*Marta Jastrzebska-Mierzynska1, Lucyna Ostrowska1, Emilia Duchnowska2, Hady Razak Hady3
Dietetic preparation of obese patient to bariatric treatment
Przygotowanie dietetyczne pacjenta otyłego do operacji bariatrycznej
1Department of Dietetics and Clinical Nutrition, Medical University of Bialystok, Poland
2Department of Emergency Medicine, Medical University of Bialystok, Poland
31st Department of General and Endocrinological Surgery, Medical University of Bialystok, Poland
Otyłość jest chorobą przewlekłą, predysponującą do rozwoju wielu schorzeń. Częstość jej występowania stale wzrasta. Szacuje się, że na świecie w 2016 roku otyłych było 650 milionów osób dorosłych (1). Próby leczenia zachowawczego otyłości olbrzymiej często nie przynoszą pożądanych rezultatów, w związku z tym chorzy poddawani są leczeniu zabiegowemu. Udowodniono, że chirurgia bariatryczna jest najskuteczniejszą metodą terapii pacjentów otyłych, jednak obarczona jest szeregiem powikłań. Objęcie chorego specjalistyczną opieką w okresie przedoperacyjnym może to ryzyko obniżyć. Szczególnie istotne wydaje się być przygotowanie dietetyczne. Ma na celu przede wszystkim: zmianę dotychczasowych nawyków żywieniowych, redukcję masy ciała, wyrównanie niedoborów pokarmowych oraz edukację żywieniową w zakresie wymaganych zmian w sposobie żywienia po operacji bariatrycznej.
Przeszukano bazy PubMed i Medline (manuskrypty opublikowane w latach 2000-2018). Słowa kluczowe użyte podczas wyszukiwania w przeglądarce elektronicznej to: „chirurgia bariatryczna”, „żywienie”, „dieta”, „zalecenia żywieniowe”, „stan odżywienia”, „przedoperacyjna dieta niskokaloryczna”.
Odpowiednie przygotowanie żywieniowe pacjenta wpływa na przebieg i skuteczność leczenia operacyjnego.
Obesity is a chronic disease that predisposes to the development of many diseases. The incidence of its occurrence is constantly increasing. It is estimated that worldwide in 2016 650 million adults were obese (1). Attempts of conservative treatment of morbid obesity often do not bring the desired results, therefore, patients are reffered for surgical treatment. It has been proven that bariatric surgery is the most effective method of therapy for obese patients, however, it is subject to a number of complications. Specialistic treatment in pre-operative care may reduce the risk. Dietetic preparation seems to be particularly important. Its main purpose is to change previous eating habits, reduce body mass, compensate nutritional deficiencies and nutritional education in terms of required changes in the diet after bariatric surgery.
The PubMed and Medline database were searched (manuscripts published from 2000 to 2018). The keyword used in the electronic serach included: “bariatric surgery”, “nutrition”, “diet”, “dietary recommendations”, “nutritional status”, “preoperative low calorie diet”.
Adequate nutritional preparation of the patient affects the course and effectiveness of surgical treatment.
Obesity is considered a civilization disease of the 21st century which brings a threat to the health and life of highly developed societies. Currently, it is one of the main public health problems in the world, due to the health effects, range and rapid increase in its frequency (1-3).
Attempts to treat obesity conservatively by using low calorie diets, increased physical activity or pharmacotherapy are insufficient in some patients to achieve significant, permanent weight reduction. More frequently, among patients previously treated conservatively without an effect, surgical treatment is applied, which results in greater loss of body weight, durability of the effect and a more significant improvement in the treatment of obesity-related diseases (4). Adequate nutritional preparation of the patient in the pre-operative period is one of the factors determining the effectiveness of surgical treatment of obesity.
According to international and Polish recommendations in the field of bariatric and metabolic surgery, the best results of surgical treatment of obesity are obtained if the time of preparation of the patient for the procedure lasts at least 3 months, and optimally 6-12 months. At this time, it is recommended to have at least 3 visits to the doctor coordinating bariatric treatment (surgeon) or other specialists who are part of a multidisciplinary team (5, 6). Proper preparation of the patient allows optimization of treatment of diseases resulting from obesity and comorbidities, and thus, reduces the risk of untoward events in the perioperative period (5, 7-9). In addition, it allows assessment the patient’s motivation and willingness to cooperate and participate in long-term post-operative control. An essential element of effective surgical treatment of obesity is the patient’s cooperation with a dietitian not only in the postoperative period, but also at the pre-operative assessment stage and preparation for surgery (10-12).
Pre-treatment dietary proceedings should include a detailed assessment of the current diet, assessment of nutritional status, determination of the weight reduction plan, nutritional education, as well as constant control of the effects of the process of looping weight (11, 12).
The assessment of the diet is aimed at learning about the current eating habits of the obese patient, including the number and frequency of meals consumed, the size and composition of individual meals, the frequency of consumption of various groups of food, its dietary preferences, culinary techniques used during the preparation of meals. In addition, all weight reduction attempts and their effects should be discussed with the patient. A precise analysis of the diet allows the dietitian to identify and correct the nutritional mistakes made by the patient, which significantly influenced the increase in body weight or were the cause of failure during attempts to lose weight.
The results of own study and other authors, indicate that the diet of obese people, despite high energy value, is characterized by low nutritional density, which results in food deficiencies (13-15). Numerous studies provide evidence that latent food deficiencies, especially vitamin D3, calcium, iron or folic acid, are very common in people with obesity (16-18). In connection with the above, the patient’s preparation for the surgical procedure should also include the diagnosis of the nutritional status of the patient. In addition to the basic anthropometric measurements (body weight, waist circumference, hip circumference), the body composition and blood biochemistry tests should be performed to identify nutritional deficiencies, properly compose the patient’s diet, and select the appropriate supplementation (if required). The results of the body composition analysis will also serve as a reference in assessing the effectiveness of the patient’s diet both in the pre-operative and post-operative period.
The role of a dietician is to develop a plan to reduce body weight and to define a measurable goal (loss of 5-10% of the initial body weight) that the patient should achieve. It is beneficial to designate a few small goals for the patient, the achievement of which will allow them to develop and consolidate new, healthy eating habits. The change of the current way of nutrition should start with learning how to regulate the consumption of food. During the day, the patient should eat 5 regular meals, at intervals of 3-3.5 hours. Especially important in daily nutrition is the consumption of breakfast for an hour after waking up. Supper should be eaten about 2 hours before bedtime. Regular consumption of food with low energy density accelerates metabolism, prevents fluctuations in blood glucose concentration, and thus prevents hunger attacks and the desire to eat something sweet between meals (19). It was shown that people who aim at loosing weight regularly consuming breakfast had lower body mass in comparison with people who did not eat breakfast.
In addition, the consumption of a breakfast containing higher amounts of protein and dietary fiber helps increase the feeling of satiety and reduce the number of kilocalories and contributes to lowering the energy value of the all-day diet (20-22). It should also be recommended for patients to reduce the portions of meals, do not eat between meals, avoid eating at night. It should be made clear to the patient that meals should be consumed without haste for at least 20 minutes, and each bite should be masticated (20-30 times). In addition, the patient should avoid additional sugar, eating candy, sweet drinks, as well as fast food. The current way of preparing meals should also be modified. Dishes should be prepared using such cooking techniques as: boiling, steaming, grilling, baking in a foil or sleeve.
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