How stigma affects patients after surgery
Dr Yitka Graham, a senior lecturer in public health, has produced a ground-breaking piece of research into how bariatric patients adjust to life after surgery. Healthcare professionals will be able to use her findings to support patients pre- and post-operatively by raising awareness of issues that they may encounter in social situations, discussing how other patients have dealt with these situations and how they might cope themselves.
The study, carried out by researchers from the Faculty of Health Sciences and Wellbeing, University of Sunderland, looked at the experiences of patients who underwent bariatric surgery and how it affected their lives and social interactions. The researchers found that social aspects of bariatric surgery did not appear to be widely understood by those who had not undergone bariatric surgery.
So far there has been little research into patient experiences of daily life and social interactions after bariatric surgery. Now AHPs can look at the paper – ‘Patient experiences of adjusting to life in the first 2 years after bariatric surgery: a qualitative study’, published in Clinical Obesity ( doi: 10.1111/cob.12205) – for guidance.
Dr Graham’s paper found that after bariatric surgery, patients make major changes to their lifestyles, including dealing with altered eating habits and a rapidly changing physical appearance, while at the same time experiencing a period of psychosocial adjustment.
Patients were involved in the research, from design to dissemination to make sure that the patient voice was embedded into the study. Patients were encouraged to speak about their experiences openly without being constrained by set questions. Most participants reported that prior to surgery, they had experienced weight-related stigma from others. This had been a source of anxiety which they felt would reduce following surgery as they lost weight. However, the stigma of obesity was exchanged for the judgment of bariatric surgery as the weight loss mechanism.
Dr Graham says: “This study sought to explore patients’ experiences of adjustment to life after bariatric surgery. We found that many participants were reluctant to discuss their experiences of surgery in social situations, sometimes even with close relatives, with frequent partial or non-disclosure of the method of their weight loss. Within social environments, discussions surrounding bariatric surgery were reported to be a source of worry with regards to the potential risks of revealing having undergone bariatric surgery due to being judged by others.”
BDA and BOMSS agree to closer collaboration
Following the recent World Obesity Day, the BDA is pleased to announce the signing of a Memorandum of Understanding with the British Obesity and Metabolic Surgery Society (BOMSS).
A number of BDA members are already members of BOMSS, so this step will build on existing strong links. It will commit both bodies to raise awareness of the other within their own membership, alongside greater collaboration on joint communications and policy on the important topics of obesity and weight management.
The BDA’s Obesity Specialist Group will continue to take the lead on the Association’s relationship with BOMSS. Mary O’Kane, BDA Obesity Specialist Group Bariatric Officer and Allied Health Professional representative to BOMSS Council said;
“I am delighted that we have taken this step to further bolster the relationship between the BDA and BOMSS. Obesity is probably the biggest public health challenge now facing the UK, and it is vital that healthcare professionals work together to tackle this issue, be developing training, campaigns or resources of professional relevance.”
- Read the BDA and BOMSS MoU here.
- The British Dietetic Association, founded in 1936, is the professional association and trade union for dietitians in Great Britain and Northern Ireland. It is the nation’s largest organisation of food and nutrition professionals with almost 9,000 members.
- Dietitians are the only qualified health professionals that assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Uniquely, dietitians use the most up to date public health and scientific research on food, health and disease, which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.
- Dietitians are the only nutrition professionals to be statutorily regulated, and governed by an ethical code, to ensure that they always work to the highest standard. Dietitians work in the NHS, private practice, industry, education, research, sport, media, public relations, publishing, non-government organisations and government. Their advice influences food and health policy across the spectrum from government, local communities and individuals.
Looking ahead to IFSO in London
We are looking forward to IFSO 2017 takes place at QE11 Centre, Westminster, London from 29 August to 2 September.
For AHPs, the conference starts with the AHP/primary care pre-congress day on the 30th August. It opens with a key note lecture: Bariatric surgery and type 2 diabetes by Professor Francesco Rubino. The rest of the morning consists of 4 parallel sessions enabling participants to choose their preferred sessions. In the afternoon, all disciplines join together. This study day will appeal to all healthcare professionals in primary and secondary care, including doctors, nurses, dietitians and psychologists, involved in the management of patients with severe and complex obesity. Please spread the word to your colleagues including those in primary care.
Within the main conference there are further sessions which will appeal to AHPs (Integrated Health professionals). These include Bariatric surgery and mental health; Fertility and pregnancy after bariatric surgery session; Exercise and bariatric surgery; Multidisciplinary management and Nutrition and bariatric surgery. It is a fantastic opportunity for BOMSS AHPs to attend the IFSO conference, share good practice and build up and widen networking opportunities. Further details of the pre-congress day and the conference itself can be found at http://www.ifso2017.com/
Obesity Empowerment Network
Prof Rachel Batterham has been instrumental in setting up Obesity Empowerment Network UK. This is a new non-profit, user led, advocacy organisation, dedicated to giving people affected by obesity a public voice through empowerment.
