Bariatric Nutrition

Laparascopic adjustable gastric banding (LAP-BAND), Roux-en-Y gastric bypass, gastric sleeve (sleeve gastrectomy), biliopancreatic diversion  (BPD) with or without duodenum switch are all types of bariatric gastric surgery that are performed to treat obesity in a morbidly obese individual in face of increased risk of obesity-related morbidity and mortality, and with failure to achieve proper weight loss with lifestyle changes and weight-loss medications.

Studies show that weight loss surgery may result in  long-term weight loss, enhanced lifestyle, improvement  in baseline  risk factors (except for hypercholesterolemia) and significant reduction of long-term total mortality, in particular deaths from diabetes, heart disease, and cancer. Bariatric surgery leads to lower overall energy intake, higher physical activity, greater recovery from diabetes, hypertriglyceridemia, hypertension, and hyperuricemia. The use of medications for obesity-related conditions is reduced, and there is a significant improvement in the quality of life.  Most recent data show that bariatric surgery may also reduce the number of cardiovascular events *.

Gastric surgery

Patients with Type II diabetes may improve blood glucose levels which is especially true for those who has had diabetes for less than 5 years and who are only on oral hypoglycemics. If a patient has been on insulin for a long period of time, most likely diabetes will never go away, but insulin dosage may be decreased. Moderate and mild sleep apnea may completely be resolved usually after 20-30 lbs weight loss. Hypoventilation is reduced due to the decrease in pressure caused by visceral fat loss. Serum lipids may improve within 6 months. Other conditions that improve are

  • hypertension,
  • degenerative joint disease and mobility,
  • non-alcoholic fatty liver disease,
  • asthma,
  • polycystic ovary syndrome,
  • infertility,
  • gastroesophageal reflux disease (GERD)
  • urinary incontinence *.

Bariatric Dietitian

However, even though, bariatric surgery is one of the most effective way to lose significant weight and improve the quality of life for a morbidly obese individual, it is not a guarantee and certainly not a cure for the obesity. It is rather a tool for proper weight management. The key for successful weight loss and maintenance after bariatric weight loss surgery is the combination of physical activity, behavioral change and continuous medical nutrition therapy with a bariatric  dietitian (licensed bariatric nutritionist).

Bariatric dietitina has a vital role in the overall success of the weight loss surgery. Being a part of a multidisciplinary medical team, registered dietitian (RD) starts his/her contribution with the evaluation of the patient for the surgery. RD performs initial preoperative assessment and identifies patient’s readiness for a complete change in his/her diet, lifestyle and behavior. RD collects data about the patient and transfers it to entire medical team in order to provide the best care for the patient. Based on the information obtained from the evaluation, specifically eater type, amount of excess weight, portion size, sweet-tooth,  RD discusses with the patient and other members of the team the best procedure that would fit patient’s dietary habits. RD makes the patient aware of risks and benefits of the procedure so that the patient has realistic expectations about the surgery and weight loss*.

Bariatric nutrition care before the surgery

Scientific data show that patients are more likely to succeed in weight loss if they see RD pre- and postoperatively on a regular basis. It is important for the patient to understand that good nutritional status before the surgery ensures the success as well as long term outcomes. It is vital for immune system, wound healing and recovery time.

The postoperative management of the bariatric diet and success of the long-term weight loss starts preoperatively through nutritional status evaluation, strong education and follow-up reinforcement program.  Nutrition therapy does not focus only on the dietary intake. Along with diet recommendations, RD integrates multiple disciplines such as physical activity, behavioral therapy and pharmacotherapy in order to provide the most appropriate and individualized nutrition care to the patient. Preoperatively RD and the patient begin to develop healthy behaviors so that to achieve better control over comorbidities and improve health status. The emphasis of the nutrition therapy lies on:

  • general nutrition knowledge about bariatric diet, techniques and bariatric surgery complications: proper chewing, importance of hydration, reduced stomach volume and amount of food, vomiting, dumping syndrome, and others;
  • help in preparation of the kitchen with appliances and appropriate foods for gastric surgery diet;
  • cultural and economic issues;
  • realistic and individualized goal setting;
  • behavioral modification;
  • preoperative weight loss*.

Bariatric nutrition care after the surgery

The postoperative nutrition therapy is mostly focused on protein and fluid intake, vitamin and mineral supplementation and dealing with complications. RD works with the patient on

  • advancing the diet as tolerated,
  • modifying meal structure,
  • adjusting portion sizes,
  • increasing food selections,
  • creating meal plans,
  • availability of healthy foods in the house,
  • increasing fruits and vegetables,
  • eliminating cues to overeating,
  • recognizing physical versus emotional hunger,
  • mindful eating and recognizing satiety,
  • eating at patient’s own pace and listening to the body,
  • introducing physical activity,
  • adherence to the recommendations *.

It is important to emphasize that work with the bariatric dietitian should be ongoing through monthly meetings, e-communication, monitoring and evaluation which will decrease risk of complications, promote weight loss and prevent weight regain. Once the weight goal is achieved, patients have to be reeducated on healthy eating behaviors to maintain the weight. It is recommended to follow up every 2 to 3 months for the first 6 months postoperatively, once during second 6 months and next year, and annually thereafter if no nutritional or metabolic comorbidities present. With comorbidities and complications, patients should follow up more often.

RD’s role is to make patient realize that weight loss surgery needs a lifelong management, and that  patient’s eating behavior has to be changed forever which is the biggest challenge for long-term weight management. Patients should remember that gastric surgery is not a cure for obesity and can only serve the patient lifelong if the patient uses it properly. “Surgery changes the body, not the environment”, and triggers to non-hunger eating will always be there. Food can always be a great temptation if a patient allows it to be. The patient with the help of RD have to change the meaning of food which will require great honesty and responsibility for decisions and choices made *.


Bariatric Bypass Surgery Dietitian in Philadelphia

At Nourish Me Nutrition Therapy, our registered bariatric dietitian will support the decisions her patients make and will lead them all the way towards to a healthier life. She will become patient’s personal coach and will teach her patient to be his/her own support, determine strengths and weaknesses, set realistic goals and take pride in success. Our RD will deal with the emotional bond patients have with food and help integrate bariatric diet recommendations with physical activity, behavioral therapy and pharmacotherapy in order to aid in lifestyle modification and provide the most appropriate and individualized nutrition care to the patient. She is truly a  “care manager” and a reflective listener for her each bariatric patient because she always defines options, facilitates access to the information and promotes skill building and behavioral change so that to decrease risk of postoperative complications and promote significant weight loss and long-term weight management *.


Call Nourish Me Nutrition Therapy Today 215.315.3859

Call us to set up your appointment. Bariatric weight loss surgery is a huge step, and our registered dietitian will be happy to  guide you through the entire process on your road to a more healthy and productive life.




* Source: Research paper “Roux-en-Y Gastric Bypass: The Role of the Registered Dietitian in the Success of Weight Loss Surgery” by Natallia Hainutdzinava. Copy available upon request for additional cost.