This role statement was created by Accredited Practising Dietitians (APDs) working in weight loss surgery.

It details the role of a dietitian working in the area of weight loss surgery.

Importance of APDs in weight loss surgery

In the last 20 years across the world there has been a dramatic increase in people living with obesity. Nearly one-third of Australians live with obesity, a condition causing ill-health. The harmful effects of excess body fat impacts many organs (for example heart, liver, joints) and high levels also contribute to poor quality of life and early death. Fortunately, health can be improved with 5% loss of body weight and all obesity treatments rely on eating healthily. People experiencing lots of health issues because of excess weight may choose more intensive treatments such as weight loss drugs or surgery.

Weight loss surgery, also called bariatric or metabolic surgery, is a treatment proven safe and effective for people who meet eligibility criteria. In Australia, every year more than 20,000 people have weight loss surgery. This is a speciality surgical area and clinicians require expert knowledge about how each operation impacts on the gut, nutrition, and a person’s ability to eat normally.

Those having weight loss surgery often have complex medical histories including higher rates of mental illness. Treatment success is improved by coupling expert knowledge with advanced nutrition counselling skills to build long-term therapeutic relationships. This is particularly important as weight loss surgery has lifelong consequences and obesity is a chronic and relapsing condition.

What all APDs in weight loss surgery can do

Entry level competencies ensure all APDs can conduct assessments, diagnose nutrition issues, and develop, monitor, and evaluate interventions. This applies to individuals, groups, communities, organisations, and population and systems levels. Dietitians in What dietitians do in weight loss surgery have specific skills to:

• Be patient-centred with an approach that excludes judgement about the choice to have surgery.
• Complete comprehensive assessments considering the psychosocial aspects of seeking surgery, readiness for change and emotional connections with food.
• Assist in understanding of lifelong impacts of weight loss surgery, encouraging realistic weight and health goals, promoting nutrient adequacy with consideration to medical, surgical, weight and psychological history.
• Identify disordered and maladaptive eating behaviours requiring further support to prompt and facilitating appropriate referral.
• Recognise the complexity of mental health issues that may require clinical supervision with a more senior dietitian or alternative qualified colleague.
• Provide nutrition education before and after surgery supporting adherence to nutritional recommendations. For example, very low energy diets to increase surgical safety, nutrient adequacy and texture modifications for safe recovery, prevention of dumping syndrome, and individualised assistance with multivitamin dosage.
• Patient management through the lifecycle including management of pregnancy following surgery, preventing and treating nutrient deficiencies and management of weight regain.
• Recognise the impact of medications such as psychotropics, pain medications and steroids on weight management and gut health.
• Assist with menu planning and provision of food services for patients in hospital.
• Participate in the early detection and management of post-operative surgical complications such as strictures, leaks, gallstones, and band/ring erosion.

What APDs with greater experience in weight loss surgery can do

As APDs gain experience and expertise in their area of practice, they can take on more complex tasks.

• Gain further skills in cognitive behavioural therapy to engage and treat clients with complex psychological histories.
• Use motivational interviewing skills to develop long-term therapeutic relationship enhancing treatment outcomes, and to re-engage clients lost to follow-up.
• Manage post-operative nutritional complications using artificial tube feeding such as nasogastric (NG), percutaneous endoscopic gastrostomy (PEG) and intra-venous total parental nutrition (TPN).
• Participate in advisory committees to help shape work on policy, practice and advocacy.
• Develop, implement, and lead research to extend the evidence base.
• Offer mentoring, provide training, engage in teaching and present research to upskill other clinicians interested in developing their weight loss surgery expertise.

For more, download the full role statement.