The Endocrinologist’s Role in Bariatric Surgery

Bariatric surgery is indicated for certain high-risk patients who have clinically severe obesity. A key aspect of care for the post-bariatric surgery patient population is addressing non-surgical aspects of perioperative care, most notably nutritional and metabolic support. Clinical endocrinologists can and should play a central role in assisting bariatric surgery patients with this support and in making decisions on the most appropriate bariatric operation to select. A multidisciplinary team approach has been emphasized in the care of patients with metabolic diseases, including obesity, but this emphasis has not been as strong for patients undergoing or considering bariatric surgery. Clinical endocrinologists have been largely underutilized in bariatric surgery. However, these specialists can be of great assistance by: Helping manage the causes and complications of obesity. Discussing surgical risks and benefits, procedural options, and choices of surgeon and medical institution. Providing patients with education and guidance throughout the course of treatment. Nutritional Evaluation Before Bariatric Surgery According to guideline recommendations, all patients considering bariatric surgery should undergo an appropriate nutritional evaluation, including selective micronutrient measurements, before any procedure is performed. Clinical endocrinologists can help during this phase of treatment, especially for malabsorptive procedures in which more extensive perioperative nutritional evaluations are required. They can also assist patients during their protocol-derived staged meal progression based on the type of surgical procedure that is selected. Patient education on nutrition and meal-planning guidance before bariatric surgery and during the early postoperative hospital course is critical. This education can be reinforced during future outpatient visits. Additional education can be given on a balanced meal plan; appropriate intake of protein, nutritional supplements, and fluids; and parenteral...