bariatric nutrition is a branch of medicine that deals with the causes, prevention and treatment of obesity.

1. Bariatric Nutrition :
Swati Shukla and Mani Mishra
Research Scholars
Department of Food and Nutrition, College of Home Science
Maharana Pratap University of Agriculture and Technology, Udaipur-313001 (Rajasthan)
Email-id: swatishukla.shukla9@gmail.com
A way to Manage
Obesity

2. D
E
F
I
N
I
T
I
O
N
S
• Obesity is defined by the Center of Disease Control (CDC)
as, “Someone who’s weight is greater than what is
considered healthy for their height.”
– Adults who’s BMI is between 25 and 29.9 is considered
overweight.
– Adults who’s BMI is greater than 30 is considered obese.
• Whereas, Bariatric is the branch of medicine that deals with
the causes, prevention, and treatment of obesity. The term
bariatric was created around 1965.

3. • Bariatric surgery (weight
loss surgery) includes a
variety of procedures
performed on people who
are obese .
• Weight loss is achieved by
reducing the size of the
stomach with a gastric
band or through removal of
a portion of the stomach or
by resecting and re-routing
the small intestines to a
small stomach pouch.

4. • Obesity is a global epidemic
• Obesity is one of the leading causes of preventable death
• Excess body fat impacts health which impacts health care
costs
• In Canada 47% of the population is either overweight or
obese.
• The proportion of Canadian population which is obese has
tripled in the last 15 years.
• Health problems include: CAD, cancer, hypertension,
Infertility, chronic muscular and joint problems and
respiratory disease.
Why

5. Surgical Criteria
• U.S. Department of Health and Human Services National
Institutes of Health Clinical Guidelines state surgery would be a
good option if the patient has
• BMI>40
• BMI>35 and has a condition such as
– Cardiovascular Disease
– Sleep apnea
– Uncontrolled type 2 diabetes
• Before surgery patients are evaluated by multidisciplinary team
consisting of a medical doctor, psychiatrist, and a registered
dietitian.
• Candidate for surgery should be a well-informed, highly
motivated individual with a good support system

6. Laparoscopic Adjustable Gastric
Banding
Tice, J., Karliner, L.,Walsh, J., Petersen, A., & Feldman, M. (2008) Gastric banding or bypass? A systematic review
comparing the two most popular bariatric procedures. The American Journal of Medicine, (121), 885-893.
• Laparoscopic band placed
around the upper part of
the stomach.
• Saline is used to inflate
or reduced the size of the
band.
• Restricts food
consumption and slows
digestion.
•Less invasive than Roux-
en-Y.

7. Vertical Banded Gastroplasty
•A small vertical pouch is created at
top of stomach by stapling both
walls of stomach.
• Outlet is secured with plastic band
which controls volume of pouch and
prevents stretching.
• This constricts the amount of food
a patient can consume at one time.
• Dietary plan is an especially
important aspect to a successful
outcome.

8. Roux-en-Y Gastric Bypass
• Most common form in America,
constituting for about 80% of all
bariatric procedures.
• A small pouch (15-30 ml) is
created at base of the esophagus.
• Bypasses duodenum and part of
the jejunum, connecting the
jejunum to the pouch.
• Quickly induces satiety and
achieves weight reduction through
the restriction of intake of food and
malabsoroption.

9. Biliopancreatic Diversion/ Duodenal
Switch
•The stomach is divided
vertically and 50-70% of the
stomach is removed.
• The stomach is directly
connected to small intestine
bypassing the whole duodenum.
• It is linked with high mortality
rate and complications.
• Performed less than one
percent of the time in the United
States.

10. Surgical Outcomes-Effectiveness
• 47.5% weight loss from adjustable gastric band
• 61.6% weight loss for gastric bypass
• 68.2% weight loss for gastroplasty
• 70% weight loss for biliopancreatic diversion with or without
duodenal switch

11. Postoperative Diet- First Week
• All clear liquid diet
– Frequent small 1oz servings of water and/or ice
chips.
– A protein liquid supplement in necessary in small
servings at this time.
– Patients aim to consume 64oz of liquid in a day (1-
2oz over a 30 min time setting)

12. Postoperative Diet- First Month
• Protein based soft diet
-Broth of low fat
-Scrambled eggs
-Oatmeal with added protein powder -Tuna salad
-Fat free pudding
• Chewable multivitamin added
• No fluid for 20-30 minutes before or after food consumption.

13. Postoperative Diet
• Around week six patient can add textured foods to their
diet.
• Dry, sticky, or gummy foods have been known to present
the biggest problem in patients.
• Patients should always set aside a 20 minute time period
to avoid bolus eating and allow the feeling of satiety to
occur.
• Proteins should be eaten before fats and carbohydrates.
Patients should aim for at least 60 grams of protein daily.
*This is the most critical time for patient to be taking
supplement so malnutrition does not occur.

14. Supplements
• There is not a set standard for supplements after bariatric
surgery. Each patient gets a recommended level of intake from
their surgeon.
• There are few studies done that examine the postoperative
nutritional status and deficiencies in patients. The studies that
have been done have a wide variety of reported deficiencies due
to…
– Patient populations
– Surgical techniques
– Supplement protocols
– Completion of patient follow-ups

15. Supplement- Vitamin B-12
• Provides protection around nerve fibers and is needed for
normal growth.
• 1000- µg injections every 3 to 6 months or sublingual (under
tongue) supplement of 300-500 µg/d.
• Deficiency
– Seen in 24% to 36% of patients, usually 2 years after
operation.
– Can impair intelligence, spatial ability, and short term
memory.
– Corrected by 500 µg/d oral supplementation.

16. Supplement- Vitamin D
• 400 IU/d
• 1000 IU for patients who receive little sunlight exposure.
• Deficiency seen in 51% of RYGB patients
• With a deficiency the production of protein that binds calcium
in the intestinal cells slows. Even when diet is ample in
Vitamin C, it will pass through the GI tract unabsorbed

17. Supplement- Iron
• 320 mg 2X daily.
• Iron deficiencies seen in 15.7% of patients but has been
seen as high as 52% in RYGB patients.
• Bypassing the duodenum and proximal jejunum contribute to
iron deficiency because that is the main site of iron
absorption.
• Even with iron supplement it is hard to prevent anemia in
menstruating women.

18. Supplement-
Folate
• 400- 1000 µg
• Deficiency
– 6% -38% in RYGB
patients.
– Decreased intake of folate
is leading factor
– Impairs cell division and
protein synthesis
– Neural tube defects
• Symptoms
– Anemia
– GI tract deterioration
Supplement-
Calcium
• 1200-1500 mg
• Deficiency
– Seen in 10% of RYGB
patients
– Result of bypassing
duodenum and proximal
jejunum
– Low intake of Ca
sources post-op
• Calcium citrate is
recommended over
calcium carbonate.