Nutrition Care in Bariatric Surgery

NCBS: Post-operative Medical Nutrition Therapy (2017)

Intervention
What is the effect of post-operative medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) on behavior change in adults who have undergone bariatric surgery?
- Conclusion
  Three studies [including gastric bypass, gastric band and biliopancreatic diversion patients (with the majority of patients having undergone gastric bypass)] reported on the effect of medical nutrition therapy (MNT) from a registered dietitian nutritionist (RDN) on behavior change. One study reported that MNT, provided as 15-minute in-person sessions with an RDN every other week for the first four months after surgery, resulted in a significant increase in cognitive restraint (controlled eating) for up to 18 months compared with standard care. However, two studies reported mixed results regarding the effect of MNT on increasing protein intake and physical activity.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of post-operative medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) on behavior change in adults who have undergone bariatric surgery?
- Search Plan and Results: NCBS: Medical Nutrition Therapy 2015
What is the effect of post-operative medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) on weight loss in adults who have undergone bariatric surgery?
- Conclusion
  Four studies [including gastric bypass, gastric band, sleeve gastrectomy and biliopancreatic diversion patients (with the majority of patients having undergone gastric bypass)] reported that patients receiving medical nutrition therapy (MNT) from a registered dietitian nutritionist (RDN) for two to six visits during the first year post-surgery had a significant excess weight loss ranging from 60% to 80% and significant reduction in body mass index (BMI) ranging from 5% to 31% at 12 months. An MNT session duration of 90 minutes was reported in one study, which also demonstrated that a higher frequency and duration of MNT visits resulted in the greatest weight loss (80% vs. 64% excess body weight loss at one year post-surgery), compared to those receiving standard care.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the effect of post-operative medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN) on weight loss in adults who have undergone bariatric surgery?
- Search Plan and Results: NCBS: Medical Nutrition Therapy 2015