Backgound/aim of the study: A large number of obese people chose to travel to different countries to undergo biliopancreatic diversion with duodenal switch surgery before the Norwegian government chose to increase funding for this kind of procedures in 2003. There was not much experience and knowledge for follow-up treatment for this patient group in our country. Therefore a lot of the patients from all over Norway were referred to dr. Serena Tonstad at the Department of Preventive Cardiology at UUH.
This project was started to gain more knowledge about anthropometric changes, nutritional status, dietary habits, supplement intake, physical activity, deficiencies, food intolerances, and other possible long- term complications.
Materials and methods: 65 patients (55 women and 10 men) who had undergone biliopancreatic diversion with duodenal switch 24 months of longer before study inclusion took part in the study. Data was collected by a precoded food diary, consultations with a master student, consultations with dr. Serena Tonstad, the International Physical Activity Questionnaire, the Binge Eating Scale questionnaire, pedometer, patient records and blood tests. Statistical analysis was performed on SPSS for Windows 15.0.
Results: The patients overall compliance sending back the dietary record, pedometer result, the Binge Eating Scale and the International Physical Activity Questionnaire was poor. We received 29 dietary records, 24 pedometer results, 40 Binge Eating Scale questionnaires and 28 International Physical Activity Questionnaires.
Most of our patients (n=35) underwent surgery in Spain, Alicante. The mean length of the common channel was 71 cm (SD= 17). Mean age at follow up was 40 years (SD= 8.6), mean change in BMI 21.1 (SD= 7.1) About 74 % of the patients reported post surgery food intolerances. Stool frequency and problems varied greatly with a mean stool frequency of 3.5 loose stools per day. Although the patients were instructed to eat a high protein diet, the mean intake of proteins only accounted for 17 % of the daily energy intake. The sugar intake was around 10 %, which resembles the general populations in Norway. In general the patients had a higher intake of fat (39 %) than recommended. Fiber intake was 18 g per day. That is lower than recommended, but about the same as for the normal population.
All patients were instructed to take dietary supplements. About 89 % of the patients took some kind of supplement. About 57 % of the patients took extra vitamins, minerals and other health food supplements than the ones recommended.
On average the patients walked 5583 steps per day with a span from 642 steps to 13760 steps per day. Only 11 % of the study population was highly active according to the International Physical Questionnaire.
Conclusion: The risk of malnourishment is present also 24 months or more post surgery if compliance is low. The pre operative risk factors that were strong indicators for bariatric surgery, were improved for our study population 24 months of longer post surgery.
It is important that bariatric surgery patients receive adequate follow-up by skilled health professionals.
We expected the patients to be more active and have a higher compliance to nutritional recommendations than we actually experienced in our study.