Bariatric surgery is one of the safest and most effective methods to combat obesity, especially in individuals in a state of grade II and III obesity. However, before the procedure, the patient needs to reduce his body weight, in order to avoid complications during surgery, the recommendation is around 10 % of body weight and for this, nutritional management is indispensable. Thus, we created a nutritional guide in bariatric surgery and compiled the best recommendations for this public. Read on to learn more.
Weight Loss in the Preoperative Period
Some factors such as high abdominal wall thickness, higher amount of intra-abdominal fat and also increased liver size are predisposing factors for greater occurrence of complications during bariatric surgery. Thus, preoperative weight loss is indicated, especially for patients with BMI above 50 kg/m2 and associated comorbidities.
Thus, the reduction of 5 to 10% of the weight is recommended. For this, a study shows that a low calorie diet (LCD) and the very low calorie diet (VLCD) present similar results in weight loss, with the indicated duration of 2 to 12 weeks prior to surgery.
Nutritional management
Pre-Surgical
In this sense, a low-carbohydrate diet and the Mediterranean diet can be used in the preparation of the patient in association with caloric deficit. Recommended caloric intake is 800-1200 Kcal per day. One point to be highlighted is the proportion of proteins offered in the diet, because with rapid weight reduction, muscle mass tends to be reduced.
Therefore, the supply of proteins of high biological value should be a priority of the nutritionist. Added to this, guidelines on water consumption should be made, associated with guidelines for the consumption of Whole foods, rich in fiber, fruits and low calorie vegetables that will be able to provide the appropriate amounts of micronutrients.
Post Surgery
Nutritional care after surgery is able to prevent malnutrition, reduces the risk of weight gain and also gastrointestinal complications. Thus, the food offered depends on the individual acceptance capacity, and the energy deficit must be maintained.
Therefore, complete liquid diets, clear liquid and pasty are offered in the days following surgery. The recommended caloric intake is 1000 calories. However, the individual tolerability of the patient should be taken into account when defining the total calories that will be offered, being a joint choice between nutritionist and patient.
Bariatric Supplementation and Surgery
Bariatric patients have difficulties in consuming the daily amount of protein. In this sense, protein supplementation can be a strategy, the different sources of soy, egg white, casein and whey protein are widely available in the market.
However, whey protein it is more indicated since it has a high amount of branched chain amino acids, indispensable in the process of post-surgical muscle remodeling. In addition to these, data indicate that the consumption of omega 3 in the pre-surgical period was associated with greater weight loss.
In addition, the main micronutrients that may present deficiency in bariatric patients in addition to vitamin B12 are vitamins A, E and K, calcium, vitamin D, folate, and iron. In this context, supplementation may be beneficial in order to prevent the onset of symptoms such as weakness, nail and hair loss, excessive tiredness and fatigue, typical signs of micronutrient deficiency.
Bariatric Surgery and Physical Activity
Some patients undergoing bariatric surgery may suffer from musculoskeletal problems and also with chronic diseases, which theoretically makes it difficult to perform physical activities. However, physical activity should be implemented in the patient’s daily routine in order to reduce the risk of death associated with chronic diseases and maintain adequate patient weight.
Clinical practice
Thus, we list here in this nutritional guide for bariatric surgery the main recommendations, which are in a summarized and practical way: from 2 to 12 weeks before the procedure the energy supply should be around 800 to 1200 kcal, about 100 g of proteins, 1g/kg of fats or 30 % of VET and the rest in the form of carbohydrates, prioritizing natural foods, whole foods of low caloric value.
For omega 3 presurgical supplementation with good concentration of EPA and DHA. In addition, in the post-surgical period, the use of Whey Protein can be a beneficial strategy. Finally, encouraging the practice of regular physical activity is paramount for bariatric patients.
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Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline [published correction appears in Obes Surg. 2020 Feb;30(2):793]. Surg Obes
. 2019;29(10):3385-3400. doi:10.1007/s11695-019-04112-y
