The Best Diets for Healthier Aging After Bariatric Surgery

| August 1, 2020

by Ethan Lazarus, MD, FOMA

Dr. Lazarus serves on the Board of the Obesity Medicine Association and as its delegate in the American Medical Association.

FUNDING: No funding was provided.

DISCLOSURES: Dr. Lazarus serves on the Board of the Obesity Medicine Association and as its delegate in the American Medical Association.

Bariatric Times. 2020;17(8):20–21

Aging is inevitable, but healthier aging is possible.1 As clinicians, we share a responsibility to guide patients toward health outcomes that enable the maintenance of functional ability and lower the burden of medical problems, such as obesity, Type 2 diabetes, and cardiovascular disease. That clinical guidance includes identifying and counseling patients on how to best address the modifiable risk factors that influence healthy aging, including smoking status, body mass index, and diet.2

For the 41 percent of older adults between the ages 65 and 74 who live with obesity, weight loss surgery presents a low risk avenue to treat a potential roadblock to healthy aging.3,4 But what is the surgeon’s role in promoting health outcomes after surgery? How can bariatric and metabolic surgeons help to mitigate the unique nutritional risks facing this population? And what role does diet play in promoting healthier aging among older adults postsurgery?

Older Bariatric Patients Need Continued Nutritional Support—Here’s Why

Decades of medical research have revealed a strong association between aging and mitochondrial dysfunction. However, research has also proven the value of dietary bioactive compounds in functional foods to improve or even prevent this type of cellular dysfunction.5 A diet rich in antioxidant vitamins, polyphenols, carnitine, carnosine, and other functional compounds can support a range of positive health outcomes. Unfortunately, micronutritional deficiency is a well-documented risk associated with metabolic and weight loss surgeries.6

Micronutrient deficiency tends to persist or even worsen after bariatric surgery, making it critical to make routine nutrition screenings and nutritional guidance a key component of postsurgery care plans. Surgeons have an opportunity to take a more active role in older patients’ postoperative weight loss and wellness journeys—and mitigate the risk of nutritional deficiency—by offering ongoing nutritional support and resources, including referrals to dietitians and other specialized healthcare professionals, when necessary.7

Eating Styles That Can Support Healthier Aging in Bariatric Patients

Aging already presents a number of challenges for maintaining nutritional status and these challenges can be compounded by bariatric surgery.8 Consider the following when advising older bariatric patients about today’s most popular diet plans:

The Mediterranean eating style. First touted in the 1960s after it was observed that coronary disease caused fewer deaths in countries like Greece and Italy, Mediterranean styles of eating main components include: daily consumption of vegetables, fruits, whole grains, and healthy fats; weekly intake of fish, poultry, beans, and eggs; moderate portions of dairy products; and limited intake of red meat.9 This eating plan offers a number of medical benefits, such as improved lipid and lipoprotein profiles, improved insulin sensitivity, lower blood pressure, reduced inflammation, and more. Further, adherence to a Mediterranean diet is associated with a 50-percent lower mortality rate among individuals aged 70 to 90 years, making it a proven and sustainable eating plan for older patients after weight loss surgery.

The plant-based eating style. Vegetarian and vegan eating plans that emphasize whole, minimally processed foods and eschew animal products can unlock similar heart health benefits as the Mediterranean diet—plant-based food plans have been associated with reduced blood lipid concentrations and a lower risk of cardiovascular disease.10 Because vegan and vegetarian food plans offer a heart-healthy style of eating, they might also be an ideal choice for older bariatric patients with concerns about maintaining nutritional status and reducing cardiovascular risk as they age.11

The keto eating style. The ketogenic diet demands a low-carbohydrate, high-fat, high-protein approach to eating that might be effective for weight loss, but is also associated with a number of unfavorable health outcomes, including the potential for an increased risk of heart disease.12,13 That said, a short-term ketogenic preoperative eating plan can lower certain risk factors of surgery in patients with severe obesity, such as problems with anesthesia or injury where the laparoscopic ports are inserted. However, because of the diet’s association with cardiovascular issues, it should only be considered as a long-term eating plan for patients with certain metabolic conditions, such as Type 2 diabetes.

Bariatric surgeons play a critical role in helping patients manage obesity and discover optimal health and longevity. You might already be certified by the American Board of Obesity Medicine (ABOM), but it’s also important to seize opportunities to further advance your knowledge of obesity medicine. The Obesity Medicine Association (OMA) offers a number of resources to support those efforts, including ABOM certification preparation, Obesity Treatment Proficiency Badges™, the Obesity Algorithm®, the Fundamentals of Obesity Treatment virtual course and more.14–16

To become an OMA member, visit: https://obesitymedicine.org.

Are you interested in gaining introductory education on obesity medicine? Join the OMA and earn 9.5 CME/CE at the Fundamentals of Obesity Treatment Virtual Course! In this two-day interactive course, you will learn about the basic concepts that define obesity as a disease, the pathophysiology of obesity, and how to evaluate patients for obesity and related diseases using ethical, nonstigmatizing communication. Reserve your virtual seat now by visiting: https://obesitymedicine.org/conferences/fundamentals-of-obesity-treatment/.

 

References

  1. What is Healthier Ageing? World Health Organization. https://www.who.int/ageing/healthy-ageing/en/. Accessed July 14, 2020.
  2. Peel N, McClure R, Bartlett H. Behavioral determinants of healthy aging. Am J Prev Med. 2005;28(3): 298–304.
  3. Prevalence of Obesity Among Older Adults in the United States, 2007-2010. Centers for Disease Control. https://www.cdc.gov/nchs/products/databriefs/db106.htm. Accessed July 14, 2020.
  4. Marihart CL, Brunt AR, Geraci AA. Older adults fighting obesity with bariatric surgery: benefits, side effects, and outcomes. SAGE Open Med. 2014 Apr 23;2:2050312114530917. eCollection 2014.
  5. Ferrari CKB. Functional foods, herbs and nutraceuticals: towards biochemical mechanisms of healthy aging. Biogerontology. 2004;5:275–289.
  6. Toh, S, Zarshenas N, Jorgenson J. Prevalence of nutritional deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–1156.
  7. Beckman, L, Earthman C. Nutritional implications of bariatric surgery and the role of registered dietitians. J Acad Nutr Diet. 2013;113(3):398–399.
  8. Leslie W, Hankey C. Aging, nutritional status and health. Healthcare. 2015;3:648–658.
  9. Mediterranean Diet: A Heart-Healthy Eating Plan. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801. Accessed July 14, 2020.
  10. Barnard N, Fleeman R, Hlozkova A, et al. A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein. Nutr Diabetes. 2018;8:58.
  11. Tuso P, Ismail M, Ha BP, Bartolotto C. Nutritional update for physicians: plant-based diets. Perm J. 2013;17(2):61–68.
  12. Lindblad A, Ting R. Ketogenic diet for weight loss. Can Fam Physician. 2018;64(12):906.
  13. Jornayvaz F, Kosinski C. Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies. Nutrients. 2017;9(5):517. 
  14. Obesity Treatment Proficiency Badges™. Obesity Medicine Association. https://obesitymedicine.org/badges/. Accessed July 14, 2020.
  15. 2020 Obesity Algorithm®. Obesity Medicine Association. https://obesitymedicine.org/obesity-algorithm/. Accessed July 14, 2020.
  16. Fundamentals of Obesity Treatment Virtual Course. Obesity Medicine Association. https://obesitymedicine.org/conferences/fundamentals-of-obesity-treatment/. Accessed July 14, 2020.

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Category: Medical Methods in Obesity Treatment, Past Articles

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