Last month at Obesity Week in Washington, we had the opportunity to attend a presentation outlining the updated Nutrition in Bariatric Surgery Guidelines which resulted from a number of years of micronutrient research following the different weight loss surgery procedures performed world-wide.
Data gathered from a large number of studies has shown that the prevalence of micronutrient deficiencies is increasing, while monitoring of patients at follow-up is decreasing. Subsequently, there were a number of recommendations made for pre and post-op screening, preventative supplementation and repletion of nutrient deficiencies that will impact our guidelines for our WLS patients. Interestingly, three of the most prevalent micronutrient deficiencies highlighted were Vitamin D & Calcium, Vitamin A and Zinc, with Folate, Iron and Vitamin B1 not far behind.
Whilst it is the responsibility of the WLS Program to determine individual variations as they relate to patient nutritional care, we have introduced the following changes to our guidelines:
1. Routine Vitamin D screening for our patients post-operatively. All patients to have Vitamin D as a part of their daily multivitamin, and ALL patients to have daily Calcium supplementation (1200-1500 mg/day)
2. Vitamin A screening for patients who have had gastric bypass surgery and have fat malabsorption ( often evident by pale, floaty stools)
3. Vitamin B1 (Thiamine) screening for patients at risk ( those with GI symptoms)
4. All patients to take at least 18 mg Iron daily, including men and post-menopausal women. Menstruating women to take 45-60 mg elemental Iron daily (as per our standard guidelines)
5. All patients to take daily Bariatric quality vitamin supplements, and these to be taken as per manufacturers instructions. This will be updated in our handouts as soon as possible.