1. Top Ten Things You Need to Know About Bariatric Surgery Patients
Laura Dyck, M.S., R.D., LDN
Comprehensive Weight Management Center,
Kingsport, TN

2. Top Ten Things You Need to Know About Bariatric Surgery Patients
1) Who qualifies?
2) Surgery options
3) Who benefits?
4) Who may NOT be a good candidate?
5) How safe is the
surgery?
6) Where should I refer candidates for surgery?
7) Post-Op diet
8) Supplements/Lab
Monitoring
9) Post-Op exercise
10) Other potential
issues related to
bariatric surgery

3. 1) Who Qualifies?
BMI of with co-morbid conditions OR >40 without co- morbid conditions
Documented failed attempts at weight loss
Weight Class
BMI (kg/m2)
Normal Weight
Overweight
Obesity (Class I)
Obesity (Class II)
Morbid Obesity (Class III)
>40.0

4. Who Qualifies?
Able to comprehend, and motivated for, lifelong lifestyle changes
Committed to lifelong medical monitoring
Willing to give up tobacco, NSAIDs
Age range (typical) ~ years
Able to obtain psychological clearance for surgery.

5. Who Qualifies?
Many insurances cover surgery (Medicare and Medicaid do cover)- Must complete insurance company requirements (medical weight management, weight loss requirements, etc.)
PCP and/or FNP may provide medical weight management (designated number of consecutive monthly appts., solely to discuss diet, exercise and behavior change)

6. 2) Common Surgical Options for Weight Loss
Restrictive- Gastric banding & sleeve gastrectomy (sleeve can be Part One of 2 part procedure)
Malabsorptive- Biliopancreatic diversion & biliopancreatic diversion with duodenal switch
Combination- Roux-en-Y gastric bypass

7. Common Surgical Options for Weight Loss- Gastric Banding
Images Courtesy of Ethicon

8. Common Surgical Options for Weight Loss- Sleeve Gastrectomy
Image Courtesy of Ethicon

9. Common Surgical Options for Weight Loss- Gastric Bypass
Image Courtesy of Ethicon

10. Common Surgical Options for Weight Loss- Comparison
Gastric Banding
35-50 % Weight Loss*
In 2-3 years
Gastric Bypass
70-75 % Weight Loss*
In 9-12 months
*%ages refer to “Excess Weight” Lost
Sleeve Gastrectomy
50-70 % Weight Loss*
In 12 months

11. Common Surgical Options for Weight Loss- Which is Best?
Depends on many individual factors:
How much weight to lose?
Which is safest given body shape/size?
Compliance with dietary changes?
Work/family schedule?
Geographic location?

12. 3) Who Benefits? Obese patients with: GBP1 Sleeve2 Band1
1) Diabetes
2) Hypertension
3) High Cholesterol
4) Sleep Apnea
Resolved 83.7%
Resolved 67.5%
Improved 94.9%
Resolved 80.4%
R- 56%
R- 49%
R- 43%
R- 60%
R- 47.8%
R- 43.2%
I- 78.3%
R 94.6%
Improvements/Resolution also seen with:
-GERD3 -Depression4 -Osteoarthritis/Joint Pain4
-Stress Urinary Incontinence4 -Menstrual dysfunction d/t PCOS5
-Ovulation and Fertility Restored5 -Quality of Life/Increased Activity1

13. 4) Who may NOT be a Good Candidate for Surgery?
Have other untreated medical conditions that may have caused obesity
Psychological or cognitive limitations that jeopardize informed consent and cooperation with long term follow-up
Immobility
Medical issues that make surgery too risky

14. Who may NOT be a Good Candidate for Surgery?
Unwilling to give up tobacco & NSAIDs
Hepatic cirrhosis with impaired liver function
Active Drug/Alcohol Abuse
Not willing to/motivated to make lifelong lifestyle changes
Patient is pregnant

15. 5) How Safe is Surgery?
Bariatric surgery holds no more risk than gallbladder or hip replacement surgery- the risks of surgery are lower than long term risks of living with obesity (increasing risks of dying due to heart disease, diabetes, etc. daily)6

16. How Safe is Surgery? Bariatric surgery is now endorsed by the:
American Heart Association
American Diabetes Association
International Diabetes Federation
American Association of Clinical Endocrinologists

17. Risks and Complications
Dumping Syndrome (a blessing & a curse!)
Bleeding
Infections
Complications with anesthesia
Blood clots
Injury to stomach, esophagus, surrounding organs
Leaks or blockages at site where tissue has been sewn or stapled

18. 6) Where should I refer candidates for surgery?
Look for a: Bariatric Surgery Center of Excellence

19. Where should I refer candidates for surgery?
The American Society for Metabolic and Bariatric Surgery (ASMBS) + the American College of Surgeons (ACS)=
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program
(MBSAQIP)

20. Holding a Center of Excellence Designation Means Centers Are:
Accountable for the quality and safety of surgery in their center
Participating in ongoing data collection/analysis
Going through a site inspection/approval process every 3 years
Stressing safety, proficiency and volume

21. Holding a Center of Excellence Designation Means Centers Are:
Requiring a multidisciplinary team for appropriate patient care
Hosting monthly support group meetings for patients
Dedicated to long term follow-up (Patients should be followed by their bariatric surgeon for LIFE!)

