Wolf Rinke Associates, Inc./EasyCPEcredits.com

CPE Home Page

Frequently Asked Questions

List of All Courses/Programs
Quick way to order!

Nutrition & Clinical

CDEs / NCBDE

Prof. Development

Management

eCourses/ePrograms
Including FREE ETHICS

Bargain Corner/Sales

Share a Program:
Reporting Forms only

Non-CPEU Products

Become One of Our Authors

Order Form
For fax, mail, or Purchase Orders

Submit Reporting Form

FREE:Read & Grow Rich
eNewsletter-Sign up For Alerts
New programs/Special Offers/Coupons

FAQs

Contact Us


Nutritional Management of Bariatric Surgery Patients
Laura L. Frank, PhD, MPH, RD, CD


C235
18 CPEUs
HARD COPY
$144.95
C235E
18 CPEUs
ELECTRONIC
$134.95
 

Manual with 1 Reporting Form, 158 pgs.
The goal of this continuing education program is to provide the information and skills needed by Food and Nutrition/Dietetic professionals to develop competencies in medical nutrition therapy (MNT) for the bariatric surgical patient. In addition, readers will learn about several different areas of emphasis regarding bariatric surgery nutrition including recognition and management of micronutrient deficiencies associated with bariatric surgery.This new comprehensive manual will enable you to:

  • Describe the indications and contraindications of bariatric surgery.
  • Assess the three broad categories of bariatric surgeries and explain at least one specific surgery associated with each respective category.
  • Implement perioperative nutrition guidelines for different surgery types.
  • Identify the four “stages” of suggested diet progression associated with different surgery types.
  • Recognize protein deficiency, distinguishing from protein energy malnutrition vs. protein malnutrition in your bariatric patient.
  • Recommend appropriate nutrition interventions for micronutrient deficiencies in post-bariatric surgery patients.

For more information and customer comments click here.
Approved/Accepted by CDR, CBDM, NCBDE

For RDs/RDNs & DTRs/NDTRs for the Professional Development Portfolio:

SUGGESTED Learning Need Codes:
2000, 2070, 2090, 3000, 3005, 5000, 5125, 5370

SUGGESTED Performance Indicators (PIs):
8.1.1, 8.1.2, 8.1.4, 8.1.5, 8.3.1, 8.3.6,10.1.3, 10.2.1, 10.2.4, 10.2.5, 10.2.7, 10.2.9, 10.2.10, 12.4.6

DON'T SEE your Performance Indicator or Code Listed here?
There are many Performance Indicators (PIs) that are applicable we can't list them all &
Per CDR you may use ANY PI or CODE as long as it relates to your Learning Plan.
For details
click here.

Share with a friend and Save! Click here for important information about sharing.
To order an ADDITIONAL Reporting Form click below:

C235F
18 CPEUs
REPORTING FORM
$50.00

Nutritional Management of Bariatric Surgery Patients
Laura L. Frank, PhD, MPH, RD, CD

Copyright 2012 Wolf Rinke Associates, Inc. All rights reserved for this self-directed, accredited learning program. Reproduction in whole or part without written permission from the publisher is prohibited.

Customer Comments

Larry Cugino: “I got a lot out of this program. I learned a lot, in particular about the micronutrient needs/issues with bariatric surgery patients on an inpatient basis and will definitely use the information learned.”

Heidi Schmidt: "The material was a good balance of in-patient, clinical basics and outpatient reality: counseling, support, and where research for the bariatric community either lacks, or lacks consensus. I would take a course from Wolf Rinke again!"

Kenneth M. Yates: "Very informative. I really liked it."

Linda Ann Nowbar: "This course gave a very detailed overview of the various type of bariatric surgery. I especially liked the detailed discussions of the vitamin and mineral concerns with these procedures."

Linda Maria AhMu: "This course was clearly written, concise, interesting. I found the format easy to use."

