Nutrition to Enhance Metabolic-Bariatric Surgery Outcomes

Gender-specific post-surgical goals for 12-month percent body fat (%BF) based on World Health Organization (WHO) obesity thresholds and for lean mass-sparing were published as preliminary body composition (BC) guidelines to address a knowledge gap in metabolic-bariatric surgery (MBS). Other studies' %BF outcomes inconsistently fell below obesity thresholds; none described nutrition practices. To help practitioners positively influence patients' BC and weight changes, this study describes the team-supported process of conducting serial body composition analysis (sBCA) concomitantly with the evidence-based nutrition practices applied to generate the preliminary guidelines.

Guidelines were generated using the cumulative outcomes of separate, original research board-approved Roux-en-Y Gastric Bypass and Sleeve Gastrectomy studies. One dietitian assessed BC using the same bioimpedance machine, educated patients, and collected data from patients aged 18 and older in a 532-bed nonprofit acute-care institution in Northeast Ohio, USA, from May, 2007, through November, 2016. Essential to pre- and postoperative education was the "Nutrition Goal Checklist," an evidence-based synopsis of imperative practices. Body composition was assessed on initial visit, presurgically, and postoperative months 3, 6, and 12, generating individual patient handouts of progressive weight and BC changes with coordinating %BF graphs. Serial assessment enabled intervention toward meeting BC goals.

For genders in both surgeries, the described process influenced highly significant fat mass reduction, transitioning %BF below obesity thresholds. Lean mass-sparing outcomes supported the suggested preliminary guidelines.

Utilizing sBCA with evidence-based nutrition practices consistently generated outcomes to formulate preliminary BC guidelines following MBS. Further research is needed to solidify formal guidelines.