A Program of Life-Style Modification Improved the Body Weight and Micronutrient Status in Obese Patients after Bariatric Surgery

Abstract

Introduction: Bariatric surgery is an efficient approach to rapidly reduce morbid obesity and associated comorbidities. However, approximately one-fourth of patients experience weight and comorbidity recurrence, and both obesity and bariatric surgery can lead to micronutrient deficiencies. Implementing a structured program of lifestyle modification (PLM) might enhance weight loss and improve micronutrient status. Methodology: A total of 121 severely obese patients underwent Roux-en-Y gastric bypass (RYGB). Among them, 71 adhered to a PLM involving dietary changes (low- and very-low-calorie Mediterranean diets) and physical exercises (aerobic and resistance training) both before and after surgery, while 50 patients followed a conventional protocol. Anthropometric measurements and serological parameter quantifications were conducted throughout the procedures. Results: The obese study population, primarily female (76.9%), with an average age of 47.11 ± 9.68, and a body mass index (BMI) of 44.68 ± 5.08 kg/m2, underwent either RYGB with a PLM or a conventional procedure. Before surgery, the PLM group exhibited significant reductions in body weight (6.3%) and phosphoremia compared to the conventional protocol (0.78%). Post-RYGB, the PLM group demonstrated shortened in-hospital stays and further BMI reductions (−16.12 kg/m2) that persisted for up to 2 years. Furthermore, the PLM group experienced increased plasma vitamin D levels (14.79 ng/mL vs. 1.2 ng/mL) for up to 2 years, as well as elevated folic acid (1.52 vs. −0.29 ng/mL) and phosphorus (0.48 vs. 0.06 mg/dL) levels at 1 month and 1 year after intervention, respectively. Notably, these effects were independent of weight loss. Conclusions: Initiating a structured PLM from the early stages of patients’ preparation for RYGB could enhance and extend the benefits of weight loss and positively impact micronutrient (vitamin D, phosphorus, and folic acid) status in obese patients.

Baseline 25(OH)D level is a prognostic indicator for bariatric surgery readmission: a matched retrospective cohort study

“…Furthermore, surgery can induce and exacerbate vitamin D reduction and antagonize the positive weight loss-inducing effects of bariatric surgery owing to post-operative physiological changes, weight loss, altered gut microbiome, loss of intrinsic factor/gastric acid, and medication use ( 37 , 38 ). Risk of malabsorption is stratified in different surgery types.…”

“…Seasonal variables were included in this study primarily to balance the potential influence on vitamin D levels ( 37 , 40 ). Studies on the seasonal chronology of surgical complications regardless of the influence on 25(OH)D are limited.…”

“…Thus, this study shows that the vitamin D classification criteria should be optimized for obese patients, and the prognostic effect should be considered in individual supplementation. Furthermore, surgery can induce and exacerbate vitamin D reduction and antagonize the positive weight loss-inducing effects of bariatric surgery owing to post-operative physiological changes, 10.3389/fnut.2024.1362258 weight loss, altered gut microbiome, loss of intrinsic factor/gastric acid, and medication use (37,38). Risk of malabsorption is stratified in different surgery types.…”