Experts issue recommendations for treatment of post-bariatric surgery patients

Today, The Endocrine Society released a new clinical practice guideline for the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes mellitus. The guideline features a series of evidence-based clinical recommendations developed by an expert task force. The guideline is published in the November 2010 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.

Between 1999 and 2004, obesity rates in the United States increased by 24 percent. Bariatric surgery has gained wide acceptance as a treatment for severe obesity, especially when complicated by type 2 diabetes. Common operations include laparoscopic banding procedures and gastric surgeries, which restrict the volume of food entering the stomach and intestines. Patients undergoing bariatric surgery may still experience weight regain and may also present with associated co-morbidities, including type 2 diabetes, polycystic ovarian disease, metabolic bone disease, fatty liver, hypertension and obstructive sleep apnea.

"Bariatric surgery is not a guarantee of success, and patients require postoperative care," said David Heber, MD, PhD, of the University of California, and chair of the task force that developed the guideline. "To help prevent weight regain, ensure that co-morbid conditions are adequately managed and ease the transition to life after bariatric surgery, the guideline recommends that patients receive the support of a multidisciplinary team that includes an experienced primary care physician, endocrinologist or gastroenterologist."

Other recommendations from the guideline include:

• Active nutritional patient education and clinical management to prevent and detect nutritional deficiencies for all patients undergoing bariatric surgery;
  
• Management of potential nutritional deficiencies for patients undergoing malabsorptive procedures as well as strategies to compensate for food intolerance in patients who have had a malabsorptive procedure to reduce the risk for clinically important nutritional deficiencies;
  
• Patient enrollment in a comprehensive program for nutrition and lifestyle management; and
  
• Future research aimed at addressing the effectiveness of intensive postoperative nutritional and endocrine care in reducing morbidity and mortality from obesity-associated chronic diseases.

The Hormone Foundation, the patient education affiliate of The Endocrine Society, has published a companion patient guide. It outlines steps patients and their health care team should take to avoid nutritional deficiencies and resulting complications, such as protein malnutrition or bone loss, particularly after malabsorptive operations. The guide explains that, in most patients, obesity-related health problems disappear or greatly improve after surgery. It also encourages patients to have realistic expectations about what the surgery can do for them and the lifestyle changes they must make to lose weight and keep it off. The patient guide can be found online at: www.hormone.org/bariatric-patient-guide.