22. QUIZ TIME!

23. Which foods will I need to avoid after gastric bypass surgery?
Alcohol
Carbonated beverages
Sugar
All of the above

24. Which foods will I need to avoid after gastric bypass surgery?
Alcohol
Carbonated beverages
Sugar
All of the above

25. After surgery I will need to:
Chew my food thoroughly
Take minutes to eat a meal
Eat and drink at the same time
a & b

26. After surgery I will need to:
Chew my food thoroughly
Take minutes to eat a meal
Eat and drink at the same time
a & b

27. Xylitol, Lactitol and Sorbitol found in foods are classified as:
Sugar
Sugar Alcohols
Fat
Preservatives

28. Xylitol, Lactitol and Sorbitol found in foods are classified as:
Sugar
Sugar Alcohols
Fat
Preservatives

29. Chewing gum is not allowed
Chewing gum is not allowed. If you do chew it and swallow it you might have which complication?
Ulcer formation
Headache
Diarrhea
Outlet obstruction of your gastric pouch

30. Chewing gum is not allowed
Chewing gum is not allowed. If you do chew it and swallow it you might have which complication?
Ulcer formation
Headache
Diarrhea
Outlet obstruction of your gastric pouch

31. Fat Sugar Sugar Alcohols All of the above
Dumping Syndrome after gastric bypass (and possibly sleeve gastrectomy) can occur by eating foods high in:
Fat
Sugar
Sugar Alcohols
All of the above

32. Fat Sugar Sugar Alcohols All of the above
Dumping Syndrome after gastric bypass (and possibly sleeve gastrectomy) can occur by eating foods high in:
Fat
Sugar
Sugar Alcohols
All of the above

33. 7) Post-Op Diet
“Phases” are slowly progressed through for ~8-12 weeks after surgery
Diet for life is a low fat, sugar free, balanced diet with smaller serving sizes
60-75 grams of Protein/day

34. Post-Op Diet STOP when full- otherwise, will lead to N/V
CHEW WELL- otherwise, will lead to N/V
Dumping Syndrome with high fat and/or high sugar foods after Gastric Bypass (and mild dumping is possible after sleeve gastrectomy)

35. Post-Op Diet Separate foods/fluids by at least 30 minutes
Fluid goals: 6-8 cups/day, SF, non-carbonated, caffeine free, non-caloric
Avoid Alcohol- ESPECIALLY GBP patients

36. 8) Post-Op Supplements/Lab Monitoring
Sleeve Gastrectomy/Gastric Banding
MVI/Mineral Supplement daily
Calcium Citrate mg/day
Gastric Bypass
Vitamin B mcg/day sublingual or 1000mcg IM injection/month
Iron (for menstruating women or if directed by MD or FNP) mg of Ferrous Sulfate daily

37. Post-Op Labs to Monitor/Check
CMP (electrolytes, albumin, etc.)
CBC
Serum B12 (especially with GBP)
Ferritin/Iron Profile
Lipid Panel
25-hydroxyvitamin D or ionized Calcium

38. Is an absolute MUST!!! 9) Post-Op Exercise
Patients should gradually work up to goal of 45 minutes- 1 hour of exercise most days of the week.
Should have education pre-operatively and resources, if needed

39. Post-Op Exercise
Support groups are great places to build on exercise knowledge
Utilize community resources (parks, rec centers, senior’s centers, gyms, Med Fit Center, etc) and nationally offered resources (National Institute on Aging, Go4Life Exercise and Physical Activity Books/DVD)

40. 10) Other Potential Issues Related to Bariatric Surgery
Ulcers/Reflux (Don’t smoke/Avoid NSAIDs)
Incisional hernias (especially if open procedure)
Loose skin
Hypoglycemia
Strictures
Addiction Transfer Syndrome
Weight Regain (~10% regain is normal)

41. References
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292:
EES summary of data contained in review article: Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:
Wittgrove A, Clark G. Laparoscopic gastric bypass, Roux-en-Y patients: technique and results, with 3-60 month follow-up. Obes Surg ;10(3):
Schauer P, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):
Eid GM, Cottam DR, Velcu LM, et al. Effective treatment of polycystic ovarian syndrome with roux-en-Y gastric byapss. Surg Obes Related Dis ;2:77-80.
The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. N Engl J Med ;361:

42. QUESTIONS?