Surgical suggestion.

For suggestion of surgical treatment, the patient needs to present weight 200% above the ideal one and at least needs to have BMI of 35kg/m2, besides presenting co morbidity associated with DM, HAS, sleep apnea, among others. Another requisite is to be between 18-50 years old. For older patients there is a high rate of morbid-mortality, however this is still very controversial.

Nutrition and Morbid Obesity Treatment

Nutrition has great importance in morbid obesity surgical treatment, mainly regarding the great changes that occur in the gastrointestinal tract. Independent of the surgical process performed, the main objective is:

to promote adequate weight loss;

to maintain a good nutritional state, avoiding nutrient need.

to not let one lose the pleasure and other aspects concerning food (social aspects among others).

How nourishment works in the post-surgical period

Nutrition in the post-surgical period is mainly centered in increasing the patient’s potential for success. Therefore, the main objectives are:

To promote reduction in the initial weight;

To identify nourishment problems and suggest new alternatives;

To Create in the patient a real expectation of weight loss in the post-surgical period;

To prepare the patient for the diet that must be followed;

It is important that the patient have in mind that the surgery is not the cure for obesity, but a tool that used together with behavior changes can take him/her to the desired success.

Weight loss in this period is necessary to minimize surgical complications. Therefore, respiratory problems are reduced, besides the fact that with weight loss the co-morbidity improves, and the whole surgical process gets better too. Quitting smoking is also important.

How nourishment works in the post-surgical period

In this period, the person should not have any doubts related to the nourishment plan to be followed. The most important aspect is that the patient should observe how the gastric volume reduction would interfere in his/her capacity to eat. He/she also should be very well informed of the discomforts and consequences that he/she will go through if the protocol is not followed. This period is composed of three phases.

Phase 1
Composed of liquid diet. This step serves mainly to test the new stomach form; it helps cicatrisation (because it is a poor residue diet, there is decrease in the gastric effort) and maintains hydration.
 

Phase 2
Composed of pasty diet. From this step on, it is important for the nutritionist to create alternatives to not make the diet monotonous and therefore demotivate the patient.
 

Phase 3
Beginning of the solid diet and the nourishment reeducation process, aiming balanced nourishment and rich in several nutrients, mainly iron, calcium, folic acid and vitamin B12.
The nutrients’ absorption is prejudicial because of the gastrointestinal transit deviation promoted by the surgery and therefore needs to get special attention.
It is necessary to point out that the meal volume is always very reduced, varying from 30ml to 150ml, from the 1st to the 3rd phase.

Because of the small amount of food that is consumed daily, deriving from the restriction of the stomach size and bad absorption of some nutrients after the surgery, in the third week, vitamin and mineral supplementation starts to avoid future nutritional needs like iron deficiency anemia.

Considerations in the long run

The most important aspect is the change in the eating habit and life style, being this an important step in the treatment.

Basic principles of balanced nourishment

Variety
There is no food that contains all necessary nutrients for good health. Therefore, we should vary the food the most so that our body may absorb several nutrients.

Moderation
All foods can be consumed, including sweets, since it is done moderately.

Proportionality
It means to eat more healthy foods (or that they belong to the pyramid group of healthier foods) and less unhealthy food.

Food pyramid

The food pyramid is an ideal illustrative food distribution form for better comprehension by all, on how to consume food in sufficient quantities so that together they compose a nutritionally adequate diet.

The best pyramid for a healthy life has as base the daily practice of physical exercise, daily portions of whole cereals (rice, oat, wheat and whole products in general), fruit, vegetables and beans.
This means that the above-cited foods, because they constitute the pyramid base, should be consumed in greater amounts.
Fish (mainly sardines, salmon, etc), eggs, chicken, dairy products (preferably skim) should be consumed in less quantity because they are at the top of the pyramid. Lastly, red meat should be eaten in even less quantity. In general sweets should be consumed sporadically.

Nutritionists
Magda Rosa Ramos Quadros
Lourença Dalcanale