Patient perspectives on post-bariatric surgery nutritional supplementation.

BACKGROUND: Bariatric procedures increase patient risk of long-term metabolic complications primarily due to nutrient deficiencies. The mainstay of prevention includes routine vitamin and mineral supplementation; however, patient-reported barriers to daily compliance are poorly understood. METHODS: Post-bariatric surgery patients electively participated in an 11-point outpatient survey at a single academic institution. Surgical procedures included either laparoscopic sleeve gastrectomy (SG) or gastric bypass (GB). At the time of survey, patients ranged from 1-month to 15 years from surgery. Survey items consisted of dichotomous (yes/no), multiple choice, and open-ended free response questions. Descriptive statistics were evaluated. RESULTS: Two hundred and fourteen responses were collected, 116 (54%) underwent SG and 98 (46%) underwent GB. Of these, 49% of samples were during short-term postoperative follow-up visits (0-3 months), 34% intermediate follow-up (4-12 months), and 17% long-term follow-up (> 1 year). A total of 98% of patients reported that insurance did not cover their supplement cost. Most patients reported current vitamin use (95%), with 87% reporting daily compliance. Daily compliance was observed in 94%, 79%, and 73% of SG patients at short-, intermediate-, and long-term follow-up visits, respectively. While GB patients reported daily compliance in 84%, 100%, and 92% of short, intermediate, and long-term responses. Of those who were unable to take vitamins daily, non-compliance was attributed most to forgetting (54%), and less often to side effects (11%), or taste (11%). Patient-reported strategies for remembering to take vitamins included tying into daily routine (55%), use of a pill box (7%), and alarm reminders (7%). CONCLUSIONS: Daily compliance with post-bariatric surgery vitamin supplementation does not appear to vary based on postoperative time-period or surgical procedure. While a minority of patients struggle with daily compliance, factors associated with non-compliance include patient forgetting, side effects, and taste. Widespread utilization of patient-reported daily reminder strategies may lead to improved overall compliance and reduce incidence of nutritional deficiencies.

Effectiveness, Compliance, and Acceptability of Preoperative Weight Loss with a Liquid Very Low-Calorie Diet Before Bariatric Surgery in Real Practice.

OBJECTIVE: A preoperative very low-calorie diet (VLCD) is a common method to reduce weight before bariatric surgery. However, patient compliance and acceptability are not always known. The aim of this study is to evaluate the effectiveness, compliance, and acceptability of our regimen in a metropolitan academic quaternary care center. METHODS: Patients with a BMI < 50 kg/m2 and a BMI ≥ 50 kg/m2 were instructed to be on a liquid VLCD for 1 week and 2 weeks, respectively. The primary outcome was the amount of weight loss. Secondary outcomes were patient compliance and acceptability of either regimen using a questionnaire for hunger, satisfaction, desire, and deviation for solids. RESULTS: The study included 128 patients. Ninety-four patients were in the BMI < 50 kg/m2 group, and 34 patients were in the BMI ≥ 50 kg/m2 group. The BMI ≥ 50 kg/m2 group had a greater percentage of total weight loss (mean ± SD) than that of the BMI < 50 kg/m2 group without statistical differences (4.4 ± 1.3% vs. 3.8 ± 1.6%, p = 0.072). There were no statistical differences between the groups in terms of hunger, satisfaction with a liquid diet, or satisfaction of eating over drinking. However, hunger sensation (median [IQR]) tended to be higher in the BMI < 50 kg/m2 group than that in the BMI ≥ 50 kg/m2 group (2 [2] vs. 2 [2, 3]; p = 0.06). There was no statistical difference in the percentage of patient compliance between the groups (75.5% [n = 71] vs. 61.8% [n = 21], p = 0.18). CONCLUSIONS: Preoperative liquid VLCD provided a modest amount of weight loss and showed a high rate of patient compliance and acceptability.