A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
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15 Clinical Nursing Education Bariatric Times • February 2017 LIMITATIONS/FURTHER AREAS OF STUDY Measurement of micronutrient supplementation adherence is hampered by the limitations of self- reporting, especially in the absence of lab values or in the presence of lab values that do not reflect the t rue nutrient status. For example, several nutrition studies rely on ferritin levels to assess iron status and the potential of iron deficiency a nemia. However, ferritin in the absence of other biomarkers, is not an adequate test as it is an acute phase reactant and will likely be elevated in the presence of inflammation. 26 It is well known that obesity causes a chronic low-grade whole body inflammatory response. 31 Future directions for nutritional studies should focus on standardizing biomarkers that truly reflect the micronutrient deficiency that is being screened. A database, similar to the Metabolic and Bariatric Surgery Accreditation and Q uality Improvement Program (MBSAQIP), would be helpful in tracking nutrition deficiency outcomes and help standardize micronutrient deficiency monitoring. This would assist in greater understanding of micronutrient deficiencies and proper micronutrient supplementation recommendations to prevent common deficiencies. Additional areas of interest are in improving education on obesity and its treatments for primary care providers and building strong local relationships between metabolic and bariatric surgery practices and primary care provider practices. A good start would be to ensure that they receive education on postoperative screening of micronutrients, including what serum markers need to be evaluated and up-to-date recommendations on what micronutrient supplements metabolic and bariatric surgery patients need to take. It would also be helpful for primary care providers to know what questions to ask and the contact information local bariatric practice and/or obesity medicine specialists. CONCLUSION Self-management of any health behavior, especially one that involves complex treatment strategies, is challenging but necessary. As clinicians, we need to equip patients with proper education and individualized strategies for success. The research shows the risk for micronutrient deficiencies is greater as patients' progress from surgery, that adherence to micronutrient supplementation decreases over time, and that follow-up clinic visits decline progressively after surgery. 32 If nutrition deficiencies are not recognized as a real risk after surgery, adherence is likely to r emain suboptimal. We must continue to study micronutrient s tatus in the metabolic and bariatric surgical patient population and use scientific evidence to support our micronutrient supplementation r ecommendations for our patients. 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Story, RDN, is Clinical Science Liaison for Bariatric Advantage (Aliso Viejo, California), and Scientific Advisor for Apollo Endosurgery (Austin, Texas ). ADDRESS FOR CORRESPONDENCE: Cassie I. Story, RDN; E-mail: c.story@bariatricadvantage.com See page 15 for accompanying case study: Treating Micronutrient Deficiency after Roux-en-Y Gastric Bypass CASE STUDY