A functional approach: Metabolic and bariatric surgery

Photo by  Hush Naidoo Jade Photography

We understand that obesity is a multifactorial disease. We use current treatments that include lifestyle changes in nutrition and physical activity, and behavioral therapy to assist people living with obesity. We also support those considering other effective solutions for those with obesity, including metabolic and bariatric surgery. Our next blog series takes a deep dive into what metabolic and bariatric surgery is, how we support both those considering surgery and who have already undergone surgery through a functional nutrition perspective.

What is metabolic and bariatric surgery? 

Metabolic and bariatric surgery is an effective long-term solution for those with obesity. Not only does it help to decrease body weight overall, but it also can help manage chronic conditions such as type 2 diabetes, heart disease, hypertension, and sleep apnea. Surgery is often categorized in a couple of ways: restrictive, malabsorptive or a combination. Restrictive surgery limits food intake by reducing stomach size while malabsorptive surgery limits nutrient absorption by bypassing parts of the small intestine. In addition, some procedures combine both of these aspects. Not only does surgery affect nutrient intake, there’s also hormonal changes that also occur with metabolic and bariatric surgery.

However, bariatric surgery isn't suitable for everyone with obesity, as specific medical criteria must be met. After qualification for surgery, there is an extensive screening process and preparation for surgery including nutrition, lifestyle and even mindset changes. This is where we come in to provide support leading up to surgery, educate on how surgery affects these various aspects, and guide through any potential complications post-surgery.  

By looking at metabolic and bariatric surgery through a functional lens, we can understand that the gastrointestinal microbiome and hormones are widely affected by obesity but are also rapidly changing post-metabolic and bariatric surgery. For this reason, assessing micronutrient deficiencies, gut health, and hormone balance are of vital importance before and after the procedure. Micronutrient deficiencies comprise of vitamin and mineral level  It's important to understand why these changes occur and what can be done to help enable optimal health following the procedure.

Micronutrient Deficiency Signs & Symptoms 

• Fatigue 

• Pale skin 

• Weakness 

• Constipation 

• Hair loss 

• Depression 

• Menstrual issues 

• Poor concentration 

Micronutrient deficiency is defined as a lack of essential vitamins and minerals that are required in small amounts by the body for proper growth and development. The most common deficiencies before and after surgery include B vitamins, vitamin D, iron, and zinc to name a few. Deficiencies before surgery may be caused by intake that lacks these micronutrients or even low “good” bacteria that can help with the absorption of these nutrients. Pre-operative screening is important in minimizing deficiencies leading up to surgery. If deficiencies are present, supplementation of vitamins and minerals may begin before surgery. Due to changes in your anatomy as a result of surgery, absorption of vitamins and minerals may be decreased, so supplementation is used. Other reasons for deficiencies include reduced acid production in the stomach and decreased nutritional intake. This is why supplementation of vitamins and minerals is lifelong after surgery.

Poor Gut Health Signs & Symptoms 

• Upset stomach

• Weight gain 

• Bloating and gas 

• Constipation and diarrhea 

• Constant fatigue and sleep problems 

• Skin irritations 

Poor gut health is caused by several factors including a low fiber, high processed foods, history of antibiotic use, poor stress management, inadequate sleep, and inadequate hydration may also add to the effects of poor gut health. Metabolic and bariatric surgery changes the digestive process, therefore, addressing symptoms of poor gut health before surgery can improve post-surgery symptoms. Gut health after surgery may take time to adjust back to normal, which is why optimizing microbiome function is vital to returning to normal as quickly as possible.

Hormone Imbalance Signs & Symptoms 

• Weight loss or weight gain

• Fatigue 

• Muscle aches and weakness 

• Mood swings 

• Increased or decreased sensitivity to cold and heat 

Possible causes of hormone imbalances prior to surgery include medications, autoimmune disorders, diabetes, eating disorders, and stress. Hormone imbalances can be further caused by pregnancy, lactation, menopause, and diagnoses such as PCOS or endometriosis. Addressing hormonal imbalances prior to surgery may improve post-surgery symptoms. Adipose or fat tissue plays a large part in endocrine system function and hormone communication. Changes in weight after surgery can disrupt hormone balance overall and may need to be further assessed.

In summary, metabolic and bariatric surgery can assist in improving the overall health picture of someone with obesity. Long-term monitoring of micronutrients, gut health, and hormone balance are essential to ensure continued whole-body health. In our next blog, we will dive into our more specific functional approach to micronutrient deficiencies.

Interested in learning more about how we support weight loss surgery?

We’d love to work with you! Schedule a complimentary Meet + Greet session. We look forward to finding individualized solutions to fit your needs and being a partner with you in your bariatric journey

Published: April 22nd, 2024.

This blog post was written by Amanda Sikkema MS, RD, LD, CSCS, a dietitian at Katie Chapmon Nutrition. She works with clients virtually and is accepting new clients.