Keys to Long-Term Care After Metabolic Bariatric Surgery | Recording-Keys to Long-Term Care After Metabolic Bariatric Surgery

Video Transcription

Video Summary

This workshop, part of the Obesity Association’s “Changing the Conversations Around Obesity” series, focused on optimizing long-term care after metabolic bariatric surgery (MBS). Dr. Joe Northrup reviewed key long-term surgical complications: internal hernia (rare but can occur years later and may present acutely or as vague chronic pain; diagnosis often via CT; treatment is surgical), marginal ulcer after gastric bypass (higher risk with smoking/NSAID use; usually treated medically), and gastroesophageal reflux after sleeve gastrectomy (often managed with acid suppression but a common reason for revision to bypass). He emphasized that MBS delivers durable weight loss for 10–15+ years, often outperforming medical therapy in higher-BMI populations, and produces major metabolic benefits including reduced all-cause mortality and lower rates of heart failure, myocardial infarction, and stroke. MBS also improves type 2 diabetes outcomes, with high remission rates early and sustained long-term glycemic control, particularly when performed earlier in the disease course. He noted MBS is underutilized (<1% of eligible U.S. patients). Clinical pearls for primary care include annual nutritional lab surveillance, ensuring bariatric-specific multivitamin use, and vigilance for thiamine deficiency in patients with persistent nausea/vomiting.<br /><br />Dr. Nina Crowley addressed nutrition, behavior, and pharmacotherapy for weight maintenance. She advocated reframing “regain” as “recurrence,” reducing shame, and using patient-centered language. Core strategies include protein-forward structured eating, ongoing micronutrient monitoring (B12, iron, thiamine, fat-soluble vitamins, calcium/vitamin D), and multidisciplinary follow-up across phases (first year foundation; years 2–5 maintenance; lifelong annual surveillance). She highlighted behavioral factors (expectation drift, identity changes, stress/emotional eating) and the role of anti-obesity medications post-surgery to support physiology and manage plateaus or recurrence.

Keywords

metabolic bariatric surgery

long-term postoperative care

internal hernia

marginal ulcer

sleeve gastrectomy reflux

gastric bypass revision

nutritional lab surveillance

bariatric multivitamin

thiamine deficiency

weight recurrence management

anti-obesity pharmacotherapy