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Background: The effect of a Roux-en-Y gastric bypass (RYGB) on body weight has been amply documented, but few studies have simultaneously assessed the evolution of energy and macronutrient intakes, energy expenditure, and changes in body composition over time after an RYGB., Objective: We evaluated energy and macronutrient intakes, body composition, and the basal metabolic rate (BMR) in obese female patients during the initial 3 y after an RYGB., Methods: Sixteen women with a mean ± SEM body mass index (in kg/m(2)) of 44.1 ± 1.6 were included in this prospective observational study. The women were studied on 6 different occasions as follows: before and 1, 3, 6, 12 (n = 16), and 36 (n = 8) mo after surgery. On each occasion, food intake was evaluated from 4- or 7-d dietary records, body composition was assessed with the use of bio-impedancemetry, and energy expenditure was measured with the use of indirect calorimetry., Results: Body weight evolution showed the typical pattern reported after an RYGB. Total energy intake was 2072 ± 108 kcal/d at baseline and decreased to 681 ± 58 kcal/d at 1 mo after surgery (P < 0.05 compared with at baseline). Total energy intake progressively increased to reach 1240 ± 87 kcal/d at 12 mo after surgery (P < 0.05 compared with at 1 mo after surgery) and 1448 ± 57 kcal/d at 36 mo after surgery (P < 0.05 compared with at 12 mo after surgery). Protein intake was 87 ± 4 g/d at baseline and ± 2 g/d 1 mo after surgery (P < 0.05 compared with at baseline) and increased progressively thereafter to reach 57 ± 3 g/d at 36 mo after surgery (P < 0.05 compared with at 1 mo after surgery). Carbohydrate and fat intakes over time showed similar patterns. Protein intake from meat and cheese were significantly reduced early at 1 mo after surgery but increased thereafter (P < 0.05). The BMR decreased from 1.12 ± 0.04 kcal/min at baseline to 0.93 ± 0.03, 0.86 ± 0.03, and 0.85 ± 0.04 kcal/min at 3, 12, and 36 mo after surgery, respectively (all P < 0.05 compared with at baseline)., Conclusions: Total energy, carbohydrate, fat, and protein intakes decreased markedly during the initial 1-3 mo after an RYGB, whereas the BMR moderately decreased. The reduction in protein intake was particularly severe at 1 mo after surgery, and protein intake increased gradually after 3-6 mo after surgery. This trial was registered at clinicaltrials.gov as NCT01891591., (© 2016 American Society for Nutrition.)

After a gastric bypass, covering protein needs is impossible. This deficit is co-responsible for several postoperative complications so it is essential to inform, prepare and train every patient candidate for such an intervention. To increase protein intake, it is important to work on two different aspects: on the one hand on food sources, targeting the richest food and, on the other hand, on food tolerance so that these foods can be consumed. In fact, gastric bypass induces not only a reduction in gastric volume, but also reduces the passage from the stomach to the intestine. Changes in feeding behavior are much needed to improve food tolerance.

Bariatric surgery is the only treatment inducing effective weight loss on the long term. The success of such an intervention is possible by carefully selecting and educating the candidates. Good understanding of the bariatric surgery implications allows the patients to modify their eating habits and thus decrease complications and food intolerance. Therefore patient education requires a multidisciplinary approach which implies the follow-up of a dietician on the long term. Mastication, speed of food ingestion, avoidance of carbonated beverages as well as the obligation to drink at frequent and regular intervals are the most difficult aspects to be taught to the patients.

Background: During the last 5 years, the performance of bariatric operations has doubled via our outpatient obesity clinic. Currently, 52% of the patients presenting for weight loss are interested in bariatric surgery. Gastric banding and Roux-en-Y gastric bypass are the two laparoscopic procedures proposed. The aim of this study was to evaluate the impact of preoperative teaching on the patients' surgical option., Methods: All the candidates for bariatric surgery were submitted to preoperative teaching and those between February 2001 and December 2002 are the subject of this study. The teaching consisted of 3 weekly interactive 2-hour sessions. During the first session, the patients were asked about the type of operation that they had in mind: gastric banding, gastric bypass, or not yet decided. The same questions were repeated at the end of the third session, with an additional possible answer: no surgery., Results: 297 consecutive patients with a BMI >35 kg/m(2) with at least one severe co-morbidity, were submitted to preoperative teaching. 80% of the patients were women. Median age was 41 years. Before teaching, 68 patients (23%) were uncertain, 100 (34%) favored gastric banding, and 129 (43%) wanted a gastric bypass. After education, only 3 patients (1%) remained uncertain, 45 (15%) changed their surgical option, and 27 (9%) declined surgery. The proportion of patients opting for gastric banding decreased from 34% to 20%, whereas those electing bypass increased from 43% to 70%., Conclusions: Preoperative training provides an informed and better patient selection for bariatric surgery. It helps the patients understand the various surgical options, and makes their decision easier.