Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice

Obesity: pathophysiology and therapeutic interventions

Over the past few decades, obesity has transitioned from a localized health concern to a pressing global public health crisis affecting over 650 million adults globally, as documented by WHO epidemiological surveys. As a chronic metabolic disorder characterized by pathological adipose tissue expansion, chronic inflammation, and neuroendocrine dysregulation that disrupts systemic homeostasis and impairs physiological functions, obesity is rarely an isolated condition; rather, it is frequently complicated by severe comorbidities that collectively elevate mortality risks. Despite advances in nutritional science and public health initiatives, sustained weight management success rates and prevention in obesity remain limited, underscoring its recognition as a multifactorial disease influenced by genetic, environmental, and behavioral determinants. Notably, the escalating prevalence of obesity and its earlier onset in younger populations have intensified the urgency to develop novel therapeutic agents that simultaneously ensure efficacy and safety. This review aims to elucidate the pathophysiological mechanisms underlying obesity, analyze its major complications-including type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), non-alcoholic fatty liver disease (NAFLD), obesity-related respiratory disorders, obesity-related nephropathy (ORN), musculoskeletal impairments, malignancies, and psychological comorbidities-and critically evaluate current anti-obesity strategies. Particular emphasis is placed on emerging pharmacological interventions, exemplified by plant-derived natural compounds such as berberine (BBR), with a focus on their molecular mechanisms, clinical efficacy, and therapeutic advantages. By integrating mechanistic insights with clinical evidence, this review seeks to provide innovative perspectives for developing safe, accessible, and effective obesity treatments.

The Effect of Adding a Smartphone-Based Platform to the Metabolic Bariatric Surgery Nutritional Preparation Process: A Randomized Controlled Trial

BACKGROUND

Metabolic bariatric surgery (MBS) candidates undergo a comprehensive nutritional preparation process by a registered dietitian (RD). The effect of eHealth interventions on the MBS preparation process is unknown.

OBJECTIVES

To assess the impact of adding an application to the nutritional preparation process on pre-surgery nutritional knowledge, physical, and behavioral parameters among MBS candidates.

METHODS

An open-label randomized controlled trial among MBS candidates. All participants received 3-6 meetings with an RD and the intervention group also received access to an application containing information modules and a communication platform. Data was collected at baseline and end of preparation.

RESULTS

Forty participants were recruited, of them 67.5% women, with a mean age and body mass index of 34 ± 10.1 years and 43.5 ± 6.0 kg/m2, respectively. Nutritional knowledge, anthropometrics, functionality, adherence to most behavioral recommendations, and subjective state of health improved in both groups (P Time ≤ 0.044). Physical activity initiation (i.e., beginning of regular exercise engagement) was higher among the intervention group (40% at baseline and 68% at end of preparation vs 35% at baseline and 32% at end of preparation for interventions and controls, respectively, P Time × Group = 0.026). The application was rated as providing added value (8.2 on a scale of 1 (no added value) to 10 (meaningful added value)).

CONCLUSIONS

Nutrition preparation process with an RD improved MBS knowledge, adherence to behavioral recommendations, subjective state of health, and modestly enhanced weight and functionality outcomes among MBS candidates. Although rated as having an added value, incorporating an application had only a minimal impact on these outcomes.

Bariatric nutrition and evaluation of the metabolic surgical patient: Update to the 2022 Obesity Medicine Association (OMA) bariatric surgery, gastrointestinal hormones, and the microbiome clinical practice statement (CPS)

Background

In 2022, the Obesity Medicine Association (OMA) published a Clinical Practice Statement (CPS) which provided an overview of bariatric surgery and related procedures, a discussion on gastrointestinal hormones and a review of the microbiome as it relates to patients with obesity. This update to the 2022 OMA CPS provides a focus on nutrition as it relates to the adult bariatric surgery patient, incorporating a detailed discussion on how to conduct a bariatric nutrition assessment and manage patients seeking metabolic and bariatric surgery (MBS) and postoperative nutrition care. In particular, the section on macronutrients, micronutrients, and bariatric surgery has been updated, highlighting practical approaches to nutrient deficiencies typically encountered in the bariatric surgery patient. Also included is a section on how to envision and develop an interdisciplinary team of medical providers with evidence-based nutrition knowledge and consistent information that improves the quality of nutrition care provided to MBS patients. This CPS adds to the series of OMA CPSs meant to provide guidance to clinicians in their care of patients with obesity.

