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Guidance issued to help primary care clinicians provide more support to bariatric patients

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General practices should help more with follow-up and advice for patients that have undergone surgery for obesity due to the huge increase in such operations, claim those behind new guidelines.

Advice on nutrition and pregnancy following bariatric procedures are among the key areas where assistance could be given in primary care, according to the European Association for the Study of Obesity.

“Follow-up should be, at least in part, transferred to primary care over time”

Luca Busetto

The EASO highlighted that the number of bariatric operations performed yearly worldwide had increased by five times over the past 15 years, peaking close to 200,000 procedures in 2017.

It claimed that the only way for health systems to cope with the increased demand was for primary care to assist with giving advice to patients and following-up after their surgery.

As a result, to help primary care staff, the association has drawn up new guidelines, which have just been published in the journal Obesity Facts.

It noted there was often a lack of training and knowledge to deal with the issue in primary care, but suggested its guidance should help GPs and nurses not specifically trained in bariatric medicine.

Nutrition, the management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention were all covered in the new guidelines, said the EASO.

It cited common problems encountered after surgery were nutritional deficits, as patients adjusted to the smaller intake of their stomach or digestive tract, as well as the amounts of food they ate.

“This is the only way to cope with the increasing use of obesity surgery across Europe”

Luca Busetto

The guideline authors highlighted that deficiencies in key vitamins such as vitamin B and D, minerals such as iron, and other key nutrients such as folic acid was a frequent problem.

The new guidelines recommended that blood tests on nutrient levels should be carried out every three to six months in the first year after surgery and every 12 months thereafter.

General practices could “easily” deal with such tests, while at the same time checking blood pressure and cholesterol, or advising on any medication requirements, such as for diabetes, said the authors.

They said that primary care could also deal with other dietary advice such as quantity and frequency of food intake, and ensuring patients were consuming enough protein – at least 60 grams per day.

An important component of successful and long-lasting weight loss was adherence to nutrient-dense foods, containing sufficient amounts of lean proteins and fibres, highlighted the guideline authors.

In addition, the guidance noted the physiological changes caused by the surgery could make patients more susceptible to the effects of alcohol.

Meanwhile, it also covered pregnancy after obesity surgery, a “crucial area” where there was generally considered to be a low-level of knowledge in general practices, said the authors.

The guidance stated that pregnancy was not recommended during the first 12-18 months after surgery, so the foetus would not be affected by rapid maternal weight loss and so women could achieve their weight-loss goals.

The authors said another vital issue covered by the guidelines was the mental health of patients following surgery, and the very low but increased risk of suicidal ideation.

Evidence has shown an excess of suicides among obesity surgery patients, with 30% of these occurring within two years and 70% within three years, they warned.

They also said there could be other severe mental health side-effects of surgery, including patients having unrealistic expectations and some may require therapy or another assistance.

University of Padova

Guidance to help primary care support obesity surgery patients

Luca Busetto

Professor Luca Busetto, from the University of Padova in Italy and co-chair of the EASO Obesity Management Task Force, said: “Given the increasing number of obesity surgery patients, follow-up should be, at least in part, transferred to primary care over time.

“The major aim of our new guidelines is precisely this: to provide to all healthcare professionals involved in the care of post-obesity surgery patients all they need to provide appropriate first-level medical care to these particular patients,” he said.

“While of course we would expect complex issues to continue to be referred to obesity teams in hospitals, we believe that with dissemination of appropriate knowledge and training, many problems may be resolved in more basic and less expensive settings,” said Professor Busetto.

“This is the only way to cope with the increasing use of obesity surgery across Europe, while simultaneously providing appropriate follow-up care and advice for patients,” he warned.

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