The Importance of Nutrition Before and Following Metabolic/Bariatric Surgery

Abstract

Obesity is a chronic disease, a global epidemic and among the non-communicable disease targets which are identified by World Health Organization (WHO). Bariatric surgery (BS) is one of the treatment approaches used in the fight against obesity. In this article, it is aimed to present general information about BS, nutritional evaluation before and after BS, various nutrition-related conditions, and information on how food supplements and diet phases should be maintained. In addition, factors that should be taken into consideration in individuals undergoing BS and new approaches in BS are included. BS has different methods, such as restrictive and malabsorptive methods. The process before and after BS differs. It is important to evaluate and follow up on an individual basis in a multidisciplinary way. BS methods may have an effect on the absorption of nutrients and the food intake may not meet the requirement due to anatomical changes after surgery. Therefore, food supplements should be given based on the need. In addition, an individual's diet should progress in stages. Considering the risk factors of individuals with BS, postoperative body weight loss should be maintained in the healthiest way. In order to use BS as an effective tool in obesity management, it is considered necessary to develop solutions for the risk factors carried by the individuals who constitute the target group for BS, to manage and maintain the process and follow-up in the most ideal way.

Keywords

• Bariatric surgery
• obesity
• food supplements
• weight loss

Metabolik/Bariatrik Cerrahi Öncesinde ve Sonrasında Beslenmenin Önemi

Abstract

Obezite, Dünya Sağlık Örgütü (DSÖ) tarafından tanımlanan bulaşıcı olmayan hastalık hedefleri arasında yer alan, kronik bir hastalık ve küresel bir salgındır. Bariatrik cerrahi (BC), obeziteyle mücadelede kullanılan tedavi yöntemlerinden biridir. Bu makalede, BC ile ilgili genel bilgiler sunulmasının yanı sıra, BC öncesi ve sonrası beslenme değerlendirmesi, beslenmeyle ilişkili çeşitli durumlar, gıda takviyeleri ve diyet evrelerinin nasıl sürdürülmesi gerektiği konularında bilgi verilmesi amaçlanmıştır. Ayrıca, BC geçiren bireylerde dikkate alınması gereken etkenler ve BC'deki yeni yaklaşımlar bu makalede ele alınmıştır. BC’nin kısıtlayıcı ve malabsorptif yöntemler gibi farklı yaklaşımları vardır. BC öncesi ve sonrası süreçler birbirinden farklılık gösterir. Bu süreçte, multidisipliner bir yaklaşımla bireysel bazda değerlendirme ve takip yapılması önemli görülmektedir. BC yöntemleri, besin ögelerinin emilimini etkileyebilir ve ameliyat sonrası meydana gelen anatomik değişiklikler nedeniyle besin alımı, vücudun ihtiyaçlarını karşılamayabilir. Bu yüzden, bireyin gereksinimlerine göre gıda takviyeleri verilmelidir. Ayrıca bireyin diyetinin aşamalar halinde ilerlemesi gerekmektedir. BC geçiren bireylerin risk etkenleri göz önünde bulundurulduğunda, ameliyat sonrası vücut ağırlığı kaybı en sağlıklı şekilde sürdürülebilmelidir. BC’nin, obezite yönetiminde etkili bir araç olarak kullanılabilmesi için BC'nin hedef grubunu oluşturan bireylerin taşıdığı risk etkenlerine yönelik çözümler geliştirilmesi, ameliyat öncesi, ameliyat sırası ve ameliyat sonrasındaki sürecin en ideal şekilde yönetilip sürdürülmesi gerektiği düşünülmektedir.

Keywords

• Bariatrik cerrahi
• obezite
• gıda takviyeleri
• vücut ağırlığı kaybı

References

1. 1. Mechanick JI, Apovian C, Brethauer S et al. Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored By American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Endocr Pract. 2019; 25, 1–75. https://doi.org/10.4158/GL-2019-0406
2. 2. World Obesity Federation. World Obesity Atlas 2024. London: World Obesity Federation, 2024. https://data.worldobesity.org/publications/?cat=22
3. 3. Aguas-Ayesa M, Yárnoz-Esquíroz P, Olazarán L, Gómez-Ambrosi J, Frühbeck, G Precision nutrition in the context of bariatric surgery. Rev Endocr Metab Disord. 2023; 24(5):979–991. Springer. https://doi.org/10.1007/s11154-023-09794-5
4. 4. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: State of the art. Nat Rev Gastroenterol Hepatol. 2017; 14(3):160–169. https://doi.org/10.1038/nrgastro.2016.170
5. 5. Bettini S, Belligoli A, Fabris R, Busetto L. Diet approach before and after bariatric surgery. Rev Endocr Metab Disord. 2020; 21(3):297-306. https://doi.org/10.1007/s11154-020-09571-8
6. 6. Miedziaszczyk M, Ciabach P, Szałek E. The effects of bariatric surgery and gastrectomy on the absorption of drugs, vitamins, and mineral elements. Pharmaceutics. 2021; 13(12). https://doi.org/10.3390/pharmaceutics13122111
7. 7. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022;18(12):1345–1356. https://doi.org/10.1016/j.soard.2022.08.013
8. 8. Ochner CN, Gibson C, Carnell S, Dambkowski C, Geliebter A. The neurohormonal regulation of energy intake in relation to bariatric surgery for obesity. Physiol Behav. 2010;100(5):549-559. doi: 10.1016/j.physbeh.2010.04.032