Methods

The foundation of this paper is supported by scientific evidence in the medical literature and expert opinion derived from several bariatric nutrition resources, as well as from the 2022 OMA CPS focused on bariatric surgery.

Results

This OMA Clinical Practice Statement provides an overview of the current bariatric nutrition clinical guidelines and nutrition tools adapted for clinicians who may not have access to an MBS team or a registered dietitian knowledgeable about bariatric nutrition.

Conclusions

This evidence-based review of the literature includes an overview of current bariatric nutrition recommendations. It is intended to provide clinicians with more advanced knowledge and skills in nutrition assessment and management of the preoperative and post-surgical MBS patients. This CPS also addresses macronutrient and micronutrient deficiencies common in MBS patients, and treatment recommendations designed to help the clinician with clinical decision making.

Preventing and Managing Pre- and Postoperative Micronutrient Deficiencies: A Vital Component of Long-Term Success in Bariatric Surgery

Bariatric surgery (BS) is an effective treatment for severe obesity and its related comorbidities, such as type 2 diabetes and hypertension. However, the anatomical and physiological changes associated with these procedures significantly increase the risk of preoperative and postoperative micronutrient deficiencies, which can lead to severe complications such as anemia, osteoporosis, and neurological disorders. This narrative review examines the prevalence and clinical implications of micronutrient deficiencies in BS patients, as well as evidence-based strategies for their prevention and management. The most common deficiencies include iron, vitamin B12, folate, calcium, vitamin D, and fat-soluble vitamins (A, E, and K). Procedures with a hypoabsorptive component, such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS), pose higher risks of deficiencies compared to restrictive procedures like sleeve gastrectomy (SG). Effective strategies involve the preoperative correction of deficiencies, continuous monitoring, and tailored supplementation. However, long-term adherence to supplementation tends to decrease over time, influenced by behavioral and socioeconomic factors. Hence, preventing and managing micronutrient deficiencies are crucial for the long-term success of BS. While current guidelines provide valuable recommendations, many are based on low-certainty evidence, underscoring the need for more robust studies. A multidisciplinary approach, combined with innovative strategies, such as telemedicine, can enhance adherence and achieve sustainable clinical outcomes.

Preoperative Nutrition in Bariatric Surgery: A Narrative Review on Enhancing Surgical Success and Patient Outcomes

Bariatric surgery has become the preferred treatment for individuals with morbid obesity. Nutrition is key in optimizing surgical outcomes by reducing risks and enhancing recovery. Preoperative strategies, such as reducing body fat, decreasing liver size, and improving metabolic profiles, have been shown to facilitate safer surgical procedures with fewer complications. This narrative review aims to provide an analysis of the fundamental role of preoperative nutritional management in improving bariatric surgery outcomes, emphasizing the importance of addressing specific nutritional challenges to enhance surgical safety, recovery, and overall health. Preoperative nutritional interventions focus on correcting comorbidities and nutritional deficiencies, particularly hypovitaminosis and micronutrient imbalances, through a multidisciplinary approach involving nutritionists and other healthcare professionals. These interventions not only prepare patients for the physiological demands of surgery but also initiate a period of adaptation to new dietary habits, aiming to improve long-term compliance and mitigate risks such as postoperative weight regain and dumping syndrome. Adopting dietary changes, such as very low-calorie or ketogenic diets 6-12 weeks before surgery, enhances adherence to postoperative restrictions and overall surgical success. Future research should focus on developing comprehensive guidelines for preoperative nutritional care to improve patient outcomes globally.

