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Obesity Surgery
Published in: Obesity Surgery 10/2019

01-10-2019 | Bariatric Surgery | Review

Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline

Authors: Mastaneh Rajabian Tabesh, Faezeh Maleklou, Fatemeh Ejtehadi, Zahra Alizadeh

Published in: Obesity Surgery | Issue 10/2019

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Abstract

According to ASMBS, the rate of bariatric surgery increased from 158,000 in 2011 to 196,000 in 2015. Nevertheless, this growth in invasive techniques does not eliminate unhealthy habits, so lifestyle modification such as healthy nutrition and correct physical activity programs may improve surgical results. The objective of the present narrative review was to categorize the guidelines related to nutrition, physical activity, and supplement prescription before and after bariatric surgery. The main key words including nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y gastric bypass, sleeve gastrostomy, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google scholar. The recommendations are classified based on the type of surgery. The indications for surgery and the type of bariatric surgery are not included in this review. This review helps medical teams, including bariatric surgeons, nutritionists, and sports medicine specialists, with proper management before and after bariatric surgery.
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Literature
1.
2.
Gerber P, Anderin C, Thorell A. Weight loss prior to bariatric surgery: an updated review of the literature. Scand J Surg. 2015;104(1):33–9.PubMedCrossRef
3.
Deitel M. How much weight loss is sufficient to overcome major co-morbidities? Obes Surg. 2001;11(6):659.PubMedCrossRef
4.
Ballantyne GH, Svahn J, Capella RF, et al. Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma and the metabolic syndrome. Obes Surg. 2004;14(8):1042–50.PubMedCrossRef
5.
Schwartz ML, Drew RL, Chazin-Caldie M. Laparoscopic Roux-en-Y gastric bypass: preoperative determinants of prolonged operative times, conversion to open gastric bypasses, and postoperative complications. Obes Surg. 2003;13(5):734–8.PubMedCrossRef
6.
Schwartz ML, Drew RL, Chazin-Caldie M. Factors determining conversion from laparoscopic to open Roux-en-Y gastric bypass. Obes Surg. 2004;14(9):1193–7.PubMedCrossRef
7.
Stephens DJ, Saunders JK, Belsley S, et al. Short-term outcomes for super-super obese (BMI≥ 60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass. Surg Obes Relat Dis. 2008;4(3):408–15.PubMedCrossRef
8.
Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux en-Y-500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000;10(3):233–9.PubMedCrossRef
9.
Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):141–5.PubMedCrossRef
10.
Livhits M, Mercado C, Yermilov I, et al. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Relat Dis. 2009;5(6):713–21.PubMedCrossRef
11.
Edholm D, Kullberg J, Karlsson FA, et al. Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass. Surg Obes Relat Dis. 2015;11(3):602–6.PubMedCrossRef
12.
13.
Benjaminov O, Beglaibter N, Gindy L, et al. The effect of a low-carbohydrate diet on the nonalcoholic fatty liver in morbidly obese patients before bariatric surgery. Surg Endosc. 2007;21(8):1423–7.PubMedCrossRef
14.
Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21(3):345–50.PubMedCrossRef
15.
Iannelli A, Martini F, Schneck AS, et al. Preoperative 4-week supplementation with omega-3 polyunsaturated fatty acids reduces liver volume and facilitates bariatric surgery in morbidly obese patients. Obes Surg. 2013;23(11):1761–5.PubMedCrossRef
16.
Lewis MC, Phillips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast® very low calorie diet. Obes Surg. 2006;16(6):697–701.PubMedCrossRef
17.
