Obesity, Nutrition and Bariatric Surgery Research

Research Summary on Obesity/Bariatric Surgery

1.   “Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults.” https://jandonline.org/article/S2212-2672(15)01636-6/fulltext

Key Findings:

·        Weight loss of only 3%-5% that’s maintained can lead to clinically relevant health improvements (Lower triglycerides, blood glucose and risk of developing type 2 diabetes.) Further weight loss can have additional improvements, especially with LDL and HDL cholesterol and blood pressure.

·        Dietary interventions to reduce excessive caloric intake and enhance nutrient levels are recommended along with at least 150 minutes per week of moderate intensity exercise, or 75 minutes per week of physical intensity exercise.

·        Internally, food intake is regulated by homeostasis, interacting with nutrient and hormonal interactions as well as the “hedonic system” which involves liking and rewarding food qualities based on learning, attention and memory.

·        External/environmental factors affecting intake include food availability, variety, energy density and portion size.

·        The RDN, along with other health professionals should measure BMI, and risk of CVD, T2DM and all-cause mortality.

·        RDNs should tailor caloric restriction strategies around these guidelines: 1200-1500 kCal/day for women and 1500-1800 kCal/day for men.

2.   Evidence Analysis Library. Nutrition Care in Bariatric Surgery. https://www.andeal.org/topic.cfm?menu=5308

Key findings:

·        Statistically significant decrease in resting metabolic rate (RMR), as high as 26% at one year post-surgery, which was sustained at two years.

·        Statistically significant reduction in self-reported energy intake after operations. Up to 72% in the first six months post-surgery and 28-38% at 4-5 years post-surgery.

·        Significant excess weight loss of 60%-80% and significant BMI reduction of 5%-31% for patients receiving medical nutrition therapy (MNT) from a registered dietitian nutritionist (RDN) for 2-6 visits during the first year post-surgery.

3.   Gómez-Martin JM, Balsa JA, Aracil E, et al. Beneficial changes on plasma apolipoproteins A and B, high density lipoproteins and oxidized low density lipoproteins in obese women after bariatric surgery: comparison between gastric bypass and sleeve gastrectomy. Lipids in Health and Disease. 2018;17:145. doi:10.1186/s12944-018-0794-5.

Key findings:

·        Followed 40 women with metabolic syndrome who underwent either gastric bypass or sleeve gastrectomy.

·        Significant decreases in total cholesterol, triglycerides, oxidized LDL, apolipoprotein B and significant increases in apolipoprotein A and HDL for both surgeries, when compared to control group on calorie-restricted Mediterranean diet.

4.   “Bariatric Surgery: Postoperative Concerns.” American Society for Metabolic and Bariatric Surgery Website. https://asmbs.org/app/uploads/2014/05/bariatric_surgery_postoperative_concerns1.pdf. Updated 2/7/2008.

Key Findings:

·        Dumping syndrome, diarrhea, constipation and dysphagia are all common conditions after bariatric surgery. Diet modifications specific to patients and conditions is generally helpful.

·        It is also common that patients reach weight loss plateaus and is not suggested for patients to weigh themselves too frequently.

·        Postoperative exercise should generally be mild (20-40 minutes/day, 3-4X/week) and tailored to patient tolerances.

5.   “ASMBS Integrated Health and Nutrition Guidelines for Surgical Weight Loss Patient 2016 Update.” https://asmbs.org/app/uploads/2008/09/ASMBS-Nutritional-Guidelines-2016-Update.pdf

Key Findings:

·        Data continue to suggest the presence of micronutrient deficiencies is rising, while follow-up monitoring of patients is declining. As a result, specific vitamins/minerals recommended to prevent deficiencies. Especially with vitamins B1 (Thiamine), B12, A, E, K, D, Folate, and minerals calcium, iron, copper and zinc.

·        Patients should be educated before and after surgery on the risk of developing nutrient deficiencies, and alterations in metabolism, digestion, absorption and excretion.

6.   BARRETO, Bruno Leandro de Melo et al. “PHYSICAL ACTIVITY, QUALITY OF LIFE AND BODY IMAGE OF CANDIDATES TO BARIATRIC SURGERY”. ABCD, arq. bras. cir. dig.[online]. 2018, vol.31, n.1 [cited  2018-07-19], e1349. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-67202018000100310&lng=en&nrm=iso&tlng=en

Key Findings:

·        “When assisted by personal trainers, obese patients can change behavior, increase health quality and physical activity levels and experience less pain. Increase in physical activity, when well structured can benefit these patients.”

7.   Zoom HFA, de Brujin SEM, Smeets PAM, et al. “Altered Neural Inhibition Responses to Food Cues After Roux-en-Y Gastric Bypass.” Biological Psychology. 2018; 137. https://www.sciencedirect.com/science/article/pii/S0301051118303193?via%3Dihub

Key Findings:

·        “RYGB led to increased neural inhibitory control of high-energy food cues.”

