Patients require significant counseling both before and after surgery. Doina Kulick, MD, University of Nevada School of Medicine, Reno, and colleagues discuss the role of the registered dietitian as an important part of the surgical team. She writes, "Surgery represents only one point in the continuum of care for the obese patient. The long term outcome of bariatric patients relies on their adherence to lifetime dietary and physical activity changes. A comprehensive team approach provides the best care to these patients and RDs play an important and growing role in this process. Because of the pre- and postoperative dietary issues, RDs can assess, monitor and counsel patients in order to improve adherence and reduce the risk of nutrient deficiencies."

Because bariatric surgery has grown more common over the past 10 years, data regarding follow-up and subsequent morbidity and mortality are now emerging. Investigators Maaike Kruseman, RD, MPH, and colleagues at the University for Applied Sciences of Western Switzerland, Geneva, followed 80 patients for 8 years after gastric bypass surgery. They report that while more than half of the patients achieved successful weight loss, these patients had disordered eating behaviors. They observe, "Successful and unsuccessful patients experienced similar rates of problematic eating behavior, depression and anxiety. These patterns can be easily ignored by the caregivers if they are not routinely screened for, as weight loss is the usual measure of success. This could affect patients' quality of life and self-esteem, and give them a feeling of failure despite the objective success in terms of weight loss."

Collectively, these articles demonstrate that gastric bypass patients require careful assessment and guidance to further promote and sustain weight loss, provide essential nutrients and offer a lifestyle shift that can permanently accomplish their goals. Registered dietitians can make an important contribution to managing bariatric surgery patients before and after surgery.

Source: Elsevier Health Sciences