Van Wissen J, Bakker N, Doodeman H, et al. Preoperative methods to reduce liver volume in bariatric surgery: a systematic review. Obes Surg. 2016;26(2):251–6.PubMedCrossRef
18.
Collins J, McCloskey C, Titchner R, et al. Preoperative weight loss in high-risk superobese bariatric patients: a computed tomography-based analysis. Surg Obes Relat Dis. 2011;7(4):480–5.PubMedCrossRef
19.
Huerta S, Dredar S, Hayden E, et al. Preoperative weight loss decreases the operative time of gastric bypass at a Veterans Administration hospital. Obes Surg. 2008;18(5):508–12.PubMedCrossRef
20.
Liu RC, Sabnis AA, Forsyth C, et al. The effects of acute preoperative weight loss on laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15(10):1396–402.PubMedCrossRef
21.
Still CD, Benotti P, Wood GC, et al. Outcomes of preoperative weight loss in high-risk patients undergoing gastric bypass surgery. Arch Surg. 2007;142(10):994–8.PubMedCrossRef
22.
Csendes A, Burgos AM, Altuve J, et al. Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg. 2009;19(2):135–8.PubMedCrossRef
23.
Cassie S, Menezes C, Birch DW, et al. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Relat Dis. 2011;7(6):760–7.PubMedCrossRef
24.
Ochner C, Dambkowski C, Yeomans B, et al. Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome. Int J Obes. 2012;36(11):1380–7.CrossRef
25.
Parikh M, Dasari M, McMacken M, et al. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study. Surg Endosc. 2012;26(3):853–61.PubMedCrossRef
26.
Hutcheon DA, Byham-Gray LD, Marcus AF, et al. Predictors of preoperative weight loss achievement in adult bariatric surgery candidates while following a low-calorie diet for 4 weeks. Surg Obes Relat Dis. 2017;13(6):1041–51.PubMedCrossRef
27.
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(S1):S1–S27.PubMedCrossRef
28.
Alvarado R, Alami R, Hsu G, et al. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15(9):1282–6.PubMedCrossRef
29.
Medicine ACoS, Roitman JL, Herridge M. ACSM’s resource manual for guidelines for exercise testing and prescription. Lippincott Williams & Wilkins Philadelphia; 2001.
30.
Tsai AG, Wadden TA. The evolution of very-low-calorie diets: an update and meta-analysis. Obesity. 2006;14(8):1283–93.PubMedCrossRef
31.
Schiavo L, Scalera G, Sergio R, et al. Clinical impact of Mediterranean-enriched-protein diet on liver size, visceral fat, fat mass, and fat-free mass in patients undergoing sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(5):1164–70.PubMedCrossRef
32.
Albanese A, Prevedello L, Markovich M, et al. Pre-operative very low calorie ketogenic diet (VLCKD) vs. very low calorie diet (VLCD): surgical impact. Obes Surg. 2019;29(1):292–6.PubMedCrossRef
33.
Gonzalez-Perez J, Sanchez-Leenheer S, Delgado AR, et al. Clinical impact of a 6-week preoperative very low calorie diet on body weight and liver size in morbidly obese patients. Obes Surg. 2013;23(10):1624–31.PubMedCrossRef
34.
Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304–11.PubMedCrossRef
35.
Wadden TA, Stunkard AJ. Handbook of obesity treatment. Guilford Publications; 2002.
36.
de Castro GS, Calder PC. Non-alcoholic fatty liver disease and its treatment with n-3 polyunsaturated fatty acids. Clin Nutr. 2017.
37.
Kunešová M, Braunerova R, Hlavatý P, et al. The influence of n-3 polyunsaturated fatty acids and very low calorie diet during a short-term weight reducing regimen on weight loss and serum fatty acid composition in severely obese women. Physiol Res. 2006;55(1).
38.
Kushner RF, Still CD. Nutrition and bariatric surgery. 2015.
39.
Moizé VL, Pi-Sunyer X, Mochari H, et al. Nutritional pyramid for post-gastric bypass patients. Obes Surg. 2010;20(8):1133–41.PubMedCrossRef
40.
Allied Health Sciences Section Ad Hoc Nutrition C, Aills L, Blankenship J, et al. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S73–108.
