PRMCE

1. PRMCE Bariatric Weight Loss Surgery November 2012 Diet Host In-service Jen Hey, Dietetic Intern Clinical Nutrition

2. Successful Completion of this Required Learning includes: • Reading the module • Completing the post-test with 100% of correct answers chosen

3. Objectives: • Know the different types of bariatric weight loss surgery that will be performed at PRMCE • Identify the diets for patient’s post-surgery • Know what is meant by “dumping syndrome” • Understand tray modifications for patients that undergo bariatric weight loss surgery at PRMCE or have had previous bariatric weight loss surgery

4. Bariatric Weight Loss Surgery • Patient profile: Patients undergoing bariatric weight loss surgery are severely obese and have failed at traditional weight loss attempts, many have co-morbidities such as diabetes, heart disease, and sleep apnea • Definition: Surgery that alters the gastrointestinal tract of a patient in order to induce weight loss • All patients that undergo bariatric surgery must make life long changes to their diet including small portions of low fat, low carbohydrate, protein rich meals

5. Types of Bariatric Weight Loss Surgery: • Gastric banding: Placement of an adjustable, inflatable band around the stomach to create a very small pouch and limit the amount of food a patient can eat

6. Types of Bariatric Weight Loss Surgery • Sleeve Gastrectomy: Reduces the size of the stomach and removes the portion of the stomach that produces ghrelin, a chemical messenger that signals hunger

7. Types of Bariatric Weight Loss Surgery • Gastric Bypass: Rerouting of the small intestine to decrease the size of the stomach and limit the absorption of nutrients

8. What to Expect at PMRCE • Surgeries to begin mid-November • Surgeries will be scheduled one day per month with 3-5 surgeries per day • The first few months will have fewer surgeries and be limited to the less complicated types of surgery • Many of the surgery patients will go home the same day and not be admitted to the hospital

9. Diets Post Surgery • For gastric banding: patients can drink up to a cup of fluids at a time, most fluids will come from the floor and not room service dining. • For sleeve gastrectomy: patients will be on a clear liquid diet and will be restricted to very small servings (30-60 mL in medicine cups) at a time, most fluids will come from the floor as well. • For gastric bypass: this is the most complicated of the surgeries;patients will be on clear liquids at first but may progress to full liquids or pureed foods in very small servings before going home. A protein supplement may be required.

10. Dumping Syndrome • One of the biggest changes these patients will likely experience after surgery is an inability to eat large meals that are high in carbohydrates and fat. If they do eat these meals they are likely to experience “dumping syndrome”, a sudden onset of the following symptoms due to the food passing very quickly through their smaller stomach and into their intestines: • Sweating • Diarrhea • Rapid heart rate • Nausea • Weakness • Abdominal Pain

11. Other Considerations for Patients • No carbonated beverages • No regular juice or sugary beverages • No caffeinated beverages

12. Patients with Past Surgeries • Patients admitted to PRMCE that have had bariatric weight loss surgery previously at another facility may also require tray modifications such as smaller portions, protein supplements, and more frequent meals. Please follow any modifications made in health touch carefully.

13. Post-Test • In what month will the first bariatric weight loss surgery at PRMCE occur? • Which type of surgery re-routes the small intestine? • T or F, all bariatric weight loss surgery patients will be admitted to the hospital overnight? • Name three symptoms of dumping syndrome: • A diet sprite is an acceptable beverage for a patient that has had gastric bypass surgery and is on a clear liquid diet?

14. Resources • 1. Academy of Nutrition & Dietetics, 2012. www.eatright.org