A Comment on Checklists in Bariatric Surgery Vitamin Deficiency after Bariatric Surgery: Parts 1 and 2

Dear Bariatric Times Editor:
This letter is in response to the Checklists in the Bariatric Surgery series, specifically Checklist #22 published in the July 2014 issue and Checklist #23 published in the August 2014 issue.[1,2]

Since these two checklists were designed to equip bariatric providers with an easy reference guide to use when treating and preventing vitamin deficiencies, I found it remarkable that the authors chose to reference their own work rather than the most comprehensive guidelines of it’s kind, the result of a collaboration of the American Society of Metabolic and Bariatric Surgery (ASMBS), The Obesity Society (TOS), and the American Association of Clinical Endocrinologists (AACE). The guidelines were published in Surgery for Obesity and Related Diseases by the ASMBS in 2008 in a supplementary publication[3] and updated in 2013 (often referred to as the ASMBS guidelines).[4] Even more remarkable is that the authors’ recommendations for daily supplementation after bariatric surgery does not meet the ASMBS recommendations for all vitamins and minerals, nor does it specify that there are different requirements depending on the type of surgery, a topic that was spelled out in detail in the ASMBS clinical practice guidelines.

Clearly these authors are renowned and recognized as leaders in the bariatric community and are associated with one of the most prestigious bariatric programs in the country as well as being fellows of the ASMBS. The omission of any mention of the ASMBS clinical practice guidelines is confusing.
Additionally, Dr. Raul J. Rosenthal does not disclose that for over one year he has been on the medical advisory board of a bariatric vitamin company who has promoted his affiliation. This company also does not compare their vitamin products to the ASMBS guidelines, but instead references the less comprehensive guidelines published by The Endocrine Society in 2010.[5]

Sincerely,
Courtney K. Boyce
Chief Executive Officer
Bari Life Bariatric Supplements, LLC
Knoxville, TN

References
1.    Rosenthal RJ, Szomstein S, Lo Menzo E. Vitamin deficiency after bariatric surgery: Part 1. Bariatric Times. 2014;11(7):11–12.
2.    Rosenthal RJ, Szomstein S, Lo Menzo E. Vitamin deficiency after bariatric surgery: Part 2. Bariatric Times. 2014;11(8):23.
3.    Allied Health Sciences Section Ad Hoc Nutrition Committee, Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S73–108. Epub 2008 May 19.
4.    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013 Mar-Apr;9(2):159–191. Epub 2013 Jan 19.
5.    Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–4843.

Editor’s Response
Dear Ms. Boyce,
Thank you for your letter and comments. Regarding the two checklists published titled, “Vitamin deficiency after bariatric surgery: Parts 1 and 2”: we did not have bad intentions in omitting the ASMBS guidelines to which you referred. In fact, as you can see from most, if not all checklists that we have published since the column’s inception, all publications referenced are from our institute (Cleveland Clinic Florida, Weston Florida). We decided to reference our own articles to back up our experience and knowledge in putting forth such checklists for bariatric surgery patient care. These checklists are by no means to be seen as standard of care, but rather as our institute’s experience and recommendations.

I was on the advisory board of Bariatric Fusion (Elma, New York) “ad honorem” until 2014, and during that time, I never received an honorarium. Our checklists are not meant to reflect any specific company or products available on the market.

Ms. Boyce, I want to thank you for your compliments and for taking the time to write this letter. I wish we would get more feedback from our readers. An open and vivid discussion is what keeps BT at the front.

Most sincerely,
Raul J. Rosenthal, MD, FACS, FASMBS
Clinical Editor, Bariatric Times;
Chief of Staff, Professor of Surgery and Chairman, Department of General Surgery; Director of Minimally Invasive Surgery and The Bariatric and Metabolic Institute; General Surgery Residency Program Director; and Director, Fellowship in MIS and Bariatric Surgery, Cleveland Clinic Florida, Weston, Florida.

Tags: vitamin deficiency, vitamins

Category: Letters to the Editor, Past Articles