Overview and Instructions

Obesity is a risk factor for a variety of chronic conditions including diabetes, hypertension, hypercholesterolemia, stroke, heart disease, arthritis, and certain types of cancers. Higher classes of obesity are associated with excess mortality, primarily from cardiovascular disease, diabetes and certain cancers. Of the obesity-related comorbidities, diabetes may be most closely linked to obesity. Prevalence of diabetes continues to increase in parallel with obesity trends.
Prevention and treatment strategies for obesity has become a public health challenge. In general, conventional weight loss strategies (diet, exercise, psychological help) result in no more than 5%-10% weight loss, and weight re-gain is common. Furthermore, there are very few FDA-approved anti-obesitiy medications available in the United States. Therefore, surgical treatment for obesity, or “bariatric surgery” may be indicated for certain high-risk patients, termed by the National Institutes of Health (NIH) as having “clinically severe obesity.” Indeed, based on NIH guidelines, potential surgical candidates fall within class 3 obesity and these clinical practice guidelines are co-sponsored by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), and the American Society for Metabolic and Bariatric Surgery (ASMBS). According to the NIH consensus of 1991, surgical intervention is the most appropriate treatment for obesity for individuals with a body mass index (BMI) >40 kg/m2 or a BMI >35 kg/m2 among individuals with comorbid conditions. Furthermore, surgery must be performed in a setting of a multidisciplinary team of practitioners inclusive of both pyschiatric and nutritional evaluation and education.
The number of bariatric surgeries have increased steadily over the last 15 years. According to the Agency for Healthcare Research and Quality (AHRQ), the total number of bariatric procedures increased almost 10-fold, from 1998 to 2004. Although growth has slowed somewhat since 2007, it is still increasing at double-digit rates today and is forecasted for a 13.4% growth rate through 2013. Women, especially in their late 30s to early 40s, are the largest demographics to undergo bariatric surgery.
Due to the continuing trend of obesity and utilization of bariatric surgery for the treatment of obesity, there will undoubtedly be a growing role for the registered dietitian (RD) to be an integral part of the multidisciplinary team in order to improve patient outcomes. The RD is a Food and Nutrition Expert and requires not only knowledge and skills in obesity management and in the overall management of the bariatric surgical patient, but also - proficiency in bariatric nutrition education and counseling.
The goal of this continuing education program is to provide the information and skills needed by Food and Nutrition/Dietetic professionals to develop competencies in medical nutrition therapy (MNT) for the bariatric surgical patient. In addition, readers will learn about several different areas of emphasis regarding bariatric surgery nutrition including recognition and management of micronutrient deficiencies associated with bariatric surgery.
Chapter 1 discusses the indications, screening criteria and contraindications for bariatric surgery. Chapter 2 outlines the history and types of bariatric surgery. Chapter 3 will focus on the benefits and risks of bariatric surgery. Chapter 4 will focus on the perioperative nutrition guidelines for specific types of surgeries. Chapter 5 will discuss the importance of the role of the macronutrient, protein, in the bariatric surgical patient. Finally, Chapter 6 will discuss micronutrient deficiencies associated with bariatric surgery.
This learning program is a level 2 Continuing Professional Education (CPE) program approved for 18 continuing professional education units (CPEUs). That means that the reader has general knowledge of the literature and professional practice in the area covered. The focus of the program is to enhance knowledge and application. To get the most benefit from this program, we suggest you adhere to the following four steps:
Step 1: Review the objectives for the learning program.
Step 2: Study each chapter. As you read, think of patients from your own practice who fit the situation described.
Step 3: Assess what you have learned by completing the self assessment instrument at the end of this learning program.
Step 4: Compare your answers to the answer key that has been provided. If you score at least 80% correct, you are ready to transfer your answers to the CPE REPORTING FORM. If you scored less than 80% correct, re-read this learning program until you score at least 80% correct.
After you have successfully completed the program, complete the CPE REPORTING FORM and:
Submit on-line at www.easyCPEcredits.com,
or mail to: Wolf Rinke Associates, Inc., 13621 Gilbride Lane, Clarksville, MD 21029,
or fax to: (410) 531-9282

We will email your Certificate of Completion.

