Bariatric Surgery Counseling

Counseling the Outpatient Bariatric Client
By Megan Tempest, RD
Today’s Dietitian
Vol. 14 No. 1 P. 38

Pre- and postoperative nutrition counseling is imperative. Here’s how to do both successfully to ensure optimal postsurgical outcomes.

It’s common knowledge that obesity is a public health crisis. Statistics from the Centers for Disease Control and Prevention (CDC) estimate that one-third of US adults are obese, as are 17% of children and adolescents. Morbid obesity (defined by a BMI of 40 or higher or 100 lbs over ideal body weight) is also a serious problem. Its incidence has risen to more than 5% of US adults, who’ve found it difficult, if not impossible, to lose weight through diet and exercise—which is the main reason bariatric surgery has become widely accepted as a viable, albeit invasive, means to weight loss.

A 2011 report that assessed trends concerning the incidence of weight loss surgery between 2003 and 2008 showed that bariatric surgical procedures peaked in 2004 and remained steady thereafter.1 The American Society for Metabolic and Bariatric Surgery (ASMBS) reported that the number of weight loss surgical procedures increased from 103,000 in 2003 to an estimated 220,000 in 2008.2

According to the ASMBS, recent research suggests that the higher mortality risk of the morbidly obese reverts to normal following weight loss surgery. The procedure, which often gives morbidly obese patients their only hope for losing weight and leading a normal life, has been an effective treatment for metabolic disease and conditions such as type 2 diabetes, hypertension, high cholesterol, nonalcoholic fatty liver disease, and obstructive sleep apnea.3

The benefits of weight loss surgery also extend to close family members. A 2011 study, “The Halo Effect of Bariatric Surgery,” by Woodard and colleagues, published in the Archives of Surgery, showed that 12 months after the procedure, adult family members of gastric bypass patients demonstrated improved eating habits, reduced alcohol consumption, and significant weight loss. Family members also engaged in increased daily activity and less emotional eating. Obese children of gastric bypass patients tended to have a lower BMI than expected for their growth curve.

Given that weight loss and improved health aren’t always synonymous, a functional knowledge of good nutrition and the implementation of healthful eating habits are essential to positive outcomes after bariatric surgery. RDs are integral members of the interdisciplinary care provided in the bariatric setting. This article will discuss several aspects involved in nutritional counseling before and after weight loss surgery and provide insight from dietetics experts who specialize in this field of practice.

Preoperative Phase
In the pursuit of weight loss surgery, individuals often approach the dietitian’s office with trepidation. Preoperative counseling sessions for bariatric surgery candidates are commonly thought to serve as a screening process. While there’s some truth to that, early counseling with a dietitian fulfills other valuable purposes. Generally speaking, it’s a window of opportunity for the dietitian to prepare prospective surgery candidates for the long-term diet and lifestyle changes they must implement and set them up for success after surgery.

Renee Cooper, RD, LD, a bariatric dietitian at University Hospitals Case Medical Center in Cleveland Heights, Ohio, reinforces the primary goal of preoperative nutrition counseling: “As a clinician, you must ask yourself if the patient is going to be successful after surgery. If not, what can you do to help them be successful?”

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