Dietary Management in the Immediate Preoperative Period of Bariatric Surgery: a National Overview : Bariatric Preoperative Diets

Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline

Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.

Very Low-Calorie Ketogenic Diet (VLCKD) as Pre-Operative First-Line Dietary Therapy in Patients with Obesity Who Are Candidates for Bariatric Surgery

Bariatric surgery is currently the most effective method for achieving long-term weight loss and reducing the risk of comorbidities and mortality in individuals with severe obesity. The pre-operative diet is an important factor in determining patients' suitability for surgery, as well as their post-operative outcomes and success in achieving weight loss. Therefore, the nutritional management of bariatric patients requires specialized expertise. Very low-calorie diets and intragastric balloon placement have already been studied and shown to be effective in promoting pre-operative weight loss. In addition, the very low-calorie ketogenic diet has a well-established role in the treatment of obesity and type 2 diabetes mellitus, but its potential role as a pre-operative dietary treatment prior to bariatric surgery has received less attention. Thus, this article will provide a brief overview of the current evidence on the very low-calorie ketogenic diet as a pre-operative dietary treatment in patients with obesity who are candidates for bariatric surgery.

Variation and outcomes of liver-reducing dietary regimens before bariatric surgery: a national retrospective cohort study

BACKGROUND

Liver-reducing diets (LRDs) are mandated prior to bariatric surgery, but there are no guidelines on their implementation.

OBJECTIVE

To establish the variation and effectiveness of LRDs utilized in clinical practice.

SETTING

A nationwide, multicenter, retrospective cohort study.

METHODS

A total of 1699 adult patients across 14 bariatric centers in the United Kingdom were included. Multilevel logistic regression models were developed to examine factors predictive of 5% weight loss.

RESULTS

Most centers (n = 9) prescribed an 800- to 1000-kcal diet, but the duration and formulation of diet was variable. Overall, 30.6% (n = 510) of patients achieved 5% weight loss during the LRD. After adjustment for preoperative weight, women had reduced odds (odds ratio [OR], .65; 95% confidence interval [CI], .48-.88; P = .005), while increasing age (OR, 1.01; 95% CI, 1.00-1.02; P = .043) and having type 2 diabetes (OR, 1.49; 95% CI, 1.16-1.92; P = .002) increased odds of 5% weight loss. A normal consistency food LRD (OR, .64; 95% CI, .42-.98; P = .041) and energy prescription of >1200 kcals/d (OR, .33; 95% CI, .13-.83; P = .019) reduced odds, while an LRD with a duration of 3 weeks (OR, 2.28; 95% CI, 1.02-5.09; P = .044) or greater increased odds of 5% weight loss.

CONCLUSIONS

There is wide variation in how LRDs are delivered in clinical practice, highlighting the need for an evidence-based consensus. Our findings suggest the optimal LRD before bariatric surgery contains 800 to 1200 kcals/d over a duration of 3 to 4 weeks. Further research is required to determine the optimal formulation of LRD and whether women may require a lower-energy LRD than men.

Higher Preoperative Weight loss Is Associated with Greater Weight Loss up to 12 Months After Bariatric Surgery

BACKGROUND

Prior research suggested presurgical weight loss is associated with greater total weight loss, resulting in a more effective bariatric intervention. We aimed to assess whether preoperative weight loss is a predictor for total weight loss, and which patient factors are associated with successful weight loss.

METHODS

All patients (N = 773) that underwent primary bariatric surgery between June 2017 and August 2019 were included in this single-center retrospective study. Outcome measures were preoperative weight loss (%preopWL) and total weight loss (%TWL) up to 1 year postoperatively. Patients were divided into 4 groups based on quartiles of %preopWL.

RESULTS

Total weight loss after 1, 6, and 12 months for the upper quartile was 16.9%, 33.4%, and 37.8%, and for the lower quartile 11.8%, 28.9%, and 35.2%, respectively (p < 0.001). Seven hundred fourteen patients (92.4%) were available for the 1-year follow-up. Preoperative weight loss was not associated with the incidence of complications. Independent factors predicting increased %preopWL were mandated preoperative weight loss program (MWP) (p < 0.001), older age (p = 0.005), weight measurement in the week before surgery (p = 0.031), and non-diabetic status (p = 0.010). Predictors for superior %TWL were MWP (p = 0.014), younger age (p = 0.001), non-diabetic status (p = 0.005), female gender (p = 0.001), higher Body Mass Index (p = 0.006), and banded gastric bypass (p = 0.001).

CONCLUSION

Higher preoperative weight loss is associated with persisting greater weight loss up to at least 12 months post-surgery. In order to optimize preoperative weight loss, we recommend extra preoperative support to younger and diabetic patients. We advise nutritional counseling and additional weight measurement in the week before surgery.

Current preoperative strategies applied in the Dutch bariatric centers: A national survey

There is no consensus about the optimal management of patients undergoing bariatric surgery. This study aimed to identify current weight loss goals prior to bariatric surgery, as well as aimed to explore preoperative strategies related to diet, nutritional supplements and physical activity. An online survey was distributed among bariatric surgeons and dietitians in all 18 Dutch bariatric centers. This survey included the following four domains: weight loss, diet, nutritional supplements and physical activity. For the analyses one answer per center was used, either the most common answer or the answer given by the most expert responder. All 18 centers reported at least one response. Preoperative weight loss was requested in 28% of the centers, whereas 61% desired a stable weight or weight loss, and 11% had no requests. A preoperative diet was routinely recommended in 78% of the centers and on indication (ie, depending on baseline weight and/or comorbidity status) in 22%. The most frequently prescribed diet was a low-energy diet (800-1500 kcal/day) in 44% of the centers. Nutritional supplements were recommended in 78% of the centers. Physical activity with low intensity was recommended in 83% of the centers, while physical exercise training with mid- to high-intensity was recommended in 72%. Inconsistent responses within centers were observed in 56% of the questions. The current bariatric practice within the Netherlands shows high variability and inconsistencies in preoperative management. Consensus-building and standardization of strategies should be promoted in the future.

Effectiveness of a Low-Calorie Diet for Liver Volume Reduction Prior to Bariatric Surgery: a Systematic Review

An energy-restricted diet is often prescribed before bariatric surgery to reduce weight and liver volume. While very-low-calorie diets (VLCDs, 450–800 kcal per day) have shown to be effective, the effectiveness of low-calorie diets (LCDs, 800–1500 kcal per day) is less obvious. The objective of this systematic review was to elucidate the effectiveness of LCD on liver volume reduction in patients awaiting bariatric surgery. Eight studies (n = 251) were included describing nine different diets (800–1200 kcal, 2–8 weeks). An LCD was effective in liver volume reduction (12–27%) and weight loss (4–17%), particularly during the first weeks. The LCD showed an acceptable patients’ compliance. Based on these findings, an LCD (800–1200 kcal), instead of a VLCD, for 2 to 4 weeks should be preferred.