Metabolic/bariatric surgery optimization: a position statement by Arabic association for the study of diabetes and metabolism (AASD)

For patients considering bariatric surgery, it is essential to have clear answers to common questions to ensure the success of the procedure. Patients should understand that surgery is not a quick fix but a tool that must be complemented by lifestyle changes, including dietary adjustments and regular physical activity. The procedure carries potential risks that should be weighed against the potential benefits. Health authorities play a critical role in ensuring that bariatric surgery is performed under the highest standards of care. Recommendations are provided to determine who is an appropriate candidate for surgery, what preoperative evaluations are necessary, and how to monitor patients postoperatively to maximize outcomes and minimize risks. Additionally, authorities are responsible for ensuring access to follow-up care, including nutritional support and psychological counseling, which are vital for the long-term success of bariatric surgery.Understanding these aspects by both patients and decision-makers is critical before proceeding with bariatric surgery. The following questions guide patients and healthcare professionals in making informed decisions about the procedure and managing the expectations and outcomes associated with bariatric surgery.

Patient adherence, satisfaction and changes in anthropometric parameters with e-health versus in-person monitoring in metabolic bariatric surgery patients: A study protocol for a systematic review and non-inferiority meta-analysis of cohort studies

BACKGROUND

Obesity is a risk factor for cardiovascular diseases and associated with reduced life expectancy metabolic bariatric surgery (MBS) is the treatment indicated when patients are unable to lose weight through lifestyle changes and medication alone. However, more evidence is necessary to show non-inferiority of e-health compared to in-person monitoring with regard to important parameters for the success of surgical treatment of obesity such as anthropometric changes.

METHODS AND ANALYSES

This review study will include cohort studies involving individuals with obesity and e-health or in-person patient monitoring before and after MBS. This study protocol was registered in the PROSPERO (CRD42023491051). We will conduct searches in the following databases: PubMed, EMBASE (Elsevier), Cochrane (CENTRAL), Web of Science, SCOPUS and CINAHL (EBSCO) and LILACS-VHL. We will also search databases in the gray literature. The primary outcomes will be changes in body mass index (BMI), body weight (kg) and body fat percentage (BF%) and patient adherence and satisfaction. The risk of bias of individual eligible studies will be assessed using the Newcastle-Ottawa Scale and the overall quality will be assessed using the GRADE tool. Our analyses will involve comparisons of mean differences or standardized mean differences across the groups using random-effects models and 95% confidence intervals. Statistical analyses will be performed with RStudio for Windows (v1.3.959) using R package meta (v3.6.1).

DISCUSSION AND CONCLUSION

Our study can offer evidence that shows the benefits of e-health patient monitoring of individuals undergoing MBS and supports scaling up this care modality to reduce waiting times and health care costs.

Received and Desired Support Needs of Postoperative Bariatric Surgery Patients

Obesity is a worldwide health concern with one highly effective solution being bariatric surgery. The purpose of this descriptive study was to explore the experiences of postoperative bariatric surgery patients related to perceptions of helpful interventions for achieving and maintaining weight loss. Fifteen participants shared their perceived support received and their perceptions of desired support needed after bariatric surgery. The results indicated that the participants felt they primarily received support from their spouse/significant other and others who had surgery. They felt additional support was needed in the areas of nutrition, exercise, mental/emotional health, and expected stages of recovery, provided during the time when the information was needed. According to the participants, this support could be delivered in online educational modules or via telemedicine. While bariatric surgery can result in significant weight loss, ongoing support is necessary to help patients address postsurgical complications, adjustment to lifestyle modifications, maintenance of weight loss, and emotional support during times of stress.

