1. Carly Pabon NTR 573 Spring 2014

2.  The different types of bariatric surgery, their prevalence, and effectiveness.  Qualifications for bariatric surgery.  Recommended diets prior to and following surgery.  Role of a Registered Dietitian throughout process.

3.  Bariatric Surgery ◦ Category of weight loss surgeries ◦ Change your stomach and digestive system by limiting how much food you eat and the nutrients you can absorb.  Most effective and long lasting treatment for morbid obesity and related conditions, resulting in significant weight loss.  Over 200,000 people have bariatric surgery each year in the United States.

4.  Roux-en-Y Gastric Bypass (RYGB) ◦ Comprises 80% of all weight loss surgery in U.S. ◦ Decreases how food is absorbed ◦ Stomach, duodenum, and upper intestine have no contact with food  Adjustable Gastric Band (AGB) ◦ Second most common weight loss surgery ◦ A band restricts the opening from throat to stomach creating a pouch

5.  Biliopancreatic Diversion with a duodenal switch (BPD) ◦ Accounts for >5% of all weight loss surgery ◦ Removes large part of stomach ◦ Reroutes food away from small intestine  Vertical Sleeve Gastrectomy ◦ Not as common ◦ Large portion of the stomach is removed

6. http://www.meditourcz.com/wp-content/uploads/2012/06/bariatric-surgeries.jpg

8. Adults (18 and over)Children (Under 18)  BMI > 40 or >100 lbs overweight  BMI > 35 with 2 or more obesity-related comorbidities  Inability to lose weight over a period of time with weight loss efforts  BMI > 40  Adult height  Serious obesity-related health problems that will improve with surgery  Failure to lose weight after 6 months of effort

9.  Modify diet 1-2 weeks prior to surgery  Decrease fatty, sugary, and high carbohydrate foods  Avoid alcohol  Increase protein  Why? ◦ Improve surgical outcome/recovery time ◦ Prepare for muscle and tissue repair

11.  At least 1-2 days post-surgery  Sip 2-3 oz of fluid at a time ◦ Non-caffeinated ◦ Non carbonated  No more that ½ cup total per meal

12.  Day 3 to 4 weeks  No more than ¾ cup total per meal  Consistency of thick paste with no chunks

13.  4-8 weeks  Meals should be ¾ cup-1 cup total  Foods that can be mashed with a fork

14.  8 weeks and beyond  No more than 1 cup total per meal  Meat should be no more than 2 ozAvoid

15.  Poor absorption can lead to vitamin and mineral deficiencies  Adult multivitamin  Calcium citrate  Vitamin B12  B-Complex Vitamin  Vitamin D

16.  Strictures  Hernias  Dumping syndrome  Constipation  Nausea/vomiting  Blocked opening of stomach pouch  Weight gain or weight loss failure

17.  Exercise  Eat small meals  Take recommended supplements  Eat and drink slowly  Drink between meals

18. What are the benefits? Resolves: Dyslipidemia Hypercholesterolemia Metabolic Syndrome Type 2 Diabetes GERD Hypertension Reduces the risk of cardiovascular disease by 82% 30-40% reduction in 10-year mortality

19.  http://nutritioncaremanual.org/vault/editor/Docs/GastricSurger yNutritionTherapy_FINAL.pdf http://nutritioncaremanual.org/vault/editor/Docs/GastricSurger yNutritionTherapy_FINAL.pdf  Pre-Operative ◦ Educate patient on associated nutritional therapy ◦ Perform nutrition assessment ◦ Set dietary goals ◦ Assist patient in preparing for transition diet after surgery  Post-Operative ◦ Counseling during early transition post surgery and periodically after ◦ Minimize risk of nutritional deficiencies ◦ Assist patient during transition diet ◦ Address possible side effects (ex. Dumping syndrome)

20.  Pre-Surgery ◦ Excessive oral intake related to inability to limit or refuse foods despite repeated attempts to modify eating habits as evidenced by large portions of calorically dense foods recorded in food diary.  Post-Surgery ◦ Food and knowledge deficit related to lack of prior exposure to information as evidenced by demonstrating an inability to apply food and nutrition-related information.

21.  Nguyen, N.T, H Masoomi, C.P Magno, X.M.T Nguyen, K Laugenour, and J Lane. "Trends in Use of Bariatric Surgery, 2003-2008." Journal of the American College of Surgeons. 213.2 (2011): 261-266. Print.  Evidence-based Nutrition Practice Guideline on bariatric surgery published at http://andevidencelibrary.com/topic.cfm?cat=1406and copyrighted by the Academy of Nutrition and Dietetics.  http://www.dukehealth.org/services/weight_loss_surgery/care_guides/bariatr ic_surgery_diet_manual/the_recommended_diet_following_bariatric_surgery http://www.dukehealth.org/services/weight_loss_surgery/care_guides/bariatr ic_surgery_diet_manual/the_recommended_diet_following_bariatric_surgery  http://www.mayoclinic.org/tests-procedures/bariatric-surgery/in- depth/gastric-bypass-diet/art-20048472 http://www.mayoclinic.org/tests-procedures/bariatric-surgery/in- depth/gastric-bypass-diet/art-20048472  http://www.saintclares.org/assets/Uploads/Bariatrics_Images/SaintClaresPostBaria tricSurgeryDietProgression.pdf http://www.saintclares.org/assets/Uploads/Bariatrics_Images/SaintClaresPostBaria tricSurgeryDietProgression.pdf  http://www.nationalbariatriclink.org/pre-bariatric-surgery-diet.html http://www.nationalbariatriclink.org/pre-bariatric-surgery-diet.html  American Society for Metabolic & Bariatric Surgery http://www.asmbs.orghttp://www.asmbs.org  National Institutes of Health: National Institute of Diabetes and Digestive and Kidney Diseases http://win.niddk.nih.gov/publications/PDFs/Bariatric_Surgery_508.pdf http://win.niddk.nih.gov/publications/PDFs/Bariatric_Surgery_508.pdf  Kulick, D, L Hark, and D Deen. "The Bariatric Surgery Patient: a Growing Role for Registered Dietitians." Journal of the American Dietetic Association. 110.4 (2010): 593-9. Print.  http://gastro.oxfordjournals.org/content/early/2013/08/10/gastro.got023.full http://gastro.oxfordjournals.org/content/early/2013/08/10/gastro.got023.full  http://www.ncbi.nlm.nih.gov/pubmed/20496124 http://www.ncbi.nlm.nih.gov/pubmed/20496124  http://www.gastricsleeve.org/tag/vsg-complications/ http://www.gastricsleeve.org/tag/vsg-complications/