Nutritional Implications of Bariatric Surgery and the Role of Registered Dietitians

Abstract

A S THE NUMBER OF INDIVIDUALS WITH OBESITY continues to increase, so has the prevalence of bariatric surgery in the United States and worldwide. Bariatric surgery is currently the only knownmethod that offers both considerable and long-termweight loss. Depending on the surgical procedure, patients can expect to lose between 29% and 87% of excess bodyweight 1 to 2 years postsurgery. Despite the substantial weight loss and improvements in comorbid conditions observed after bariatric surgery, these procedures are notwithout nutritional risk, which underscores the importance of registered dietitians (RDs) to the bariatric surgical care team. Nutritional deficiencies after bariatric surgery can arise from a variety of factors, including surgical modifications of the gastrointestinal tract that reduce dietary intake and/or promote malabsorption, or because of poor patient compliance with treatment recommendations (eg, diet and multivitamin supplementation). In this issue, MoizE and colleagues prospectively evaluated long-term nutritional deficiencies and dietary patterns after both sleeve gastrectomy and Rouxen-Y gastric bypass (RYGB). They demonstrated that nutritional deficiencies anddietary intake patternswere similar up to 5 years after sleeve gastrectomy and RYGB. Insufficient or deficient 25-hydroxyvitamin D appeared to be the most common problem before and up to 5 years after both surgeries, despite implementing a vitamin D supplementation protocol and living in aMediterranean climate (insufficiency defined by MoizE and colleges as 10 to 29 ng/mL [25 to 72 nmol/L] and deficiency defined as 10 ng/mL [ 25 mmol/L]). Considering that amajority of patients in theMoizE and colleagues studywere either insufficient or deficient before surgery suggests that routine supplementation of vitamin D should occur preoperatively. Moreover, the results from MoizE and colleagues and others highlight the importance of vitamin D supplementation in the bariatric surgery patient population and suggest that the frequently recARTICLE INFORMATION