Nutritional Deficiencies in Obesity and After Weight Reduction

Review Article

Ann Nutr Disord & Ther. 2015;2(2): 1024.

Nutritional Deficiencies in Obesity and After Weight Reduction

Owais Bhatti¹, Klaus Bielefeldt² and Salman Nusrat³*

¹Department of Internal Medicine, University of Oklahoma Health Sciences Center, USA

²Department of Gastroenterology, University of Pittsburg,USA

³Department of Gastroenterology, University of Oklahoma Health Sciences Center, USA

*Corresponding author: Salman Nusrat, Department of Internal Medicine, Section of Digestive Disease,University of Oklahoma Health Sciences Center, 920 Stanton Young Blvd, Oklahoma City, OK 73014, USA

Received: April 06, 2015; Accepted: June 24, 2015; Published: July 01, 2015


The obesity epidemic in the USA requires physicians to have a better understanding of these patients’ nutritional needs. Obesity is a state of malnutrition and it is very common to find micronutrient deficiencies in these patients. Poor dietary choices, poor access to healthy foods and altered micronutrient metabolism likely results in micronutrient deficiency. Bariatric surgery is indicated for patients with BMI > 40 or > 35 with 2 or more obesity associated co-morbidities. Surgery has shown to result in sustained weight loss and decreased risk of future cardiovascular morbidity. Other benefits of bariatric surgery includes decreased incidence of diabetes, hypertension and all cause mortality. The increasingly popular bariatric procedures however can also result in malnutrition due to altered digestive tract anatomy, post surgical hypo caloric diets and excessive nausea/vomiting. We reviewed common micronutrient deficiencies (thiamine, B12, iron and vitamin D) and supplemental regimens for treating these deficiencies in obese and gastric bypass patients. Deficiencies of these micronutrients can result in Wernicke’s encephalopathy, peripheral neuropathy, beriberi, fatigue and osteoporosis. Close surveillance and aggressive supplementation regimens for preventing or treating micronutrient deficiencies are required.

Keywords: Obesity; Bariatric surgery; Gastric bypass; Nutrition and deficiencies


BMI: Body Mass Index; SOS: Swedish Obese Subjects study; VBG: Vertical Banded Gastroplasty; RYGB: Roux en Y Gastric Bypass; GI: Gastrointestinal; BPD: Biliopancreatic Diversion; CRP: C Reactive Protein; HB: Hemoglobin; MCV: Mean Corpuscle Volume; PPARδ: Peroxisome Proliferator-Activated Receptor Delta; PTH: Parathyroid Hormone; WE: Wernicke’s encephalopathy; 25 OH D: 25-Hydroxyvitamin D; LAGB: Laparoscopic Adjustable Gastric Banding; RDI: Recommended Dietary Intake


Obesity is defined as Body Mass Index (BMI) greater than 30 and is further classified as grade 1 (BMI 30 to 34.9), grade 2 (BMI 35 to 39.9) and grade 3 (BMI ≥40) [1]. It is one of the leading medical issues facing developed countries in modern medicine. The age– adjusted prevalence of obesity in the United States is 35.5% among adult men and 35.8% among adult women [2]. Obesity increases the risk for cardiovascular disease, diabetes, hypertension and dyslipidemia. In1987, Manson et al. [3] proved that being overweight (BMI >25) was associated with increased risk of death. In the same year, Donahue et al. [4] found an association between coronary heart disease and central obesity. In addition to the physical toll, mental health disorders are also more prevalent in obesity. A study (n=662) showed that obesity was more common among subjects suffering from depression when compared to subjects with normal BMI [5]. However it is worth noting that most medications used by psychiatrists are also associated with weight gain.

In terms of US dollars the cost of obesity is high and will continue to increase. In 2008 the US spent an estimated 147 billion dollars on the medical costs of obesity [6].

Bariatric surgery is shown to be effective in reducing weight and modifying the risk factors associated with cardiovascular morbidity. Based on current NIH guidelines, bariatric surgery should be considered for grade 3 obesity or grade 2 obesity with two or more comorbidities that are related to obesity (e.g. diabetes and hypertension) [7].

Compared with usual care, bariatric surgery is associated with decreased number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults [8]. Surgery also decreased the risk of developing diabetes when compared to usual care in obese persons [9].

The most dramatic effect of bariatric surgery is weight loss. The Swedish Obese Subjects study (SOS) [10] showed that surgery resulted in 20-35 % loss of baseline weight (depending on type of procedure) compared to 1-2 % in control groups. It also showed a 40% decrease in adjusted all cause long term mortality compared to controls. The SOS trial also showed that bariatric surgery subjects had a higher rate of maintained weight-loss compared to control sat 2 years and 10 years of follow up. In addition, it decreased the incidence of diabetes especially in patients with impaired glucose tolerance [9,10]. Bariatric surgery has shown to either normalize blood pressure or reduce the need for antihypertensive therapy [11,12]. The effect seems to correlate with the degree of weight loss [12]. A meta-analysis of 29,000patients undergoing bariatric surgery, showed that bariatric surgery patients had 50% reduction in mortality, compared to non-surgical controls. There was also a 50% reduction in the risk of cardiovascular adverse events, such as lower rates of myocardial infarction (OR 0.46, 95% CI 0.30-0.69) and stroke (OR 0.49, 95% CI 0.32-0.75) [13].

Types of Procedures

Bariatric procedures can be divided into two broad categories: restrictive and malabsorptive. Restrictive procedures includes the laparoscopically placed adjustable gastric band, (Figure 1) and the Vertical Banded Gastroplasty (VBG) that forms a small gastric reservoir of about 15ml [14]. Sleeve gastrectomy is a restrictive procedure, which leaves a proximal gastric pouch of about 100 ml, by resecting much of the greater curvature and the antrum of the stomach [14].

Citation: Bhatti O, Bielefeldt K and Nusrat S. Nutritional Deficiencies in Obesity and After Weight Reduction. Ann Nutr Disord & Ther. 2015;2(2): 1024. ISSN : 2381-8891