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T HE NATIONAL OBESITY epidemic continues to drive increased demand for bariatric surgery. Approximately 200,000 bariatric surgeries have been performed annu- ally in the U.S. since 2007, according to the American Society for Metabolic and Bariatric Surgery (ASMBS). Women account for approximately 80 percent of these. With more men and women under- going bariatric surgery for management of their obesity, all clinicians — especially primary care providers — play a vital role in post surgical care of the bariatric patient, from follow-up care to lifelong monitoring. The Benefits of Bariatric Surgery Weight loss surgery is a life changing and potentially lifesaving treatment for obese individuals who have not had suc- cess with traditional weight loss strategies such as diet modification, exercise, or medication. Bariatric surgery leads to sustainable long-term weight loss and may put obesity-related co-morbidities such as Type 2 diabetes, hypertension, hypercholesterolemia and obstructive sleep apnea in severely obese patients in remission. Weight loss surgery produces average excess weight loss of 45 to 70 percent, with 50 percent of weight lost within the first 6 months. Depending on the procedure chosen, post-surgery remission rates for Type 2 diabetes can be as high as 65 to 85 percent, while remission rates for high blood pressure, high cholesterol and sleep apnea are around 80 percent. Additionally, patients who have bariatric surgery will likely have reduced rates of premature death due to heart disease, stroke, diabetes and cancer. The most common surgical procedures for weight loss range from purely restric- tive — the laparoscopic adjustable gastric band and laparoscopic sleeve gastrec- tomy — to restrictive with a modest degree of malabsorption — the laparoscopic Roux-en-Y gastric bypass. Postoperative Care Patients should avoid non-steroidal anti-inflammatory medications (NSAIDs) and steroids. Taking these after bariatric surgery increases the risk of developing ulcers. Aspirin carries the same risk, however, the risks and benefits of daily aspirin therapy should be considered on an individual basis. Safer options include acetaminophen. Additionally, smoking should be avoided after bariatric surgery. After gastric bypass, patients need to supplement iron, calcium and B12 due to bypassing the antrum and duodenum. To avoid developing deficiencies, the fol- lowing supplements are recommended: • Chewable multivitamin with iron (must have at least 2mg copper and 18mg elemental iron) • Calcium citrate (1200–1500mg elemental calcium taken in two equally divided doses) • Vitamin D3 (800 units per day) • Vitamin B12 (1000mcg sublingual daily) • For premenopausal women: iron (40–65mg elemental iron taken with at least 100mg Vitamin C). Iron and calcium supplements should be taken 2 hours apart. Rapid weight loss predisposes patients to gallstones. It is recommended that patients take Ursodiol for six months following surgery to prevent gallstones. Although a proton pump inhibitor can provide relief, patients presenting with heartburn or acid reflux should be seen by their bariatric surgeon for evaluation. It is recommended that patients not get pregnant for 1 to 1.5 years following surgery. In preparation for pregnancy, patients should take prenatal vitamins with folic acid. A ll patients should have routine blood work every six months for the first two years postoperatively and then annually thereafter. Dr. Aviv Ben-Meir is Medical Director of the Bariatric Surgery Center at Lake Health in Willoughby, Ohio. He is board-certified in General Surgery and fellowship trained in Advanced Laparoscopy and Bariatric Surgery. He has been practicing in Northeast Ohio since 2002 and has performed more than 4,000 bariatric operations. ■ Management of the Post Surgical Bariatric Patient By Aviv Ben-Meir, MD, FACS S E L E C T I O N C R I T E R I A F O R B A R I AT R I C S U R G E R Y + Approximately 100 pounds overweight + BMI > 40 + BMI > 35 and significant co-morbidities + Failure to achieve weight control with other medically managed weight loss programs + Acceptable operative risk 2 0 1 4 S E P T E M B E R /O C T O B E R ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 5