric surgery, people are commonly deficient in folate due to…
-Decreased intake
-Vitamin B12 deficiency
After bariatric surgery, people are commonly deficient in fat-soluble vitamins due to…
Biliopancreatic diversions
Patients who had gastric bypass should get ___ servings of multivitamin per day, while those with the sleeve should get ___ serving
2; 1
After both gastric bypass and sleeve gastrectomy, patients should get ____-____ mg of calcium per day
1200-1500
Those who had gastric bypass should get their calcium from ___ ___, while someone with the sleeve can get it from either ___ ___ or ____
Calcium citrate; calcium citrate or carbonate
Patients who received gastric bypass or the sleeve should get ____ IU of vitamin D per day
3000
After either gastric bypass or the sleeve, patients should get ____-____ mcg per day of cyanocobalamin (vitamin B12)
500-1000
After either gastric bypass or the sleeve, patients should get ____ mg of thiamin (vitamin B1)
12
____ ____ should be taken as instructed for both gastric bypass and the sleeve
Ferrous sulfate
What is included in initial visits for those looking to get bariatric surgery?
-Qualify for surgery and have bariatric coverage
-Smoking cessation
-Lab work
-Cardiac clearance
-EKG
-Pulmonary clearance and sleep study
-RD visits
Before surgery, patients will also have monthly visits as well as a final ___-___ visit
Pre-op
Eliciting ____ ____ is a big part of the roles of an RD
Behavior change
What are two challenges of the RD in the bariatric setting?
-Limited amount of time with patients
-Eliminating diet mentality
Medical management of obesity is a ___-___ weight loss approach
Non-invasive
What are some weight loss drugs approved by the FDA?
-Orlistat
-Phentermine
-Belviq
-Contrave
-Qsymia
-Saxenda
With medical management of obesity, the RD can encourage ____ ____ and exercise
Lifestyle modification
