Registered Dietitians Play Essential Role In Management Of Gastric Bypass Patients

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More than one third of Americans are considered obese and approximately 15 million (5%) Americans now have a body mass index (BMI) greater than 40.

A comprehensive team approach provides the best care to bariatric surgery patients and Registered Dieticians play an important and growing role in this process.

The April issue of the Journal of the American Dietetic Association focuses on the ever-increasing use of bariatric surgery to control the excess morbidity and mortality associated with extreme obesity and the important role that registered dietitians play in the management of patients who have undergone the procedure.

In their editorial on bariatric surgery, Robert K. Kushner, MD; and Lisa M. Neff, MD, Northwestern University Feinberg School of Medicine, Chicago, compare leading approaches and offer insights into their strengths and weaknesses. They advocate treatment by a multidisciplinary team of experts including physicians, exercise specialists, behaviorists and registered dietitians, with a focus on lifestyle modification to help patients achieve weight loss, with or without pharmacotherapy as an adjunctive treatment. When these approaches fail to produce clinically significant weight loss, bariatric surgery should be considered for patients with a BMI over 40 (or over 35 in the presence of significant weight-related conditions such as diabetes or hypertension).

Bariatric surgeon Alex Nagle, MD, FACS, Feinberg School of Medicine at Northwestern Memorial Hospital, Chicago, summarizes the key rationale for the increase in bariatric surgery. While concerns remain about long-term safety and future risk for other diseases, the opportunity to halt and reverse the increasing weight gain has tremendous appeal. He cites to efforts by the American Society of Metabolic & Bariatric Surgery and the American College of Surgeons to improve both patient access and overall quality of care, through the establishment of bariatric surgery Centers of Excellence. According to Dr. Nagle, this constitutes "an important step forward toward accurately tracking outcomes, defining clinical criteria, enhancing the quality of care and improving patient access to this life-saving operation."

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.

All articles appear in the Journal of the American Dietetic Association, Volume 110, Issue 4 (April 2010) published by Elsevier. "Bariatric Surgery: A Key Role for Registered Dietitians" by Robert K. Kushner, MD, and Lisa M. Neff, MD (Editorial). J Am Diet Assoc. 110 (2010), pp. 524-526. "Bariatric Surgery: A Surgeon's Perspective" by Alex Nagle, MD, FACS (Commentary). J Am Diet Assoc. 110 (2010), pp. 520-523. "The Bariatric Surgery Patient: A Growing Role for Registered Dietitians" by Doina Kulick, MD, MS, Lisa Hark, PhD, RD and Darwin Deen, MD, MS. J Am Diet Assoc. 110, pp. 593-599. "Dietary, Weight and Psychological Changes among Patients with Obesity, 8 Years After Gastric By-Pass" by Maaike Kruseman, RD, MPH, Anik Leimgruber, RD, and Flavia Zumbach, RD. J Am Diet Assoc. 110, pp. 527-534.

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Body Mass Index BMI A statistical method of figuring out the degree of excess or insufficient weight based on one's height & weight. Though the controversial BMI does not actually measure the percentage of body fat, it is a useful tool to estimate a healthy body weight based on how tall a person is.

Bariatrics The branch of medicine that deals with the causes, prevention, and treatment of obesity. The term bariatrics was created around 1965, from the Greek root baro ("weight," as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). Besides the pharmacotherapy of obesity, it is concerned with obesity surgery.

Hypertension Also referred to as high blood pressure, HTH, HTN or HPN, hypertension is a medical condition in which the blood pressure is chronically elevated. In current usage, the word "hypertension" without a qualifier normally refers to arterial hypertension. The Mayo Clinic specifies blood pressure is "normal if it's below 120/80".

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Obesity Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk. CLICK HERE TO OPEN THE JOURNEY BMI CALCULATOR!

Center of Excellence A Bariatric Surgery Center of Excellence is a bariatric program that has been designated a Bariatric Surgery Center of Excellence (COE) by the Surgical Review Corporation, a nonprofit corporation that: Establishes guidelines for assessing bariatric programs Evaluates bariatric programs to ensure they meet certain standards for recognition as a COE A bariatric program that has been designated a COE has met strict criteria and delivers bariatric care that meets high standards. Read more about Bariatric Surgery Centers of Excellence...

Diabetes Mellitus A disease that occurs when the body is not able to use blood glucose (sugar). Blood sugar levels are controlled by insulin, a hormone in the body that helps move glucose from the blood to muscles and other tissues. Diabetes occurs when the pancreas does not make enough insulin or the body does not respond to the insulin that is made. There are two main types of diabetes mellitus: Type 1 Diabetes and Type 2 Diabetes. All forms of diabetes have been treatable since insulin became medically available in 1921, but there is no cure.

Metabolism All of the processes that occur in the body that turn the food you eat into energy your body can use. Exercise, food, and environmental temperature influence metabolism.

Registered Dietitian A dietitian is an expert in food and nutrition; A person who has studied diet and nutrition at a college program approved by the American Dietetic Association, completed 900 hours of supervised practical experience accredited by the Commission on the Accreditation for Dietetics Education, and passed an exam to become an R.D. Dietitians help promote good health through proper eating. They also supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits. The term "nutritionist" is also widely used; however, the term nutritionist is not regulated as dietitian is. People may call themselves nutritionists without the educational and professional requirements of registered dietitians.