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Preventing Chronic Disease | Importance of Nutrition Visits After Gastric Bypass Surgery for American Veterans, San Francisco, 2004–2010 - CDC

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Preventing Chronic Disease | Importance of Nutrition Visits After Gastric Bypass Surgery for American Veterans, San Francisco, 2004–2010 - CDC



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Importance of Nutrition Visits After Gastric Bypass Surgery for American Veterans, San Francisco, 2004–2010

Aung Zaw Win, MD, MA, MPH; Carol Ceresa, MHSL, RD; Anne L. Schafer, MD; Peter Mak, BS, RD; Lygia Stewart, MD

Suggested citation for this article: Win AZ, Ceresa C, Schafer AL, Mak P, Stewart L. Importance of Nutrition Visits After Gastric Bypass Surgery for American Veterans, San Francisco, 2004–2010. Prev Chronic Dis 2014;11:140289. DOI: http://dx.doi.org/10.5888/pcd11.140289External Web Site Icon.

MEDSCAPE CME

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and Preventing Chronic Disease. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at www.medscape.org/journal/pcd; (4) view/print certificate.
Release date: December 24, 2014; Expiration date: December 24, 2015

Learning Objectives

Upon completion of this activity, participants will be able to:
  • Describe the association between the number of nutrition visits a patient attended and change in body mass index after gastric bypass surgery, based on a retrospective study of veterans
  • Discuss findings of other recent studies regarding the association between the number of nutrition visits a patient attended and change in body mass index after gastric bypass surgery
  • Distinguish the role of nutrition counseling in patients undergoing gastric bypass surgery
 
EDITORS
Rosemarie Perrin, Editor, Preventing Chronic Disease. Disclosure: Rosemarie Perrin has disclosed no relevant financial relationships.
CME AUTHOR
Laurie Barclay, MD, Freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
AUTHORS AND CREDENTIALS
Disclosures: Aung Zaw Win, MD, MA, MPH; Carol Ceresa, MHSL, RD; Anne L. Schafer, MD; Peter Mak, BS, RD; Lygia Stewart, MD have disclosed no relevant financial relationships.

Affiliations: Aung Zaw Win, Carol Ceresa, Peter Mak, Clinical Nutrition, San Francisco Veterans Affairs Medical Center, San Francisco, California; Anne L. Schafer, Department of Medicine, University of California, San Francisco, Medical Service, San Francisco Veterans Administration Medical Center, San Francisco, California; Lygia Stewart, Department of Surgery, University of California, San Francisco, Surgical Service, San Francisco Veterans Administration Medical Center, San Francisco, California.

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Abstract

Introduction
Nutrition counseling is important for veterans undergoing gastric bypass surgery. The aim of this study was to explore the relationship between the number of nutrition visits a patient attended and change in body mass index (BMI) after gastric bypass surgery for the veteran population.
Methods
A retrospective study examined veterans (N = 79) who underwent Roux-en-Y gastric bypass surgery from June 2004 through July 2010. Spearman’s correlation and multivariate regression analysis were used to analyze data.
Results
A significant correlation was found between the number of postoperative nutrition visits and the change in postsurgery BMI at 2 years (Spearman’s ρ = 0.21; P = .017). After adjusting for age, sex, and race, the association between postsurgery nutrition visits and BMI change persisted (β = 0.255; 95% confidence interval, 0.015–0.581; P = .039).
Conclusion
Veterans with more nutrition visits following Roux-en-Y gastric bypass surgery experienced greater declines in BMI. This finding underscores the importance of the dietitian on the bariatric surgery team.
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Introduction

