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A) Dietary recommendations after bariatric surgery
A progressive diet should be followed after bariatric surgery. The duration of this varies, and it involves gradually incorporating foods of different textures starting with liquids, then mashed foods, soft foods, and finally more solid consistencies.
To ensure that the food is tolerated properly, patients are advised to eat and drink slowly, consume small amounts frequently, and chew their food thoroughly. Once normal textures can be consumed and food tolerance has been ensured, dietary guidelines following bariatric surgery aim to ensure healthy weight loss, mainly from fat mass while minimising the loss of muscle mass. This is done by prioritising the consumption of foods rich in protein, and reducing the intake of foods rich in fat and sugars. The patient’s diet will need to include vitamin, mineral and protein supplements as prescribed by their medical team, who will perform regular blood analysis and complementary tests for this purpose.
In order to achieve maximum weight loss, patients should continue to receive dietary education after surgery with the aim of maintaining healthy eating habits, and a regular programme of physical activity. This means it is important for the patient to undergo surgery in the context of a multidisciplinary team, and for them to continue attending regular post-operative check-ups.
B) Type 2 diabetes after bariatric surgery
The incidence of type 2 diabetes (DM2) continues to increase worldwide, mainly as a result of the obesity epidemic. One of the main reported benefits of bariatric surgery is that it leads to improvement and remission of type 2 diabetes. In the short term, a high success rate in terms of disease remission (in other words, normal blood glucose levels without diabetes treatment) has been reported. However, in the long term, some patients who were initially in remission then relapse (meaning they need to restart hypoglycaemic treatment to maintain good glycaemic control).
Several studies have described predicting factors of a lower probability of DM2 remission in the medium to long term: these include age, duration of the disease, decreased pancreatic beta-cell (insulin-producing cell) function/reserves, poorer glycaemic control, insulin treatment prior to surgery and poor initial weight loss. The last two factors have been shown to be the best predictors.
It is important that patients who will undergo this type of surgery are properly informed about the likelihood of suboptimal outcomes in type 2 diabetes, so they can make an informed decision about the surgery and can adjust their expectations.
People with obesity are not only at greater risk of being infected by COVID-19, but also have poorer progression and higher rates of hospitalisation. Furthermore, there tends to be a high percentage of people with obesity in intensive care units, which is related to a higher risk of mortality. There are various factors that can influence the increase in mortality due to COVID-19: obesity is characterised by a chronic state of low-grade inflammation with an increase in cytokines (inflammatory molecules), which reduces the body’s ability to respond to respiratory infection by COVID-19 and promotes worsening of the disease. Furthermore, obesity is associated with reduced immunity, which makes patients more susceptible to all kinds of infections, with a deficient response to treatment with antivirals and lower efficacy of vaccines. In addition, especially in people with abdominal obesity, there is greater respiratory distress due to a reduction in inspiratory reserve volume, airway resistance and mobility difficulties in the ribcage, which increases the likelihood of ventilatory failure, and in turn worsens the progression of the infection.
Obesity and lockdown
The COVID-19 pandemic, its repercussions and the measures being taken to contain it, have affected practically the whole of society in many ways. During the lockdown caused by the first wave of the pandemic, people with obesity suffered the same consequences as everyone else, in terms of emotions, lifestyle and dietary habits, as well as weight progression. Physical activity has decreased significantly, they have found it more difficult to maintain healthy eating patterns and, in general, there has been a tendency to eat more and to eat in response to anxiety, boredom, and other negative emotions. A trend of weight gain has also been observed.
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Substantiated information by:
Alba Andreu MartíNutritionistEndocrinology and Dietetics Department
Lilliam Flores MenesesEndocrinologistEndocrinology Department
Silvia Cañizares AlejosPsychologistPsychiatry and Psychology Department
Published: 17 August 2018
Updated: 20 January 2022
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