·        “Alterations in neural circuits involved in inhibitory control, satiety signaling and reward processing may contribute to effective weight loss after RYGB.”

8.   Climent E, David B, Flores-Le Roux JA. “Changes in the lipid profile 5 years after bariatric surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy.” Surg Obes Relat Dis. 2018. https://www.ncbi.nlm.nih.gov/pubmed/29941302

 

Key Findings:

·        Five-year outcome data showed that, among patients with severe obesity undergoing BS, LRYGB was associated with a higher total and low-density lipoprotein cholesterol reduction and remission in comparison to LSG, with no differences in hypertriglyceridemia and high-density lipoprotein cholesterol normalization.

9.   Barazzoni R, Bischoff S, Boirie Y, et al. Sarcopenic Obesity: Time to Meet the Challenge. Obes Facts 2018;11:294-305. https://www.karger.com/Article/FullText/490361#

 

Key Findings:

·        “Profound skeletal muscle metabolism changes may occur in obesity and may lead to altered body composition with higher fat mass and substantial impairment of muscle mass and quality.”

·        Nutritional care and physical exercise should be part of the treatment for individuals with sarcopenic obesity. Generally 1g protein/kg of their ideal body weight. More protein may be needed for higher risk individuals.

·        European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) consider sarcopenic obesity a serious clinical concern.

10.           Xinyan Bi, Yi Ting Loo, Shalini D/O et al. “Obesity is an independent determinant of elevated C-reactive protein in healthy women but not men.” Biomarkers. https://www.tandfonline.com/doi/citedby/10.1080/1354750X.2018.1501763?scroll=top&needAccess=true

 

11.           “Acceptance-Based Behavioral Treatment for Obesity.” Stephanie M. Manasse, PhD. Weight Management Matters. Winter 2018. Vol 16 (3).

Key points:

·        ABBT for obesity is based on accepting rather than changing the content of internal experiences, such as thoughts and emotions.

·        Overarching goal is to promote “psychological flexibility”, which is choosing behaviors based on their long-term value, even if it causes short term distress.

·        Behavioral weight loss strategies such as self-monitoring, stimulus control and planning are presented as “control what you can.” Strategies like mindful decision making and willingness are presented as “accept what you can’t.”

·        Long-term adherence to weight control behaviors depends on the ability to accept/tolerate unpleasant feelings such as fatigue, hunger, cravings, a sense of deprivation and tolerating a perceived reduction in pleasure.

·        ABBT led to significantly more weight loss than standard behavioral therapy (SBT) in participants showing greater baseline levels of self-reported responsivity to food cues and higher baseline levels of self-reported depressed mood.

12.           CASTANHA, Christiane Ramos et al. “Evaluation of quality of life, weight loss and comorbidities of patients undergoing bariatric surgery.” Rev. Col. Bras. Cir. [online]. 2018, vol.45, n.3 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912018000300158&lng=en&nrm=iso&tlng=en

Key findings:

·        The comorbidities with the highest percentage of resolution were sleep apnea (90.2%), diabetes (80.7%) and hypertension (70.8%).

·        The most frequent complications were hair loss (79.6%), nutritional deficiency (37.9%) and anemia (35%).

·        The BAROS protocol demonstrated that patients positively evaluated quality of life in 93.2% of the cases. The Moorehead-Ardelt questionnaire showed that quality of life "improved" or "improved greatly" for 94.1% of patients.

13.           Campos G, et al. “Changes in post-prandial glucose and pancreatic hormones, and steady-state insulin and free fatty acids after gastric bypass surgery.” Surg Obes Relat Dis. 2014. https://asmbs.org/app/uploads/2014/05/Campos-article.pdf

Key points:

·        “In morbidly obese, nondiabetic patients, RYGB produces early changes in post-meal glucose, C-peptide, glucose and pancreatic peptide responses and it appears to enhance insulin clearance early after RYGB and improve insulin sensitivity in adipose tissue at 6 months post-surgery. These changes cannot be explained by caloric restriction alone.”

14.           Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Guidelines/AACE_TOS_ASMBS_Clinical_Practice_KeGuidlines_3.2013.pdf

·        Research regarding surgery types, risks/benefits, eating practices, nutrient intake and metabolic outcomes for bariatric patients. Guidelines are similar to Mather’s current bariatric nutrition protocol.

15.           “Counseling the Outpatient Bariatric Client.” Megan Tempest, RD. Today’s Dietitian. Jan, 2012.

Key Points:

·        Assessing individual needs, knowledge and readiness to change are key parts of pre-op nutrition counseling.

·        Adequate post-op education is needed to help patients have successful surgery outcomes.

·        Promoting the value of small, attainable changes helps increase patient confidence in meeting goals.

·        Discuss strategies to resolve personal challenges to goals.

·        Provide non-judgmental, person-centered approach.