Long-Term Follow-Up After Bariatric Surgery: Key to Successful Outcomes in Obesity Management

Background/Objectives: Bariatric surgery (BS) is considered one of the most effective interventions for the treatment of obesity. To achieve optimal long-term results, continuous follow-up (FU) within a multidisciplinary treatment team is essential to ensure patient compliance and maximize the benefits of BS. However, many patients find it difficult to maintain regular FU, which can affect the quality of care and lead to postoperative complications. This review aims to highlight factors that may hinder compliance with FU after BS, examine potential causes and consequences of inadequate FU, and identify strategies to improve patient participation in long-term FU. Methods: The literature search was conducted between October 2023 and June 2024 in Medline (PubMed) and the Cochrane Library datasets. Studies were selected for their relevance to adherence to FU, multidisciplinary approaches, and long-term bariatric outcomes. Results: The pre- and postoperative period is critical for educating patients and healthcare team members about the importance of FU, addressing potential barriers (e.g., logistical, psychological, and social challenges), and highlighting the risk of relapse to obesity after surgery. The lack of a standardized FU protocol leads to differences between medical centers, further impacting patient adherence. Conclusions: Tailored and regularly updated strategies are essential to address individual patient needs and improve adherence to FU. Further research is needed to identify the specific factors that influence variability in long-term BS outcomes, highlighting the need for a patient-centered approach to obesity treatment.

A systematic review on clinical practice guidelines for managing pregnancy following metabolic-bariatric surgery

OBJECTIVE

The ongoing pandemic of obesity is associated with an increase of weight loss surgeries in women of reproductive age. This study was conducted to review clinical practice guidelines (CPGs) for managing pregnancy following metabolic-bariatric surgery.

METHODS

We conducted a comprehensive literature search of all CPGs that covered the management of pregnancy following metabolic-bariatric surgery, 2010 through 2022, and that were published in English. Two authors independently scored the quality and usefulness of CPGs using the Appraisal of Guidelines for Research and Evaluation II tool (AGREE II).

RESULTS

From a total of 20 CPGs, consistent recommendations included the following: 1) contraception with long-acting reversible contraceptives before surgery until the optimal time of pregnancy; 2) nutritional care by a dietitian; 3) considering gastrointestinal discomforts during pregnancy as a potential surgical complication; and 4) modified screening for gestational diabetes instead of glucose tolerance tests preventing post-bariatric hypoglycemia. There was a lack of uniformity concerning surgery-to-conception interval and dose of supplements, as well as research gaps regarding the surgical type, mental health, delivery type, breastfeeding, neonatal care, and weight retention.

CONCLUSIONS

All recommendations for managing pregnancy after metabolic-bariatric surgery were deemed clinically useful. Although consistent recommendations should be implemented, inconsistencies should be the focus of research.

Does Patient's Metabolic and Bariatric Surgery Knowledge Predict Optimal Clinical Outcomes?

PURPOSE

Preoperative evaluation and educational training are required before metabolic and bariatric surgery. This study evaluates patient's comprehension prior to the operation and identifies the relationship between certain sociodemographic parameters and surgery outcomes.

MATERIALS AND METHODS

An analysis of patients who completed a preoperative questionnaire and underwent metabolic and bariatric surgery between 2019 and 2021 was performed. The questionnaire evaluated surgery preparation and factors influencing weight loss after surgery.

RESULTS

In total, 81 patients completed the preoperative questionnaire. Mean age was 44 ± 11.69 years, 63 females (77%). Mean BMI was 42.85 ± 5.72 kg/m2. Roux-en-Y gastric bypass, sleeve gastrectomy, and one anastomosis gastric bypass was performed in 10 (12.3%), 28 (34%), and 43 (53%) patients respectively. Out of the patients, 38 (47%) were Israeli born Jews, 14 (17.3%) were Russian born Jews, and 29 (35.8%) were Israeli born Arabs. Mean follow-up was 30.71 ± 8.66 months. Questionnaire scores average was 67.7 ± 16.15. Based on univariate analysis, younger, single, higher educated, fewer offspring, and Israeli born Jews significantly scored higher in the questionnaire (p = 0.03, 0.05, 0.01, 0.0002, 0.02 respectively). Postoperational weight loss was significantly inferior among older patients, revisional procedures, and patients with lower educational levels (p = 0.02, 0.006, 0.05 respectively). Patients with a higher BMI, and fewer offspring had a significantly higher weight loss postoperatively (p = 0.0001, 0.02 respectively).

CONCLUSION

The number of factors can influence optimal weight loss following metabolic and bariatric surgery. Identifying groups with certain characteristics and addressing their weaknesses may improve weight loss outcomes.