From 2009 through 2010, the prevalence of obesity in the United States was 35.5% among adult men and 35.8% among adult women (1). Over the next 2 decades, obesity is expected to increase an additional 33% and severe obesity by 130% (2). The United States spends over $190 billion annually on health care directly related to obesity (3). Among veterans receiving care through the Veterans Health Administration (VHA), 73% of men and 68% of women are overweight or obese (4). The incidence of obesity has increased substantially among US veterans (5). Obesity is associated with diseases in all of the organ systems, and gastric bypass surgery can prevent secondary complications of obesity.
Surgical treatment of obesity is more effective and produces longer lasting outcomes than medication therapy or counseling (6). More than 250,000 bariatric procedures were performed in the United States in 2008 (7), and that number will continue to increase. Roux-en-Y gastric bypass (RYGB) surgery has become the gold standard among bariatric surgeries, and it is the most commonly performed bariatric procedure in the United States and all over the world (7,8). Gallagher et al reported that the cost of RYGB surgery at the VHA is offset by reduction of health care costs within the first year after surgery (9). The procedure is also reported to increase life expectancy by an average of 7.1 years (10). Moreover, weight loss surgery has been reported to ameliorate chronic medical conditions such as diabetes and improve quality of life (11,12). In veterans, long-term follow-up has confirmed significant and durable weight loss with marked improvement in comorbidities (5). Independent studies have reported significantly greater weight loss after RYGB than with vertical banded gastroplasty (13). The maximum weight loss after RYGB occurs at 2 years after the surgery, and after 2 years, up to 25% of lost weight can be regained (14,15). Studies have followed the RYGB outcomes up to 15 years after the surgery (16). However, few long-term follow up studies on results of RYGB have been conducted for the VHA patient population (14).
The role of the registered dietitian nutritionist is to perform dietary assessments, to evaluate for nutritional deficiencies, and to provide counseling to help patients meet postsurgery weight loss goals (17). Dietitians are part of the multidisciplinary bariatric team. Expert guidance and visits to dietitians are part of the surgical process. Veterans are an underprivileged and disenfranchised population, and they suffer from greater socioeconomic and health disparities than the general population (4). The aim of this study was to explore the relationship between the number of nutrition visits a patient made and change in body mass index (BMI) after gastric bypass surgery for the veteran population.

Acknowledgments

Support for this study was provided by the Department of Veterans Affairs under grant no. 5 IK2 CX000549-04. All authors declare that they have no conflicts of interest.
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Author Information

Corresponding Author: Aung Zaw Win, MD, MA, MPH, San Francisco Veterans Affairs Medical Center 4150 Clement St, San Francisco, CA 94121. Telephone: 415-221-4810, extension 2070. E-mail: aungzwin@gmail.com.
Author Affiliations: Carol Ceresa, Peter Mak, Clinical Nutrition, San Francisco Veterans Affairs Medical Center, San Francisco, California; Anne L. Schafer, Department of Medicine, University of California, San Francisco, Medical Service, San Francisco Veterans Administration Medical Center, San Francisco, California; Lygia Stewart, Department of Surgery, University of California, San Francisco, Surgical Service, San Francisco Veterans Administration Medical Center, San Francisco, California.
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References

