Body mass index (BMI) is a measure of body fat based on height and weight that applies to both adult men and women. If you are concerned about your BMI number, please contact your doctor.

BMI Categories:
Underweight = <18.5
Normal weight = 18.5-24.9
Overweight = 25-29.9
Obese = 30-34.9
Severly Obese = 35 – 39.9
Morbidly Obese = 40+

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Important Considerations of Bariatric Surgery
Provider Information Regarding Long-Term Medical Issues Related to Bariatric Surgery

The following information was developed to assist mutual providers in developing optimum care plans for postoperative bariatric surgery patients.

Symptom Considerations

Abdominal pain in these patients can be vague and misleading. Symptoms that should be managed in conjunction with a bariatric surgeon include:

• Fever
• Tachycardia
• Shoulder pain
• Recurrent cramping pain in the upper abdomen
• Disproportionate abdominal tenderness or pain
• Shortness of breath (symptom of pulmonary embolism)
• Vomiting
• Dry heaves
• Bloating with hiccups
• Pain out of proportion to exam
• Inability to tolerate liquids for 24 hours

Medication Considerations

• Extended-release and controlled-release medications may not be properly absorbed, and it is advised that patients be switched to a more immediate release formulation.
• NSAIDS (including aspirin and COX-2 inhibitors) should be used only when medically necessary. These medications should be given in liquid form and in conjunction with a proton pump inhibitor (PPI). There is an increased risk of gastric ulcerations in these patients.
• Bisphosphonates should not be used in this patient population due to the increased risk of gastric ulcerations.
• Calcium citrate is the required calcium replacement, as other calcium preparations aren't adequately absorbed.
• Potassium supplementation, if required, should be given in liquid form or crushed.
• Pill size should be considered, as large pills may get stuck in the stomach pouch and cause ulceration.
• Psychiatric medications may require increased doses due to alterations in absorption.
• Anticoagulant medication needs to be monitored very carefully as absorption is variable. Coumadin absorption is unreliable and dosing will change as weight decreases. The patient will be asked to follow up with you as soon as possible.

Metabolic Considerations

• Roux-en-Y Gastric Bypass patients are at risk for micronutrient deficiencies (vitamin B12, folate, iron, vitamin D, calcium).
  • Patients must be on a multivitamin, iron and calcium supplementation (at least 1,000 mg/day of calcium citrate) for the remainder of their lives.
• Iron-deficiency anemia is more common in these patients, particularly in menstruating women.
  • Patients can usually be treated with oral iron supplementation, but occasionally require iron infusions.
  • Chelated iron preparations (e.g. iron fumarate or iron gluconate) are better absorbed than non-chelate preparations (e.g. iron sulfate).
  • Iron absorption will be enhanced if it is taken with 500 mg of vitamin C.
• Secondary hyperparathyroidism may develop because of poor calcium intake.
  • If significant weight gain occurs after surgery, the patient should be referred for reevaluation by the bariatric surgeon.

Pregnancy

• Our female patients are advised to wait at least 12 months postoperatively before attempting to conceive.
• Should a woman patient become pregnant, it is important that she follow up immediately with our office as there is a specific protocol she should follow.