The mission is to improve access to healthcare and treatment for individuals with obesity, to increase awareness that obesity is a chronic serious medical condition, to advocate for nationwide obesity prevention and treatment strategies and fight to eliminate weight-bias and discrimination. Further information can be found on the website http://www.oen.org.uk/ and on the Facebook page and by following twitter @ObesityEmpower and Instagram https://www.instagram.com/kcoenuk/ .
Please spread the word and inform your patients.
Obesity: How prejudiced is the NHS?
Professor Rachel Batterham was featured in an excellent BBC documentary regarding access (and lack of access) to bariatric surgery. It highlights the difficulties that patients have in accessing help with severe and complex obesity in addition to raising awareness of the positive work that is being undertaken in this area. IFSO sent the following statement to its members:
“We are pleased to announce you a documentary featuring Prof Rachel Batterham (UK), on the BBC, focusing on lack of access to bariatric/metabolic surgery by the NHS. Prof Batterham brings to light the stigma and prejudice our patients face, even in developed countries. Lack of recognition of this disease and denying scientifically proven therapies or supporting research that can help the millions of individuals affected is a global issue and is an unconscionable denial of basic human rights.”
The programme is available for viewing on YouTube https://www.youtube.com/watch?v=VwSz7SuHs9w
Join us in Staffordshire
We hope many of you will join us for BOMSS 2017 in Alton. Mr Chandra Chevru has put together a superb multidisciplinary programme with world-leading national and international speakers. This is supported by an excellent training programme. Further details can be found at www.bomss.org.uk/2017conference
IFSO 2017 is fast approaching and will include a pre-conference course aimed at AHPs, nurses and GPs. We hope you have the dates in your diaries and are beginning to think ahead about what you will present at IFSO!
There is now a range of bariatric surgery diet sheets available for purchase by dieticians and their departments through NDR UK: pre-operative 800 kcal, gastric bypass, sleeve gastrectomy and gastric band. These have been developed in consultation with BOMSS dieticians and patient representatives.
‘Recipes for Life’ is bariatric cookery book developed by the Ayrshire and Arran dieticians.
NDR UK is making arrangements for patients to be able to purchase the cookery book direct. The collaborative work with NDR UK ensures that dieticians have access to high quality, evidence-based, nutrition and dietetic resources for the benefit of patients. Further information regarding orders and costs can be found at www.ndr-uk.org
Diet sheet update
The gastric bypass and gastric diet sheets have been reviewed and updated. In addition the Ayrshire and Arran dietitians have produced a preoperative “liver shrinking” leaflet and a bariatric cookery book. All should be ready and for sale through NDR UK in the near future.
Cardiff here we come
We are looking forward to an interesting BOMSS conference and training day in Cardiff. Mr Sean Woodcock has organised an excellent training day which includes topics such as lipidaemia, alcohol use after surgery and motivational interviewing. The MDT working remains an essential part of the course. The main conference will include attendance from anaesthetists and obesity physicians and so an opportunity to learn from other disciplines. There will be a parallel session for nurses and AHPs. We hope that many AHPs have submitted abstracts for both oral and poster presentations.
Both Ken Clare and Mary O’Kane are members of the NHS England Obesity CRG. Mary is leading a working party tasked with writing the guidelines for follow-up of bariatric surgery patients. The working party is comprised of a range of members including a surgeon (Sean Woodcock), bariatric nurse (Tamara Puplampu), physician, dietitian, GPs and patient representatives. We are pleased that the group has good representation from BOMSS members. The guidelines should help support the commissioning of good bariatric aftercare in the NHS.
Bookmark the website for Cardiff 2016
The 7th BOMSS Annual Scientific Meeting will take place at the beautiful Cardiff City Hall, Cardiff from 28 – 29 January 2016.
Once again, there will be a BOMSS Training Day held on Wednesday 27 January 2016 for both Surgical Trainees and Nurses and Allied Health Professionals.
Bookmark the website – http://www.bomss.org.uk/2016conference/ – the provisional Scientific Programme will be available soon.
As you are aware, BOMSS Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery are available on the website. Along with the GP guidelines, these attract the most “hits” and have highlighted the importance of this area.
Working with NDR UK
NDR UK is keen to continue collaborative work with BOMSS and produce high quality patient literature. We have started the review of the gastric bypass and gastric band diet sheets and will be contacting people who volunteered to help with this.
A successful conference in Newcastle
We had an excellent conference starting with the training day open to trainee surgeons, nurses and AHPs. There was as truly MDT feel with excellent presentations and workshops and this was reflected in the positive feedback. A full report of the day is available from http://www.bomss.org.uk/training-day-report-2015/. Discussions are now beginning about the 2016 training day.
The conference was well attended with good representation from the nurses and AHPs. The nurse /AHP parallel session was excellent with a very high standard of presentations illustrating the contributions our professions are making. The report is available from http://www.bomss.org.uk/wp-content/uploads/2014/04/BOMSS-in-Newcastle.pdf BOMSS 2016 will be in Cardiff.
NICE GC189 Obesity
NICE CG189 Obesity was published in November 2014 and updated sections in CG43. The update included new sections on bariatric surgery and follow up care. Both Ken Clare and Mary O’Kane were members of the NICE Guideline Development Group.