Bariatric Surgery and Metabolic Status

Background and Objectives: Obesity is associated with numerous co-morbidities, including dyslipidemia, insulin resistance and diabetes mellitus. Bariatric surgery is the mainstay of treatment for obesity as the only method with confirmed long-term effects in weight reduction and the remission of comorbidities. Postoperative recommendations leading to changes in dietary habits and changes in digestion and absorption in the gastrointestinal tract after bariatric surgery may additionally influence the levels of laboratory parameters that reflect the metabolic and nutritional status. The purpose of the study was to analyze the possible influence of changes in dietary habits after bariatric surgery on those laboratory results that reflect the metabolic and nutritional status. Materials and Methods: This was a retrospective study of 88 patients with a history of bariatric surgery. Data were gathered from before the surgery and at 6 months after the surgery and included diet structure and selected laboratory parameters reflecting the metabolic and nutritional status, i.e., levels of fasting glucose, glycated hemoglobin, cholesterol, low- and high-density lipoproteins, triglycerides, alanine and aspartate aminotransferases, proteins, ferrum, ferritin, vitamin B12, folic acid, vitamin D and calcium, the red blood cell count and the hematocrit. Results: Postoperative festive glucose levels were reduced by 14% and were more significant in patients after Roux-en-Y gastric bypass. There was an increase of 22% in concentrations of high-density lipoproteins. Triglyceride concentrations were reduced by 32%. Aminotransferase levels decreased by 43% for alanine aminotransferase and by 14% for aspartate aminotransferase. Among the changes in dietary habits, post-bariatric patients had a reduced consumption of red meat and an increased consumption of fish, milk and dairy products and wholegrain products. Vitamin D and ferrum levels were higher after the surgery, whereas vitamin B12 and folic acid levels remained unchanged. Conclusions: Improved dietary habits of patients after bariatric surgery may lead to changes in laboratory parameters that reflect the ameliorated metabolic and nutritional status of patients after bariatric surgery.

Phenotyping of Obesity Treatment Candidates: A Narrative Review

PURPOSE OF REVIEW

This review explores characterizing candidates for obesity treatments including pharmacotherapy, endoscopic bariatric therapies, and metabolic bariatric surgery (MBS), focusing on established clinical parameters for diagnosing obesity beyond body mass index alone.

RECENT FINDINGS

Existing literature primarily provides rates for fat mass percentage (i.e., a marker for adiposity quantity), waist circumference (i.e., a marker for adiposity distribution), and C-reactive protein levels (i.e., a marker for adiposity functionality) among obesity treatment candidates. Limited data on abnormal values and sex-based differentiation exist. The literature indicates high central-tendency measures for fat mass percentage and waist circumference, while C-reactive protein levels vary. Data on the Edmonton Obesity Staging System (i.e., a marker for adiposity-related disease severity) is predominantly available for MBS candidates. Future studies in obesity interventions should improve screening and diagnosis of obesity by incorporating sex-specific considerations and providing abnormal value rates for measurements to enhance understanding of patients' characteristics.

Positive Program Evaluation and Health Maintenance among Post-Metabolic and Bariatric Surgery Patients Following a 6-Week Pilot Program

PURPOSE

Despite lifestyle changes and medication therapies, weight loss is difficult to maintain. Metabolic and bariatric surgery (MBS) is an effective route for significant weight reduction. However, post-operation there are limited opportunities to support weight loss maintenance. The following study aimed to pilot test a 6-week, 6-session nutrition and support program for post-MBS surgery patients.

MATERIALS AND METHODS

A 6-week post-MBS pilot nutrition and support program was developed to test feasibility and acceptability. Participants completed a baseline survey that included demographics, weight changes, success post-surgery, and self-efficacy of leading a healthy lifestyle. Weight change, percent total weight loss, self-efficacy, and program evaluation measures were assessed.

