Nutrition Support in Bariatric Surgery

Dear Colleagues,

Bariatric surgery (BS) is widely accepted as a valuable treatment for persons living with obesity, mainly the ones with higher corpulence, affected by physical and psychological comorbidities, with long-term evolution and refractory to other treatment efforts.

A broad and valuable discussion is under course, on the benefits and disadvantages of mandatory structured lifestyle modification prior to bariatric surgery. Although engagement in adequate dietary habits and physical activity is undisputable, for successful obesity treatment, mandatory weight loss prior to surgery is considered an unnecessary and unacceptable barrier to accessing treatment, imposed to persons currently suffering from obesity. On the other end, weight loss before surgery was associated with less peri-operatory complications, and adequate counseling on behavior changes may contribute to better, non-weight-related, long-term results. As we should help persons with obesity to establish an individual care plane, aiming at a successful outcome, the question would be as follows: should pre-surgery lifestyle interventions focus on preparing people for the changes and challenges imposed by BS, as opposed to mandatory weight loss?               

Bariatric surgery patients may present vitamin and mineral deficiencies prior to the intervention. Additionally, sarcopenia is also prevalent among persons with obesity, resultant from insufficient engagement in physical activity/exercise and nutritional imbalances. Both conditions are associated (without a scientific basis or physiological plausibility) with unbalanced diets and other inadequate efforts to achieve weight loss. An increased risk for malnutrition exacerbation after surgery is present among these individuals. Are we doing enough to prevent this potential negative impact from BS on the health-related quality of life?

Obesity is a chronic disease with multiple physical, psychological and social negative impacts, demanding continuous access to adequate healthcare for persons living with obesity. For BS patients, in addition to pre-surgery counseling, both post-surgery personalized guidance, on stages, composition of diet and supplementation, and long-term follow-up nutrition support are mandatory to prevent complications, malnutrition and relapse. The epidemiology and chronicity of obesity imposes integration between the levels and sites of care, raising the following question: can we secure adequate long-term support and monitoring for persons undergoing BS? 

Several challenges are imposed to persons and health system architecture by obesity. A better understanding and delivery of necessary nutrition care for persons undergoing BS may help improve the outcomes of this prevalent and complex disesase.

Prof. Dr. Isabel Carmo
Dr. José Camolas
Guest Editors

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