41.
Warde-Kamar J, Rogers M, Flancbaum L, et al. Calorie intake and meal patterns up to 4 years after Roux-en-Y gastric bypass surgery. Obes Surg. 2004;14(8):1070–9.PubMedCrossRef
42.
Bobbioni-Harsch E, Huber O, Morel P, et al. Factors influencing energy intake and body weight loss after gastric bypass. Eur J Clin Nutr. 2002;56(6):551–6.PubMedCrossRef
43.
Bavaresco M, Paganini S, Lima TP, et al. Nutritional course of patients submitted to bariatric surgery. Obes Surg. 2010;20(6):716–21.PubMedCrossRef
44.
Miller GD, Norris A, Fernandez A. Changes in nutrients and food groups intake following laparoscopic Roux-en-Y gastric bypass (RYGB). Obes Surg. 2014;24(11):1926–32.PubMedPubMedCentralCrossRef
45.
Brolin RE, Robertson LB, Kenler HA, et al. Weight loss and dietary intake after vertical banded gastroplasty and Roux-en-Y gastric bypass. Ann Surg. 1994;220(6):782–90.PubMedPubMedCentralCrossRef
46.
Steenackers N, Gesquiere I, Matthys C. The relevance of dietary protein after bariatric surgery: what do we know? Curr Opin Clin Nutr Metab Care. 2018;21(1):58–63.PubMedCrossRef
47.
Vidal J, Corcelles R, Jiménez A, et al. Metabolic and bariatric surgery for obesity. Gastroenterology. 2017;152(7):1780–90.PubMedCrossRef
48.
Padwal R, Brocks D, Sharma A. A systematic review of drug absorption following bariatric surgery and its theoretical implications. Obes Rev. 2010;11(1):41–50.PubMedCrossRef
49.
Zerrweck C, Zurita L, Álvarez G, et al. Taste and olfactory changes following laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2016;26(6):1296–302.PubMedCrossRef
50.
Mirica RM, Ionescu M, Mirica A, et al. Quality of life assessment after bariatric surgery—a single-center experience. Indian J Surg. 2017;1–7.
51.
Kanerva N, Larsson I, Peltonen M, et al. Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study. Am J Clin Nutr. 2017;106(1):136–45.PubMedPubMedCentralCrossRef
52.
Faria SL, Kelly E, Faria OP. Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg. 2009;19(7):856–9.PubMedCrossRef
53.
Dagan SS, Tovim TB, Keidar A, et al. Inadequate protein intake after laparoscopic sleeve gastrectomy surgery is associated with a greater fat free mass loss. Surg Obes Relat Dis. 2017;13(1):101–9.CrossRef
54.
Tabesh M, editor. Pattern of calorie and macronutrient intake after bariatric surgery in patient with obesity: a clinical trial. Obesity Surgery; 2018. Springer 233 Spring St, New York, NY 10013 USA.
55.
Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity. 2009;17(S1):S3–S72.CrossRef
56.
Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.PubMedCrossRef
57.
Nutrition after bariatric surgery. Christine Goukasian Linda Y. Yung.
58.
Scopinaro N. Biliopancreatic diversion: mechanisms of action and long-term results. Obes Surg. 2006;16(6):683–9.PubMedCrossRef
59.
Sherf Dagan S, Goldenshluger A, Globus I, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr. 2017;8(2):382–94.PubMedPubMedCentralCrossRef
60.
Beasley JM, Wylie-Rosett J. The role of dietary proteins among persons with diabetes. Curr Atheroscler Rep. 2013;15(9):348.PubMedCrossRef
61.
62.
Schollenberger AE, Karschin J, Meile T, et al. Impact of protein supplementation after bariatric surgery: a randomized controlled double-blind pilot study. Nutrition. 2016;32(2):186–92.PubMedCrossRef
63.
Gomes DL, Moehlecke M, Da Silva FBL, et al. Whey protein supplementation enhances body fat and weight loss in women long after bariatric surgery: a randomized controlled trial. Obes Surg. 2017;27(2):424–31.CrossRef
64.
Castellanos VH, Litchford MD, Campbell WW. Modular protein supplements and their application to long-term care. Nutr Clin Pract. 2006;21(5):485–504.PubMedCrossRef
65.
Moize V, Andreu A, Flores L, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a Mediterranean population. J Acad Nutr Diet. 2013;113(3):400–10.PubMedCrossRef
