© Springer International Publishing Switzerland 2017Andrew Loveitt, Margaret M. Martin and Marc A. Neff (eds.)Passing the Certified Bariatric Nurses Exam10.1007/978-3-319-41703-5_32
32. Pre- and Postoperative Nutrition Evaluations
Kennedy Health Alliance, 2201 Chapel Ave W #100, Cherry Hill, NJ 08002, USA
Department of General Surgery, Rowan University, Stratford, NJ, USA
Upon initial nutrition consultation with a patient, a bariatric registered dietitian will review their current dietary patterns, habits, and typical intake. This assessment will help to better understand where the patient currently is before establishing dietary goals. From the assessment, the dietitian will begin to meet the patient where they are to begin implementing behavior change. It is important to establish changes the patient will have to make before surgery, so they have more of an opportunity to practice adapting. Establishing goals relating to diet, dietary habits, physical activity, and resolving biochemical complications is very important for the individual alongside of patient nutrition education on the preop diet, vitamins and minerals after surgery, common complaints, meal planning, goal setting, and diet stages after surgery.
Dietary habit changes may include the following: begin scheduling meals at regular intervals, discontinue meal skipping, begin multivitamins, and increase fruits and vegetables, lean proteins, whole grains, legumes, low-fat dairy, and possibly protein shakes. As needed, it is recommended for them to begin to eliminate or reduce unhealthy snack foods such as packaged sweets, crackers/chips, fried foods, fast food, sugar-sweetened beverages, carbonated beverages, alcoholic beverages, and soda. Other dietary changes include not drinking with meals, avoiding caffeine 2 weeks before surgery, taking 20–30 min per meal time, chewing well at meals, and preparing for their 2-week preoperative diet. It is important for the patient to express understanding of the importance of changing their diets and dietary habits as needed to promote weight loss success.
It is helpful for recent lab work to be taken before surgery. A general review of current vitamin and glucose levels as well as a lipid panel can work as a prompter for specific dietary changes as well as any supplementation if needed. If a dietary or supplemental intervention is needed, prompt action before surgery will improve overall patient health and weight loss afterward. Without proper review before surgery, a patient may be at an increased risk of worsening iron and or vitamin D deficiency. These deficiencies may impair the healing process, and may have a negative impact on successful weight loss.
The most common preoperative medical nutrition therapy interventions deal with elevated blood glucose and or A1c, elevated cholesterol, elevated low-density lipoprotein (LDL) cholesterol, low high-density lipoprotein (HDL) cholesterol, elevated triglycerides, and supplementation of vitamin D and/or iron if a patient is found to have a deficiency .
During preoperative nutrition education, patients should be educated on the 2-week preop diet. This program has been found to significantly decrease risks and complications before, during, and after their surgery. This works by decreasing the liver’s storage of carbohydrates and fatty acids which shrinks the size of the liver by 50–60 % making it easier for the surgical team to access the stomach. Up to 50 % of patients have nonalcoholic steatohepatitis or fatty liver. This is significantly decreased within the 2 weeks of the diet. The diet itself is low in fat and carbohydrates and most often includes the use of high-protein meal replacement shakes. The specifics of the 2-week diet vary from practice to practice depending on the surgeon and dietitians. With proper compliance, patients also experience a loss in weight, about 5–10 pounds that helps to shrink the abdominal cavity and provides an additional confidence boost .
Upon compliance to dietary changes, vitamin supplementation, dietary behaviors, physical activity changes, and the use of the 2-week preop diet, patients are more confident, prepared, ready, and rearing to undergo their life-changing operation. Depending on the individual’s choice of surgical team, dietitian, and their health insurance, their preoperative education may vary in length and quality. Always check with the patient to see what they already know or if they have any further questions whenever an opportunity arises. There are so many things changing in their lives at once, and it can seem overwhelming at times. Always be considerate to the individual who is about to begin the first day of the rest of their lives after surgery.
32.1 Nutritional Follow-Up
After bariatric surgery, it is very valuable for the patient to follow up with his or her registered dietitian in the office within 5–7 days. This is helpful to monitor their tolerance of fluids, volume of fluids, and any complications they may be experiencing soon after surgery such as dizziness, light-headedness, nausea, constipation, heartburn, or gas. As the patient begins to increase volume of fluids he or she is able to tolerate per sitting, the dietitian or health professional will establish a reasonable time to begin to advance his or her diet. After that appointment, nutritional follow-up with a registered dietitian is recommended by most practices to continue monitoring the success and give additional support to the patient. Some offices may have a set structure of an appointment every 3 months post-op in the first year and then annually, and some offices may offer little pre-contemplated structure. It is ultimately up to the patient how much nutritional follow-up they include in their care after surgery.