Preoperative nutritional management of bariatric patients in Australia: The current practice of dietitians

Aim: The aim of this observational study was to investigate the reported practices of Australian dietitians managing bariatric surgery patients in the preoperative stage. Methods: An online survey of dietitians providing nutritional care to bariatric patients was developed for the purpose of this investigation. The survey questions were guided by the Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic and Nonsurgical Support of the Bariatric Surgery Patient guidelines and current literature. Results: Ninety-nine dietitians completed the survey. Most participants recommended one to two different medical nutrition therapy strategies for preoperative weight loss (n = 69, 74%), with a very-low-energy diet exclusively from liquid meal replacements being the most frequently prescribed (n = 62, 69%). A significantly higher proportion of dietitians working privately reported the involvement of a bariatric surgeon in the multidisciplinary team (P = 0.002). More private practitioners also reported providing education on the nutritional consequences of the different types of bariatric procedures (P = 0.005) and postoperative vitamin and mineral supplementation (P = 0.013), as well as the use of the guidelines to guide their practice (P = 0.014), compared to dietitians who worked in the public sector. A higher proportion of dietitians working in metropolitan areas reported that screening occurred more frequently for vitamin D (P = 0.008), fasting blood lipids (P = 0.03) and glycated haemoglobin (P = 0.003) compared to those in regional/rural/remote areas. Conclusions: Reported preoperative screening practices were not consistent with the recommendations from the literature and current American guidelines. Further investigation into the difference in the nutritional management strategies and work environments is warranted