Improving follow-up for patients who have weight loss surgery (Bariatric Surgery) #obsmuk chat blog

Improving follow-up for patients who have weight loss surgery



Bariatric (weight loss) surgery is the most effective treatment option for patients affected by obesity.

It results in significant and sustained weight loss (on average 15-40% of the initial weight 10 years after surgery depending on the procedure).

Bariatric surgery has significant favourable impact on obesity-related complications such as Type 2 diabetes, Hypertension, cardiovascular disease, obstructive sleep apnoea, hyperlipidaemia, and some cancers amongst others. The effect of surgery on these complications might be remission of the condition, improvement of its control or prevention of the condition from happening.

In addition, Bariatric Surgery results in significant improvements in quality of life and physical and psychological well-being. The above mentioned benefits result in reduction in mortality in patients affected by obesity who are treated surgically.

However, bariatric surgery has short and long term complications/risks. In this chat, we will be discussing some of the non-surgical complications of bariatric surgery and how they might be dealt with/ reduced by improving follow up after bariatric surgery.

For example, the decrease in oral intake after bariatric surgery in addition to the effect of some bariatric procedures on the absorption of nutrients can result in deficiencies in minerals and vitamins such as iron, calcium, Vitamins (including Vitamin D, Vitamin B12) and trace elements ( zinc, copper and selenium) amongst others. Some  malabsorptive procedures might affect the absorption of protein also.

While many people affected by obesity suffer from psychological issues and disordered eating prior to being treated by bariatric surgery, some patients suffer from recurrence of the previous issues they had before surgery and some might even develop new issues.
Some studies showed increased risk of substance misuse, alcohol dependency and self-harm following bariatric surgery.

Some patients who had remission of their obesity-related complications post-surgery might develop these complications again after the surgery as remission rates drop over time following surgery. Patients and health care professionals need to be aware of this in order to implement appropriate screening and treatment strategies.

Hence, while bariatric surgery as effective and overall safe treatment for patients with obesity; long term follow up is essential to maximise the benefit of the procedure and to ensure long term safety.

Currently, in the UK, in the NHS, patients are generally followed up by the bariatric team for the first two years after surgery. After that the patient’s care is returned to the general practitioner and primary care. Many primary care health care professionals have very little experience of bariatric surgery and this may leave the patients vulnerable.

In 2016, Guidelines for the follow-up of patients undergoing bariatric surgery were published (O’Kane et al 2016 https://onlinelibrary.wiley.com/doi/abs/10.1111/cob.12145). These were commissioned on behalf of NHS England. The dietitian led working group included surgeon, physicians, bariatric nurse, GPs and four patient representatives.  A number of recommendations were made and these included access to dietetic and psychological support, management of reactive hypoglycaemia* and long-term annual review. It also recommended long-term follow-up as part of a shared care model. This would require training of health care professionals and investment in resources. This is where the care is shared between the GP and medical or surgical obesity centres with the ability for the GP to seek advice and refer back. In addition, NICE QS 127 (2016) recommended “People discharged from bariatric surgery service follow-up (NHS) are offered monitoring of nutritional status at least once a year as part of a shared-care model of management”.

In the Tweetchat on Wednesday 25th April at 8pm UK time, we will discuss the following questions:

1.       How should patients be followed up after bariatric surgery? Should it be in primary care (in the community) or secondary care (specialist centres) –or should care be shared between primary and secondary care?

2.       Which professional groups need to be involved in post- bariatric surgery care?

3.       Should all patients have regular blood tests post bariatric surgery as recommended by NICE QS127 and BOMSS  or just those who have particular symptoms?

4.   Does post-surgical follow up improve long term outcomes? What’s the evidence?

5.      What training on post-surgery follow-up should be available to healthcare professionals?

*Reactive hypoglycaemia refers to hypoglycaemia (very low blood sugars) and its associated symptoms that is often caused by eating or drinking foods and drinks with a high sugar content. Blood sugars may fall, resulting in hypoglycaemia typically 45–90 min after ingestion. In some cases, this can be severe and even lead to loss of consciousness.

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