  1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 2012;307(5):491–7 and . CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  2. Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med 2012;42(6):563–70. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  3. Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ 2012;31(1):219–30. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  4. Das SR, Kinsinger LS, Yancy WS, Wang A, Ciesco E, Burdick M, et al. Obesity prevalence among veterans at Veterans Affairs medical facilities. Am J Prev Med 2005;28(3):291–4. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  5. Hauser DL, Titchner RL, Wilson MA, Eid GM. Long-term outcomes of laparoscopic Roux-en-Y gastric bypass in US veterans. Obes Surg 2010;20(3):283–9.CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  6. Martins C, Strommen M, Stavne OA, Nossum R, Mårvik R, Kulseng B. Bariatric surgery versus lifestyle interventions for morbid obesity — changes in body weight, risk factors and comorbidities at 1 year. Obes Surg 2011;21(7):841–9. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  7. Schroeder R, Garrison JM, Johnson MS. Treatment of adult obesity with bariatric surgery. Am Fam Physician 2011;84(7):805–14. PubMedExternal Web Site Icon
  8. Júnior WS, Amaral JL, Nonino-Borges CB. Factors related to weight loss up to 4 years after bariatric surgery. Obes Surg 2011;21(11):1724–30. CrossRefExternal Web Site IconPubMedExternal Web Site Icon
  9. Gallagher SF, Banasiak M, Gonzalvo JP, Paoli DP, Allwood J, Morris D, et al. The impact of bariatric surgery on the Veterans Administration healthcare system: a cost analysis. Obes Surg 2003;13(2):245–8. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  10. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357(8):753–61. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  11. Alami RS, Morton JM, Sanchez BR, Curet MJ, Wren SM, Safadi BY. Laparoscopic Roux-en-Y gastric bypass at a Veterans Affairs and high-volume academic facilities: a comparison of institutional outcomes. Am J Surg 2005;190(5):821–5. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  12. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004;240(3):416–23. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  13. Brolin RE, Robertson LB, Kenler HA. Weight loss and dietary intake after vertical banded gastroplasty and Roux-en-Y gastric bypass. Ann Surg 1994;220(6):782–90. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  14. Yan E, Ko E, Luong V, Wang HJ, Romanova M, Li Z. Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass: a primary care experience. Am J Surg 2008;195(1):94–8. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  15. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2010;95(11):4823–43. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  16. Dalcanale L, Oliveira CP, Faintuch J, Nogueira MA, Rondó P, Lima VM, et al. Long-term nutritional outcome after gastric bypass. Obes Surg 2010;20(2):181–7. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  17. Kulick D, Hark L, Deen D. The bariatric surgery patient: a growing role for registered dietitians. J Am Diet Assoc 2010;110(4):593–9. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  18. Compher CW, Hanlon A, Kang Y, Elkin L, Williams NN. Attendance at clinical visits predicts weight loss after gastric bypass surgery. Obes Surg 2012;22(6):927–34. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  19. Lier HØ, Biringer E, Stubhaug B, Tangen T. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized control trial. Patient Educ Couns 2012;87(3):336–42. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  20. Shen R, Giovanni D, Rajaram K, Cabrera I, Siegel N, Ren CJ. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg 2004;14(4):514–9.CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  21. Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg 2010;20(3):349–56. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  22. Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care 2005;28(2):481–4. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  23. Shah M, Adams-Huet B, Rao S, Snell P, Quittner C, Garg A. The effect of dietary counseling on nutrient intakes in gastric banding surgery patients. J Investig Med 2013;61(8):1165–72. PubMedExternal Web Site Icon
  24. Freire RH, Borges MC, Alvarez-Leite JI, Toulson Davisson Correia MI. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition 2012;28(1):53–8. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  25. Admiraal WM, Celik F, Gerdes VE, Dallal RM, Hoekstra JB, Holleman F. Ethnic differences in weight loss and diabetes remission after bariatric surgery: a meta-analysis. Diabetes Care 2012;35(9):1951–8. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  26. Livingston EH, Liu CY, Glantz G, Li Z. Characteristics of bariatric surgery in an integrated VA health care system: follow-up and outcomes. J Surg Res 2003;109(2):138–43. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  27. Bekheit M, Katri K, Ashour MH, Sgromo B, Abou-ElNagah G, Abdel-Salam WN, et al. Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis. Surg Endosc 2014;28(8):2406–11. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  28. Still CD, Benotti P, Wood GC, Gerhard GS, Petrick A, Reed M, et al. Outcomes of preoperative weight loss in high-risk patients undergoing gastric bypass surgery. Arch Surg 2007;142(10):994–8. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
  29. Harper J, Madan AK, Ternovits CA, Tichansky DS. What happens to patients who do not follow-up after bariatric surgery? Am Surg 2007;73(2):181–4.PubMedExternal Web Site Icon
  30. Adams CE, Gabriele JM, Baillie LE, Dubbert PM. Tobacco use and substance use disorders as predictors of postoperative weight loss 2 years after bariatric surgery. J Behav Health Serv Res 2012;39(4):462–71. CrossRefExternal Web Site Icon PubMedExternal Web Site Icon
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