When you submit your CPE Reporting Form to us via www.easyCPEcredits.com fax or mail, be sure to write your correct email address in the space provided on the CPE Reporting Form. If writing by hand, be sure to print your email address clearly.

To ensure that our emails are delivered to your inbox (instead of your junk/spam folders), please add cpesupport@wolfrinke.com to your Address Book or Safe List of allowed email senders. Also, be sure to allow attachments from this email address.

HAPPY LEARNING!
Laura L. Frank, PhD, MPH, RD, CD

Objectives

Upon completion of this accredited, self-directed learning program you will be able to:

  • Apply the eligibility criteria for bariatric surgery set forth by the National Institutes of Health (NIH) Consensus panel (1991, 1992).
  • Assess approved comorbidities that would qualify a patient with a BMI of 35 kg/m2 to fit the screening criteria for bariatric surgery.
  • Describe the indications and contraindications of bariatric surgery.
  • Assess the three broad categories of bariatric surgeries and explain at least one specific surgery associated with each respective category.
  • Explain the anatomical changes associated with the Adjustable Gastric Band (AGB), Sleeve Gastrectomy (SG), Roux-en Y Gastric Bypass (RYGB), Biliopancreatic Diversion (BPD) and Biliopancreatic Diversion with Duodenal Switch (DS).
  • Identify the leading cause of death associated with bariatric surgery.
  • Specify at least three serious complications associated with bariatric surgeries.
  • Explain at least three physiological benefits associated with bariatric surgeries.
  • Recognize the role of gastric bypass in diabetes remission.
  • Implement perioperative nutrition guidelines for different surgery types.
  • Identify the four “stages” of suggested diet progression associated with different surgery types.
  • Identify what diet stage is termed the “discharge diet”.
  • Identify the recommended fluid intake amounts in both milliliters (mls) and ounces associated with general bariatric nutrition guidelines.
  • Recognize protein deficiency, distinguishing from protein energy malnutrition vs. protein malnutrition in your bariatric patient.
  • Explain the physiological roles of branched chain amino acids, especially leucine, in muscle protein synthesis, glucose homeostasis, thermogenesis and satiety.
  • Recognize micronutrient deficiencies and their associated clinical manifestations.
  • Recommend appropriate nutrition interventions for micronutrient deficiencies in post-bariatric surgery patients.
  • Calculate the excess weight loss associated with bariatric surgery and become familiar with average excess weight loss outcomes with different surgery types.