RESULTS

Participants (n = 18) were recruited from a local MBS clinic, predominately female (88.9%), non-Hispanic white (94.4%), received sleeve gastrectomy surgery (100%), and were 2-3 years post-operation (44.4%). Eight of the 18 participants attended the in-person sessions, serving as the intervention group. Both weight loss over and behavioral variables remained stable for both groups across the 6 weeks with no significant differences from pre to post program (p > 0.05). For program evaluation, intervention participants "agreed" or "strongly agreed" with 10 of 11 program satisfaction measures.

CONCLUSION

Following the program, weight loss was maintained among both intervention and control groups. Intervention feedback indicated that the program's approach to provide nutrition education and support was successful and acceptable. Future enhancement of the intervention should include a broader multidisciplinary approach, longer intervention period, and intentional recruitment of participants with a weight regain.

Management of Severe Malnutrition Post-bariatric Surgery Using Artificial Nutrition

BACKGROUND

Bariatric surgery (BS) results in major and sustained weight loss and improves comorbidities in patients with obesity but can also lead to malnutrition, especially through severe malabsorption and/or surgical complications. Little is known about the efficacy of artificial nutrition (AN) in this setting.

METHODS

In this case series, we describe data from consecutive severely malnourished patients after BS (resectional and non-resectional), managed by AN at our hospital unit over a 4-year period.

RESULTS

Between January 2018 and June 2022, 18 patients (mean ± SD age 42.2 ± 10.4 years, 94% women) required AN following BS complications. At the time of AN initiation, more than half of the patients (53%) had multiple revisional surgeries (up to four). Mean BMI was 49.7 ± 11.3 kg/m2 before BS and 29.6 ± 9.6 kg/m2 when AN was initiated. Most patients (n=16, 90%) received enteral nutrition. AN management resulted in weight regain (+4.7kg ± 8.0, p=0.034), increased serum albumin (+28%, p=0.02), pre-albumin (+88%, p=0.002), and handgrip strength (+38%, p=0.078). No major AN complication nor death was observed. Median total AN duration was 4.5 months [1-12]. During follow-up, the cumulative duration of hospitalization was 33 days [4-88] with a median of 2.5 hospitalizations [1-8] per patient.

CONCLUSION

Malnutrition can occur after any BS procedure, and AN when required in this setting appears safe and effective on nutritional parameters. It is important to recognize the potential risk factors for malnutrition, which include excessive weight loss resulting from surgical complications, eating disorders, multiple revisional BS, and pregnancy.

Psychometric Analysis of the Rapid Eating Assessment for Participants-Short Form to Evaluate Dietary Quality in a Pre-Surgical Bariatric Population

Dietary quality and eating behaviors are essential to evaluating bariatric surgery candidates. The Rapid Eating Assessment for Participants-Short Form (REAP-S) is a previously validated measure of dietary quality suited for use in primary care. This study aimed to evaluate the psychometric properties of the REAP-S in a pre-surgical bariatric population. This study included data from one academic medical center from August 2020 to August 2022. Variables included socio-demographics, the REAP-S, mental health, and assessments of appetitive traits. Statistical methods included Cronbach's alpha, confirmatory factor analysis (CFA), and multivariable analyses. A total of 587 adult patients were included in this analysis. The mean score for the REAP-S was 28.32 (SD: 4.02), indicative of relatively moderate dietary quality. The internal consistency of the REAP-S was moderate, with a Cronbach's alpha of 0.65. The three-factor CFA model resulted in a comparative fit index of 0.91. Race (p = 0.01), body mass index (p = 0.01), food fussiness (p < 0.0001), food responsiveness (p = 0.005), and socially desirable responses (p = 0.003) were significantly associated with the total REAP-S score. Although the REAP-S's original purpose was to assess dietary quality within a primary care population, it shows promise for application within a bariatric surgery-seeking population.

Nutritional Interventions for Patients with Severe Obesity Seeking Bariatric Surgery

Bariatric surgery (BS) is usually considered when other weight-loss treatments have failed, and remains an effective long-term treatment for severe obesity and its related medical complications [...].

