Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Abstract

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.

European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care

“…Therefore, long-term mineral and multivitamin supplements should be prescribed to every bariatric patient according to the surgery procedure used. In addition, periodic laboratory surveillance for nutritional deficiencies is recommended, and appropriate supplements will be individualized accordingly [57]. Patients with demonstrated micronutrient deficiencies will be treated with the respective micronutrient.…”

“…Finally, relapse in body weight gain (of various magnitudes) generally occurs after a few years to a decade. There should be an early attempt at prevention through lifestyle modification, focusing particularly on physical activity and on eventual treatment with appropriate weight loss drugs [57]. …”

“…However, part of the follow-up, particularly in the period directly after surgery, could also be carried out at primary care level (by GPs), provided these professionals have been trained specifically. The Obesity Management Task Force (OMTF) of the European Association for the Study of Obesity (EASO) recently released a paper containing practical recommendations for the post-bariatric surgery medical management [57]. …”

‘The rollercoaster of follow‐up care’ after bariatric surgery: a rapid review and qualitative synthesis

“…In the UK, the National Institute for Health and Care Excellence (NICE) recommends that bariatric surgery patients should stay under the care of the specialist surgical unit for the first 2 years post‐surgery and then be discharged to primary care under a shared care model with annual reviews . Recently, the European Association for the Study of Obesity published detailed guidance for non‐specialists that also highlighted the need for longer term follow‐up for patients following bariatric surgery. European Association for the Study of Obesity recommended that longer term follow‐up needs should be transferred to primary care physicians and other non‐surgical healthcare professionals (HCPs) when clinically appropriate , concurring with NICE guidance .…”

“…Recently, the European Association for the Study of Obesity published detailed guidance for non‐specialists that also highlighted the need for longer term follow‐up for patients following bariatric surgery. European Association for the Study of Obesity recommended that longer term follow‐up needs should be transferred to primary care physicians and other non‐surgical healthcare professionals (HCPs) when clinically appropriate , concurring with NICE guidance .…”