Post-Op Management of Bariatric Surgery

Bariatric surgery has gained wide acceptance as an effective treatment for morbid obesity, especially among those suffering with type 2 diabetes. In 2009, it’s estimated that 200,000 bariatric procedures were performed at a cost of about $5 billion, and these figures are likely to increase as the obesity epidemic continues to grow. Bariatric surgery, however, does not guarantee success, and patients require postoperative care. Approximately 20% of patients either fail to lose weight or regain weight post-surgery. To reduce this likelihood and to ensure that comorbid conditions are managed appropriately, all patients should receive careful medical follow-up after their surgery. In the November 8, 2010 Journal of Clinical Endocrinology & Metabolism, the Endocrine Society published a clinical practice guideline on the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes. The evidence-based recommendations (available online at focus on the immediate postoperative period and long-term management to prevent complications, weight regain, and management of obesity-associated comorbidities. Key Recommendations The guidelines recommend that all patients undergo active nutritional patient education and clinical management to prevent and identify deficiencies after bariatric surgery. The management of nutritional deficiencies is especially important for patients undergoing malabsorptive procedures (eg, Roux-en-Y gastric bypass). To be most successful during and after surgery, a proficient surgical program—preferably one that has been accredited by a national certifying group—and an integrated medical support team that offers proven dietary and behavioral strategies should be available to patients postoperatively and during long-term follow-up. Postoperative treatment of weight regain should include diet instruction, increased physical activity, behavior modification, and possibly pharmacologic therapy. An average daily protein intake of 60 g...