Pre-operative information, education and counselling is initiated at the first visit with the Cape Town Bariatric Clinic dietitians. We attempt to address eating behaviours that are not conducive to long term weight loss maintenance and aim towards a 10% or more weight loss during the work up period, which also helps to reduce complications intraoperatively. This has been found to be positively associated with weight loss post operatively in some studies.
Selective micro-nutrient assessments are done before surgery to correct deficiencies pre surgery, and all patients are started on the post-operative supplement protocol a month before the proposed surgery date to reduce the risk of pre-operative nutrient deficiencies. In most cases a very low-calorie diet is initiated two weeks prior to the surgery date to ensure further weight loss. This also helps to decrease liver volume, which in turn helps reduce the difficulty of the surgery. Post-operative nutritional intake should be monitored and regularly assessed. Nutrition education and meal planning guidelines are provided to the patient and ideally to the family too. Much of this is reiterated at an in hospital visit along with planned follow up appointments. We guide patients as they progress from clear liquids to full fluids, then purees, until they are eventually able to move onto soft minces and mashes approximately 4-6 weeks’ post-surgery
The ultimate goal of nutrition is to meet protein and other micro-nutrient and macro-nutrient requirements with nutrient rich foods, within the context of a low-calorie eating plan. Low calorie or calorie free beverages should only be consumed between relatively small meals and 1-2 snacks during the day. Clinical and biochemical assessments should be done at regular intervals to assess adequacy of the diet and supplement protocol and adjustments made accordingly. It serves a perfect opportunity to continue to motivate the patients along this journey and help to find solutions to possible barriers to long term success.
ARTICLE BY: GINA FOURIE (Consultant Dietitian)