9. 9. Or Koca A, İriz A, Hazır B et al. Relationships of orexigenic and anorexigenic hormones with body fat distribution in patients with obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2023;280(5):2445–2452. https://doi.org/10.1007/s00405-022-07799-5
10. 10. Huang J, Chen Y, Wang X, Wang C, Yang J, Guan B. Change in Adipokines and Gastrointestinal Hormones After Bariatric Surgery: a Meta-analysis. Obes Surg. 2023;33(3):789–806. https://doi.org/10.1007/s11695-022-06444-8
11. 11. American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2011-2022. Accessed June 9, 2024. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers/
12. 12. Sherf-Dagan S, Sinai T, Goldenshluger A, et al. Nutritional assessment and preparation for adult bariatric surgery candidates: Clinical practice. Adv Nutr. 2021;12(3):1020–1031. https://doi.org/10.1093/advances/nmaa121
13. 13. Tabesh MR, Eghtesadi M, Abolhasani M, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline. Obes Surg. 2023;33(8):2557–2572. https://doi.org/10.1007/s11695-023-06703-2
14. 14. Kushner BS, Eagon JC. Systematic Review and Meta-Analysis of the Effectiveness of Insurance Requirements for Supervised Weight Loss Prior to Bariatric Surgery. Obes Surg. 2021; 31(12):5396–5408. Springer. https://doi.org/10.1007/s11695-021-05731-0
15. 15. Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ. Nutritional deficiencies in morbidly obese patients: A new form of malnutrition? Part A: Vitamins. Obes Surg. 2008; 18(7):870–876. https://doi.org/10.1007/s11695-007-9349-y
16. 16. Simancas-Racines D, Frias-Toral E, Campuzano-Donoso M, et al. Preoperative Nutrition in Bariatric Surgery: A Narrative Review on Enhancing Surgical Success and Patient Outcomes. Nutrients. 2025; 17(3):566. https://doi.org/10.3390/nu17030566
17. 17. Ba DM, Hu A, Shen C, et al. Trends and predictors of nutritional deficiencies after bariatric surgeries: analysis of real-world data. Surg Obes Relat Dis. 2023;19(9):935–943. https://doi.org/10.1016/j.soard.2023.02.013
18. 18. Kamal FA, Fernet LY, Rodriguez M, et al. Nutritional Deficiencies Before and After Bariatric Surgery in Low- and High-Income Countries: Prevention and Treatment. Cureus. 2024. https://doi.org/10.7759/cureus.55062
19. 19. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017;13(5):727–741. https://doi.org/10.1016/j.soard.2016.12.018
20. 20. Shah M, Sharma A, Wermers RA, Kennel KA, Kellogg TA, Mundi MS. Hypocalcemia After Bariatric Surgery: Prevalence and Associated Risk Factors. Obes Surg. 2017;27(11):2905–2911. https://doi.org/10.1007/s11695-017-2705-7
21. 21. Musella M, Berardi G, Vitiello A, et al. Vitamin D Deficiency in Patients with Morbid Obesity before and after Metabolic Bariatric Surgery. Nutrients. 2022;14(16). https://doi.org/10.3390/nu14163319
22. 22. Jiao Y, Liu Y, Chen S, Tang L. Zinc Deficiency After Bariatric Surgery: A Systematic Review and Meta-analysis. Indian J Surg. 2024. https://doi.org/10.1007/s12262-024-04082-1
23. 23. Zarshenas N, Tapsell LC, Batterham M, Neale EP, Talbot ML. Investigating the Prevalence of Copper and Zinc Abnormalities in Patients Pre and Post bariatric Surgery—an Australian Experience. Obes Surg. 2023;33(11):3437–3446. https://doi.org/10.1007/s11695-023-06822-w
24. 24. Ben-Porat T, Sherf-Dagan S. Nutritional Interventions for Patients with Severe Obesity Seeking Bariatric Surgery. Nutrients. 2023;15(3). https://doi.org/10.3390/nu15030515
