Bariatric Surgery February Newsletter

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Bariatric Surgery Section Newsletter
February 2011
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Obesity 2011


Bariatric Surgery Section


Dear Bariatric Section Members,

Happy New Year!  We enjoyed seeing many of you at TOS's 28th Annual Scientific Meeting in San Diego.  Our annual Bariatric section meeting was a great success.  We enjoyed a lively and productive discussion on the important questions in our field.  This quarter's newsletter will review our meeting as well as the Bariatric section's goals for 2011.  The recent clinical guidelines for post-surgical bariatric patients published by the Endocrine Society are summarized in this issue's "Just Published...".  Dr Youdim (our Chair-elect) provides this review and commentary.  Finally, we are including a list of NIH-supported research related to bariatric surgery.  Although additional funding for research on morbid obesity and bariatric surgery is desperately needed, we are reassured to see such a wide variety of empirical studies being conducted by our colleagues.
As always, we look forward  to comments, suggestions and ideas for future topics for the next publication of the Bariatric Surgery Section Newsletter  to our Secretary/Tresurer, Leslie Heinberg. Previous newsletters and additional information can also be found on our section's website.  Please visit it at


Best Regards for a Happy and Healthy 2011,


Phil Schauer
Chair - Bariatric Surgery Section  

Adrienne Youdim



Leslie Heinberg



TOS Bariatric Section Annual Meeting

Our section met on October 11, 2010 in San Diego.  A large number of members were present.  We initially reviewed our survey results.  Based on the self-report of a sub-sample of our 300+ members, we are a highly diverse group (27.2% Medical Management, 20.7% Psychology/Mental Health, 11.6% Basic Science, 10.3% Surgeons and a myriad of other specialties including: Nutrition, Physical Activity, Industry, Anesthesia, Public Health and Policy, Pharmacy, Education, Health Care Administration and Biostatistics). 

In this survey, members noted an interest in the development of guidelines and an increased presence in the programming for TOS.  In response to the former, our Program Committee chair, Dr. Lee Kaplan, led a multidisciplinary panel discussion on the following questions: 1) Are there any patients for whom NOT offering bariatric surgery would be medically inappropriate?  If so, who are they? 2)  Should all patients undergoing RYGB have preoperative micronutrient levels measured?  Which ones? What other preoperative / postoperative guidelines should be routinely implemented? 3) Are there any affirmative recommendations (required approaches) that can be established for the prevention and/or treatment of obesity? 4) Ideally, who should manage the late postoperative medical and nutritional care of patients undergoing bariatric surgery? 5) Ideally, who should manage the postoperative care for medical comorbidities of patients undergoing bariatric surgery? 6 ) What are the highest priorities for data collection in patients undergoing bariatric surgery? and 7) What should the NIH priorities be for research related to bariatric surgery?

Our section's program and executive committee has turned these questions-and the feedback from the audience discussion-into a series of proposed symposia for TOS 2011.  We hope to see further discussion of these questions by top experts on the scientific program in Orlando.  


TOS Bariatric Section Goals: 2011


2010 was a year of significant growth and development for our section.  However, we look forward to working on the following in 2011:  

  1. Content development and organization of a "Bariatric Day" of Symposia for TOS 2011.
  2. Obesity Week 2013 Combined Symposia Development-the above stated goal is a preliminary step toward this longer-term project
  3. Increased use of electronic resources such as: website bulletin board, list-serv, and links to our department's web-based journal club.
  4. Continue to build content of our newsletter with relevant information for our membership.
  5. Develop and distribute information regarding ongoing studies involving bariatric surgery with biannual updates.
  6. Develop an electronic bariatric surgery journal club.
Just Published...


For our Just Published feature this month we are providing a truncated review of the recently published Endocrine Society Guidelines on the Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient.


The authors state the purpose of this publication is to provide guidelines on the immediate post operative and long term management of patients after bariatric surgery to prevent complications, weight regain and progression of obesity-related disorders. Here are a few highlights of the recommendations...  


 1.  Prevention and Treatment of Weight Regain:

  • Surgery should be conducted by an accredited surgical team with integrated medical support team to provide lifestyle modification and long term follow up.
  • Treatment of weight regain (WR) should include a multidisciplinary approach.       
  • In severe post operative WR suggest evaluation of gastrointestinal anatomy and consideration of revision in conjunction with patient education, behavioral modification and other weight loss therapies.

2.  Post-operative Nutritional Management:

  • Recommend 60-120 grams protein daily to maintain lean body mass
  • Recommend long term vitamin and mineral supplementation and more extensive replacement therapy for malabsorptive procedures
  • Periodic clinical and biochemical monitoring for micro-and macronutrient deficiencies (Schedule of monitoring: table 2 in article)

 3.  Management of Diabetes and Lipids:

  • Post-operative glycemic control should consist of:
    • HbA1c of  7 % or less
    • fasting blood glucose of < 110 mg/dL.
    • postprandial glucose of < 180 mg/dL.
  • MD/RNs should be familiar with glycemic targets, insulin protocols and use of dextrose free IV fluids and low sugar protein supplements.
  • In the hospital, patients with DM I should receive scheduled insulin as indicated.
  • National Cholesterol Education Program (NCEP) ATP III guidelines should be followed for lipid abnormalities and lipid lowering therapy should be continued if levels of LDL and TG are above goal.

 4.  Bone Health and Gout:

  • Patients with malabsorptive obesity surgery procedures (ie RYGB, GS, BPD) should have:
    • vitamin d, calcium, phosphorus, PTH and alkaline phosphatase levels every 6 months.
    • Dual-energy x-ray absorptiometry for bone density yearly until stable.
    • Recommend Vitamin D and calcium supplementation post-operatively with doses adjusted based on above study results.
  • Patients with frequent attacks of gout should have prophylactic therapy to lessen chance of gout post-operatively as they lose weight.

 5.  Gastroenterological and Eating Behavior Considerations:

  • Recommend bariatric surgery patients sip fluids in the immediate post-operative period and discharged when tolerating oral fluids.
  • In patients with restrictive surgery, recommend gradual progression of food consistency over weeks to months to minimize vomiting.
  • Discourage intake of simple carbohydrates to minimize symptoms of dumping.
  • Suggests patients with post-prandial symptoms of hypoglycemia, particularly neuroglycopenic symptoms, be evaluated for possibility of insulin-mediated hypoglycemia.

Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Sill C. JCEM 2010:95(11):4823-4843.


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