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New guidelines urge more primary care involvement following bariatric surgery

New guidelines urge more primary care involvement following bariatric surgery

Publication date: Tuesday, 23 January 2018

The European Association for the Study of Obesity (EASO) has recently published new guidelines on bariatric surgery and ongoing management, with recommendations for an increased role for primary care in follow-up.

The number of bariatric surgery operations performed yearly worldwide has increased by five times over the past 15 years, peaking close to 200,000 procedures in 2017. The new guidelines say that the only way for countries to cope with this increased demand is for general practices and primary care to assist with giving advice to and following-up patients following their surgery. However, it is likely that full implementation of these valuable guidelines will require significant allocation of resources for already stretched primary care services.

The major aim of the new guidelines is to provide all health care professionals involved in the care of post-obesity surgery patients with the knowledge they need to provide appropriate first-level medical care to these patients.

Issues covered in the guidelines include:

  • Nutrition
  • Management of co-morbidities
  • Pregnancy
  • Psychological issues
  • Weight regain prevention
  • Risk of alcohol-related issues

The guideline's lead author Professor Luca Busetto (Associate Professor of Internal Medicine at University of Padova, Italy) said that follow-up of patients receiving surgery should be at least every three months during the first year, starting one month post-operatively until a clinically satisfactory rate of weight loss is achieved. Thereafter, follow-up should be done annually. Although much of this work has been done by multi-disciplinary teams in hospitals, the guidelines suggest an increasing amount, particularly after the early period after surgery, should also be transferred to GPs and other primary care level obesity specialists, dieticians and nurses.

Selected recommendations in the guidelines
  • Blood tests on nutrient levels should be carried out every three to six months in the first year after surgery and every 12 months thereafter, together with checking blood pressure and blood lipids and advising on any ongoing medication requirements.
  • Encouraging adherence to nutrient-dense foods, containing sufficient amounts of lean proteins and fibres (fruits and vegetables).
  • Pregnancy is not recommended 12-18 months following surgery, so that the foetus is not affected by rapid maternal weight loss and so that women can achieve weight-loss goals.
  • Bariatric surgery has profound effects on diabetes and can lead to prompt modifications and adjustments of medical therapy.


The guidelines provide valuable information on the ongoing primary care management of patients undergoing bariatric surgery. However appropriate adoption of this guidance depends on the availability of adequate resources in primary care which is already under great strain.


Topics covered:
Category: Evidence in Practice
Edition: Volume 1 Number 1 PCCJ Online 2004

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