25. 25. Quilliot D, Sirveaux MA, Nomine-Criqui C, Fouquet T, Reibel N, Brunaud L. Evaluation of risk factors for complications after bariatric surgery. J Visc Surg. 2018;155(3):201–210. https://doi.org/10.1016/j.jviscsurg.2018.01.004
26. 26. Lange J, Königsrainer A. Malnutrition as a Complication of Bariatric Surgery- A Clear and Present Danger? Visc Med. 2019;35(5):305-311. doi:10.1159/000503040
27. 27. Dagan SS, Goldenshluger A, Globus I, et al. Nutritional recommendations for adult bariatric surgery patients: Clinical practice. Adv Nutr. 2017;8(2):382–394. https://doi.org/10.3945/an.116.014258
28. 28. Papamargaritis D, Le Roux CW. Do gut hormones contribute to weight loss and glycaemic outcomes after bariatric surgery? Nutrients. 2020;13(3):1–28. https://doi.org/10.3390/nu13030762
29. 29. Walmsley R, Chong L, Hii MW, Brown RM, Sumithran P. The effect of bariatric surgery on the expression of gastrointestinal taste receptors: A systematic review. Rev Endocr Metab Disord. 2024;25(2):421–446. https://doi.org/10.1007/s11154-023-09865-7
30. 30. Guyot E, Dougkas A, Robert M, Nazare JA, Iceta S, Disse E. Food Preferences anTheir Perceived Changes Before and After Bariatric Surgery: a Cross-sectional Study. Obes Surg. 2021;31(7):3075–3082. https://doi.org/10.1007/s11695-021-05342-9
31. 31. Taba JV, Suzuki MO, Do Nascimento FS et al. The development of feeding and eating disorders after bariatric surgery: A systematic review and meta-analysis. Nutrients. 2021;13(7). https://doi.org/10.3390/nu13072396
32. 32. Brode CS, Mitchell, JE. Problematic Eating Behaviors and Eating Disorders Associated with Bariatric Surgery. Psychiatr Clin North Am. 2019;42(2):287–297. https://doi.org/10.1016/j.psc.2019.01.014
33. 33. Quilliot D, Coupaye M, Ciangura C, et al. Recommandations sur la prise en charge nutritionnelle après chirurgie bariatrique : recommandations de bonne pratique et consensus d’experts SOFFCO-MM/AFERO/SFNCM/. J Chir Visc. 2021;158(1):53–63. https://doi.org/10.1016/j.jchirv.2020.10.002
34. 34. O’Kane M, Parretti HM, Pinkney J, et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev. 2020; 21(11). https://doi.org/10.1111/obr.13087
35. 35. El Ansari W, Elhag W. Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps-a Scoping Review. Obes Surg. 2021;31(4):1755-1766. doi:10.1007/s11695-020-05160-5
36. 36. King WC, Hinerman AS, Belle SH, Wahed AS, Courcoulas AP. Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes. JAMA. 2018;320(15):1560-1569. doi:10.1001/jama.2018.14433
37. 37. Zhang Y, Nagarajan N, Portwood C, et al. Does taste preference predict weight regain after bariatric surgery? Surg Endosc. 2020;34(6):2623–2629. https://doi.org/10.1007/s00464-019-07033-0
38. 38. Evans L, Cornejo J, Elli EF. Evolution of Bariatric Robotic Surgery: Revolutionizing Weight Loss Procedures. Curr Surg Rep. 2024;12(6):129–137. https://doi.org/10.1007/s40137-024-00398-9
39. 39. Bektaş M, Reiber BMM, Pereira JC, Burchell GL, Van Der Peet DL. Artificial Intelligence in Bariatric Surgery: Current Status and Future Perspectives. Obes Surg. 2022;32(8):2772–2783. https://doi.org/10.1007/s11695-022-06146-1
40. 40. Puca P, Petito V, Laterza L, et al. Bariatric procedures and microbiota: patient selection and outcome prediction. Ther Adv Gastrointest Endosc. 2021;14. https://doi.org/10.1177/26317745211014746
41. 41. Zambrano AK, Paz-Cruz E, Ruiz-Pozo VA, et al. Microbiota dynamics preceding bariatric surgery as obesity treatment: a comprehensive review. Front Nutr. 2024;11. https://doi.org/10.3389/fnut.2024.1393182