66.
Coupaye M, Riviere P, Breuil MC, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2014;24(2):276–83.PubMedCrossRef
67.
Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4(5):640–6.PubMedPubMedCentralCrossRef
68.
69.
Al-Najim W, Docherty NG, le Roux CW. Food intake and eating behavior after bariatric surgery. Physiol Rev. 2018;98(3):1113–41.PubMedCrossRef
70.
Moize V, Geliebter A, Gluck ME, et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13(1):23–8.PubMedCrossRef
71.
Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. Can Med Assoc J. 2006;174(6):801–9.CrossRef
72.
Amundsen T, Strømmen M, Martins C. Suboptimal weight loss and weight regain after gastric bypass surgery—postoperative status of energy intake, eating behavior, physical activity, and psychometrics. Obes Surg. 2017;27(5):1316–23.PubMedCrossRef
73.
Smith LL, Larkey L, Celaya MC, et al. Feasibility of implementing a meditative movement intervention with bariatric patients. Appl Nurs Res. 2014;27(4):231–6.PubMedCrossRef
74.
Daniels P, Burns RD, Brusseau TA, et al. Effect of a randomised 12-week resistance training programme on muscular strength, cross-sectional area and muscle quality in women having undergone Roux-en-Y gastric bypass. J Sports Sci. 2018;36(5):529–35.PubMedCrossRef
75.
Hassannejad A, Khalaj A, Mansournia MA, et al. The effect of aerobic or aerobic-strength exercise on body composition and functional capacity in patients with BMI ≥ 35 after bariatric surgery: a randomized control trial. Obes Surg. 2017;27(11):2792–801.PubMedCrossRef
76.
Baillot A, Vallée C-A, Mampuya WM, et al. Effects of a pre-surgery supervised exercise training 1 year after bariatric surgery: a randomized controlled study. Obes Surg. 2018:1–8.
77.
Waldburger R, Schultes B, Zazai R, et al. Comprehensive assessment of physical functioning in bariatric surgery candidates compared with subjects without obesity. Surg Obes Relat Dis. 2016;12(3):642–50.PubMedCrossRef
78.
Creel DB, Schuh LM, Newton Jr RL, et al. Exercise testing reveals everyday physical challenges of bariatric surgery candidates. J Phys Act Health. 2017;14(12):913–8.PubMedCrossRef
79.
de Aquino LA, Pereira SE, de Souza SJ, et al. Bariatric surgery: impact on body composition after Roux-en-Y gastric bypass. Obes Surg. 2012;22(2):195–200.PubMedCrossRef
80.
Wefers JF, Woodlief TL, Carnero EA, et al. Relationship among physical activity, sedentary behaviors, and cardiometabolic risk factors during gastric bypass surgery–induced weight loss. Surg Obes Relat Dis. 2017;13(2):210–9.PubMedCrossRef
81.
Evans RK, Bond DS, Wolfe LG, et al. Participation in 150 min/wk of moderate or higher intensity physical activity yields greater weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2007;3(5):526–30.PubMedCrossRef
82.
Medicine ACoS. ACSM’s guidelines for exercise testing and prescription. Lippincott Williams & Wilkins; 2013.
83.
Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459–71.PubMedCrossRef
84.
85.
Wiklund M, Sundqvist E, Olsén MF. Physical activity in the immediate postoperative phase in patients undergoing Roux-en-Y gastric bypass—a randomized controlled trial. Obes Surg. 2015;25(12):2245–50.PubMedCrossRef
86.
Gudzune KA, Huizinga MM, Chang HY, et al. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23(10):1581–9.PubMedPubMedCentralCrossRef
87.
Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.PubMedCrossRef
Metadata
Title
Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline
Authors
Mastaneh Rajabian Tabesh
Faezeh Maleklou
Fatemeh Ejtehadi
Zahra Alizadeh
Publication date
01-10-2019
Publisher
Springer US
Published in
Obesity Surgery / Issue 10/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04112-y

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