New nutrition recommendations after major weight loss support recovery from body contouring
Review explains how patients who lose significant weight can address nutritional needs

A new review offered nutrition recommendations for patients considering body contouring surgery after significant weight loss. Addressing protein, vitamin and mineral deficiencies before surgery may help healing and reduce complications.

"Good nutrition is essential for good wound healing," said J. Peter Rubin, MD, MBA, of the University of Pittsburgh School of Medicine, senior author of the review in the September issue of Plastic and Reconstructive Surgery. "Patients who are undergoing very significant weight loss tend to have some nutritional deficiencies."

Different weight loss methods, shared nutritional challenges

Patients now have several options for significant weight loss. Glucagon-like peptide-1 receptor agonists, commonly known as GLP-1 medications, are increasingly popular, while bariatric surgery is a long-standing obesity treatment. Some patients combine both approaches to reach their weight loss goals.

"We're seeing a new mix of patients," said Dr. Rubin. "We're seeing patients who are undergoing major weight loss with GLP-1s. We're seeing patients who have bariatric surgery, who are undergoing major weight loss very effectively. We're also seeing a mix of both of these methods. Patients are coming in who had their gastric bypass or sleeve maybe a decade ago and their weight loss plateaued. Then they go on GLP-1s, and that takes them the rest of the way."

Why nutrition matters for healing

Yet, each weight loss strategy causes different nutritional challenges for patients. Each method significantly restricts the number of calories eaten, which can cause nutritional deficiencies. Those deficits can substantially affect a patient's ability to heal after body contouring surgery, a group of procedures used to remove and reshape excess skin left after significant weight loss.

The review reported complication rates of 23 percent to 70 percent among patients undergoing body contouring after significant weight loss. Correcting nutritional deficiencies and meeting protein needs helps support healing and can reduce the risk. Body contouring surgery after weight loss has a strong track record of safety, and a majority of the complications are related to wound healing issues. While most of these wound healing issues are handled with office-based care, the risk can be reduced with attention to nutrition.

"The most common complication we see is a problem with wound healing," said Dr. Rubin. "That may involve a higher rate of infection. That may involve opening or breakdown of incisions, even though we close the skin very precisely because a patient's healing capability may be reduced."

What to discuss with your plastic surgeon

Patients seeking body contouring surgery after significant weight loss should be up front with their plastic surgeons about the techniques they are using to lose weight.

"We want them to be transparent," said Dr. Rubin. "Our primary interest is helping our patients achieve the best outcomes and keeping them safe through that process. It's very important we really understand their weight loss history."

Patients should also be willing to discuss their eating habits.

"A great way for a patient to initiate the conversation is to say, 'Hey, doctor, I've heard nutrition is really important. Let me tell you about my daily meals and my eating patterns, and let's see if there's anything more that I need to do to help get ready for surgery,'" said Dr. Rubin.

Screening for nutritional deficiencies

The review encouraged plastic surgeons to use lab tests to screen patients who experienced significant weight loss for nutritional deficiencies before body contouring surgery.

"The biggest deficiency we commonly see is protein," said Dr. Rubin. "We also see a lot of deficiencies in B vitamins, including B1, B6, B12, as well as vitamin D."

Dr. Rubin cautioned that standard multivitamins may not be enough to correct all vitamin and mineral deficiencies. There are supplements specifically designed for those undergoing significant weight loss following bariatric surgery and also new formulations for patients on GLP-1 medications. Even with oral supplements, some patients may still need injections or intravenous infusions of key nutrients, although this is less common.

"There needs to be a higher level of supplementation around some of these nutrients," said Dr. Rubin.

Meeting protein needs before surgery

The review outlined general strategies to help patients meet their protein needs even when their appetite is reduced. It may include eating protein-rich foods when patients are likely to be the hungriest. When appetite is low, patients can benefit from eating small portions of protein-rich foods multiple times per day and supplement with protein shakes.

"Plastic surgeons can recommend to their patients multiple small meals of protein, looking for sources of protein that are smaller volume and very rich in protein without necessarily having a lot of bulk and a lot of non-protein calories...concentrated proteins," said Dr. Rubin.

A nutritionist or dietitian may be included in the care team to develop an individualized diet plan.

Nutritional supplementation should begin several weeks before surgery.

"We want to go into the surgery well-prepared," said Dr. Rubin. "If patients have some laboratory values that suggest they are not ready yet for the surgery, then we're going to have to delay things to give the patient the chance to really optimize those conditions before we go to surgery."

Continuing nutrition support for recovery

Patients should expect to continue their nutrition plan after surgery to promote healing.

"It is 100 percent vital that patients maintain that rigor and diligence around good nutrition after the surgery because that is the time when their body is healing from the stress of the surgery, when nutritional demands are the highest and when it's very important to keep fueling the body with what it needs to heal," said Dr. Rubin.

Dr. Rubin, whose practice is focused on caring for people who have experienced significant weight loss, recommended lifelong attention to good nutrition for these patients.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.