Table of Contents

CHAPTER 1 Indications, Screening, and Contraindications Associated with Bariatric Surgeries
Obesity Trends and Consequences
Criteria for Bariatric Surgery in Adults
Contraindications to Bariatric Surgery
CHAPTER 2 Types and History of Bariatric Surgery
Broad Categories of Bariatric Procedures
History and Time-line of Bariatric Surgery Procedures
Restrictive-Malabsorptive Surgery: Roux-en Y Gastric Bypass
Purely Restrictive Bariatric Procedures
Purely Malabsorptive Procedures
Experimental or Investigational Procedures
CHAPTER 3 Benefits and Risks of Bariatric Surgery
Benefits of Bariatric Surgery
Complications of Bariatric Surgery
Consequences of Surgery Which May Impact Nutritional Status
CHAPTER 4 Perioperative Nutrition Recommendations for Bariatric Surgery Patients
Multidisciplinary Approach
Prior to Surgery
Preoperative Nutrition Guidelines
Postoperative Nutrition Assessment and Follow-up
Diet Progression Recommendations for Adjustable Gastric Band
Diet Progression Recommendations for Roux-en Y Gastric Bypass or Sleeve Gastrectomy
Diet Progression Recommendations for Biliopancreatic Diversion (BPD)
Vitamin and Mineral Supplementation
Exercise
CHAPTER 5 The Power of Protein: What the Nutrition Professional Should Know
Overview
Role of Protein in the Body
Sources of Protein
Digestion and Absorption of Protein
Digestion Rate
Upper Limits of Protein Digestion
Liver Processing and Elimination
Protein Requirements in Humans
Beneficial Roles of Protein: Muscle Protein Synthesis, Glucose and Lipid Homeostasis, Thermogenesis and Satiety
Muscle Protein Synthesis and Maintenance of Lean Body Mass
Glucose and Lipid Homeostasis
Thermogenesis and Satiety
Protein Malnutrition
Preoperative Risk of Protein Malnutrition
Postoperative Risk of Protein Malnutrition
Protein Prescription for the Bariatric Patient
Treatment for Protein Malnutrition in the Bariatric Patient
The “30 gram” Protein Myth
Liquid or Powder Protein Supplements
The Patient’s Role
Conclusions
CHAPTER 6 Micronutrient Deficiencies Associated with Bariatric Surgery
Overview
Water Soluble Vitamins
Thiamin: Overview, Food Sources, Digestion and Metabolism
Thiamin Deficiency: Signs and Symptoms
Thiamin: Assessment and Treatment of Deficiency
Vitamin B12: Overview, Food Sources, Digestion and Metabolism
Vitamin B12 Deficiency: Signs and Symptoms
Vitamin B12: Assessment and Treatment of Deficiency
Folate (folic acid): Overview, Food Sources, Digestion and Metabolism
Folate Deficiency: Signs and Symptoms
Folate: Assessment and Treatment of Deficiency
Fat Soluble Vitamins
Vitamin A: Overview, Food Sources, Digestion and Metabolism
Vitamin A Deficiency: Signs and Symptoms
Vitamin A: Assessment and Treatment of Deficiency
Vitamin D and Calcium: Overview, Food Sources, Digestion and Metabolism
Vitamin D and Calcium Deficiency: Signs and Symptoms
Vitamin D and Calcium: Assessment and Treatment of Deficiency
Minerals
Iron: Overview, Food Sources, Digestion and Metabolism
Iron Deficiency: Signs and Symptoms
Iron: Assessment and Treatment of Deficiency
Zinc: Overview, Food Sources, Digestion and Metabolism
Zinc Deficiency: Signs and Symptoms
Zinc: Assessment and Treatment of Deficiency
Copper: Overview, Food Sources, Digestion and Metabolism
Copper Deficiency: Signs and Symptoms
Copper: Assessment and Treatment of Deficiency
Selenium: Overview, Food Sources, Digestion and Metabolism
Selenium Deficiency: Signs and Symptoms
Selenium: Assessment and Treatment of Deficiency
Conclusions
References
Abbreviations and Acronyms
Glossary
Self Assessment Questions
Answer Key to Self Assessment Questions
Explanations to Self-Assessment Questions
About The Author
About Wolf Rinke Associates, Inc.

About the Author

Dr. Frank received a BS in 1998, a Master’s degree in Nutrition and Dietetics in 1991, a PhD in Exercise Physiology and Human Performance in 1997, and a Master of Public Health degree in Epidemiology in 2005. She became a Registered Dietitian in 1995 and has worked in many areas of dietetics including community, bariatric, and clinical nutrition. Currently, she is Clinical Assistant Professor and Director/Preceptor of Clinical Sites for the Nutrition and Exercise Physiology Program, Coordinated Program in Dietetics, College of Pharmacy, for Washington State University. She is also owner of Frank Nutrition and Exercise Consulting, LLC, in Gig Harbor, WA. Dr. Frank is an active member of the American Society for Metabolic and Bariatric Surgery (ASMBS) and serves on the Integrated Health (IH) Multidisciplinary Committee, the Nutrition Guidelines Revision Committee and is the IH Professional Education Committee Spokesperson for 2012-2014. She served as co-chair of the IH Graduate Nutrition Course at the 29th ASMBS Annual Meeting and has been a speaker for the Graduate Nutrition Course in 2008, 2010, 2011, and 2012.

Return to the top of page


If you prefer to order by phone, mail or fax click below

Order Form

or click here to contact us with other questions.

For information about our other products and services return to the sidebar at the top of the page.