The relationship between preoperative weight loss and intra and post-bariatric surgery complications: an appraisal of the current preoperative nutritional strategies

Preoperative weight loss before a bariatric surgery reduces long-term complications, but there is no solid evidence for short-term or perioperative complications. This review highlights recent evidence on dietary protocols and the possible correlation between weight loss and surgical complications. Updated evidence was searched in PubMedDirect with the terms "preoperative very low-calorie diet or very-low-calorie ketogenic diet or low-fat diet or intermittent fasting or Mediterranean diet and bariatric surgery or bariatric surgery complications." The main characteristics of each diet, achievements related to weight loss, liver reduction, peri and postoperative outcomes, surgical complications, tolerance, and adherence to the diet are presented from the selected studies. There are few reports about the Mediterranean diet as a strategy to reach these goals. The VLCKD has been associated with better body weight reduction and lesser postoperative complications risk. However, the results in animal models are still controversial. When comparing VLCD with an LCD, there is no apparent superiority between one against the other one. However, LCD has shown better tolerance and adherence than VLCD. There is still a need for more controlled studies to define the best preoperative dietary treatment for weight loss before bariatric surgery since there are controversial positions regarding this issue.

Food Addiction and Binge Eating Impact on Weight Loss Outcomes Two Years Following Sleeve Gastrectomy Surgery

BACKGROUND

Emerging evidence suggest that problematic eating behaviors such as food addiction (FA) and binge eating (BE) may alter following bariatric surgery (BS) and impact weight outcomes. We aimed to examine the prevalence of FA and BE and their associations with weight outcomes 2 years post-sleeve gastrectomy (SG).

METHODS

Forty-five women (mean age 32.4 ± 10.9 years) who underwent SG and completed 24 months of follow-up were evaluated prospectively at pre-, 3-, 6-, 12-, and 24-month post-SG. Data collected included anthropometrics, nutritional intake, and lifestyle patterns. The Yale Food Addiction Scale (YFAS) and the Binge Eating Scale (BES) were used to characterize FA and BE, respectively.

RESULTS

Pre-surgery FA and BE were identified in 40.0% and 46.7% of participants, respectively. Following SG, FA and BE prevalence was 10.0%, 5.0%, 29.4%, and 14.2% (P = 0.007), and 12.5%, 4.9%, 18.4%, and 19.4% (P < 0.001) at 3, 6, 12, and 24 months, respectively. Women with BE at baseline gained significantly more weight from the nadir compared to non-BE women at baseline (P = 0.009). There was no relationship between FA at baseline and weight (P = 0.090). Weight regained from the nadir positively correlated with BES scores at baseline (r = 0.374, P = 0.019).

CONCLUSIONS

FA and BE tend to decrease during the early postoperative period, but remains in a notable rates return by 2 years post-SG. Moreover, pre-surgical BE was related to higher weight-regain. Proper management pre-BS should include a comprehensive eating pathologies assessment, as these pathologies may remain or re-emerge post-surgery and lead to worse weight outcomes.

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

Background

This is the second updated Enhanced Recovery After Surgery (ERAS®) Society guideline, presenting a consensus for optimal perioperative care in bariatric surgery and providing recommendations for each ERAS item within the ERAS® protocol.

Methods

A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations.

Results

The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries.

Conclusion

A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.

Nutritional status prior to bariatric surgery for severe obesity: a review

Obesity pandemic represents a threat to public health of paramount importance. Bariatric surgery represents the most effective and long-lasting treatment for severe obesity so far. The nutritional status of obese patients seeking bariatric surgery is impaired prior to surgery because of prevalent nutritional deficiencies. In addition, excess micronutrient levels may also occur, although this finding is not common. The onset of nutritional anomalies encountered in bariatric surgery candidates might stem from the following: obesity itself, poor quality food choices, preoperative weight loss or insufficient/excessive preoperative oral supplementation with vitamins and minerals. Nutritional management should begin preoperatively and should include a comprehensive assessment in order to identify those patients with clinical or subclinical deficiencies and hypervitaminoses. This paper provides background information on the nutritional status of bariatric surgery candidates, as well as on the prevalence and clinical significance of the most common micronutrient deficiencies and excess levels reported preoperatively among these patients.

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.