Nutritional Deficiencies in Obesity and After Weight Reduction

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.