BOMSS has input into ‘Feeding the obese’ symposium
BAPEN held a symposium on Feeding the obese as part of its annual conference in Harrogate. Gail Pinnock’s talk discussed the pre- and post-operative nutritional management of bariatric patients and the difficulty of calculating requirements in the obese patient. Mr Shaw Somers talked about avoiding long-term nutritional deficiencies. Dr Mimi Chen covered the endocrine changes associated with bariatric surgery.
Nutritional guidance for GPs and BOMSS members
Ms Mary O’Kane, AHP representatives on the BOMSS Council, is lead author on two sets of guidance – for BOMSS members and GPs – which help ensure patients continue to meet their nutritional needs following operations.
The Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery which is aimed at BOMSS members says if there is any doubt about a patient’s nutrition they should be referred for specialist advice.
These guidelines have been complemented by GP Guidance: Management of nutrition following bariatric surgery, which is aimed at GPs. This spells out some of the nutritional deficiencies GPs should look out for including rapid weight loss, anaemia and poor wound healing.
The President of BOMSS, Mr Richard Welbourn, said: “We know how valuable surgery can be in helping people gain control of their weight. These guidelines will help make sure they continue to reap the benefits without compromising their nutritional needs.”
Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery can be seen at: http://www.bomss.org.uk/bomss-nutritional-guidance/
- GP Guidance: Management of nutrition following bariatric surgery can be seen at: http://www.bomss.org.uk/nutritional-guidelines/
Looking forward to Newcastle 2015
AHPS are already looking forward to BOMSS 2015 to be held in Gosforth, Newcastle. The Scientific Committee is working hard to ensure that the contents of the training day and conference appeal to all and registration rates for AHPS will be discounted. Start thinking about your Abstracts now and we look forward to seeing you there!
Sleeve gastrectomy diet sheet launched
We are pleased to announce that a Sleeve Gastrectomy diet sheet is now available to buy through NDR-UK. BOMSS dietitians have worked closely with Nutrition and Diet Resources UK (NDR-UK) to produce this resource. Click the following link to find out more and to view a sample copy www.ndr-uk.org/Weight-management , or contact the NDR-UK Team on 0141 202 email@example.com . Please note that the sample copy is password protected and can be viewed by a registered Dietitian only.
Review of Gastric Bypass and Gastric Band diet sheets: We are continuing to work with NDR-UK and will review the BOMSS Gastric Bypass and Gastric Band diet sheets. Part of the process involves seeking the views of dietitians and patients. Any dietitian who wishes to be part of the peer review group should contact Mary on Mary.O’Kane@leedsth.nhs.uk by 31 July 2014.
Bariatric surgery section for PENG
The Parenteral and Enteral Nutrition Group (PENG) of the British Dietetic Association (BDA) provides evidence-based information for dietitians working in nutritional support. Its Pocket Guide to Clinical Nutrition describes best practice guidelines for the management of numerous clinical specialties; the Bariatric Surgery section was published in December 2013. The authors are BOMSS dietitians with considerable experience of working in this specialist area. Feedback for this new section has been very favourable.
The section provides an overview of bariatric surgery and the procedures most frequently encountered. It covers the short and long term diet following surgery and the importance of establishing new eating behaviours. Consideration is given to the potential nutritional complications that may occur following each of the bariatric procedures with respect to protein, iron, B12, folate, calcium, vitamin D and other fat-soluble vitamins, thiamine, zinc, selenium and other trace minerals.
The importance of monitoring nutritional status pre- and post-surgery is emphasised as well as the need for vitamin and mineral supplementation in the long term. The management of early and late surgical complications is covered. Finally, it discusses the nutritional support (oral, enteral and parenteral) of the bariatric patient and appropriate routes of feeding.
The Bariatric Surgery section will be of particular interest to dietitians working in both acute and primary care settings and it can be purchased from PENG via the link below- http://www.peng.org.uk/publications/publications.html
New year updates
Many of you will recall being contacted Emma Baldry about pre-operative diets. Her paper entitled “Pre-operative Dietary Restriction for Patients Undergoing Bariatric Surgery in the UK: Observational Study of Current Practice and Dietary Effects” has been published in Obesity Surgery. Emma is very grateful for your responses.
The Sleeve Gastrectomy diet sheet is in the final stages of development with NDR-UK and is being led by Nerissa Walker. This will be endorsed by both BOMSS and the BDA. The Gastric Bypass and Gastric band diet sheets still continue to sell well and dietitians should contact Jenny Hughes (via Mary O’Kane) if they wish to purchase them.
The nutritional guidelines are near completion and will contain recommendations about nutritional assessment, nutritional monitoring and vitamin and mineral supplementation. This will also feed into the work of the Obesity Clinical Reference group on follow-up of patients.
Good sessions in Gateshead
At the last AUGIS meeting (September 2013) the BOMSS session focussed on “The problem of weight regain and how to manage it” with presentations from MDT members including the psychological view from Dr Vanessa Snowdon- Carr and the dietetic view from Mary O’Kane. There was an interactive discussion at the end illustrating the difficulties in managing weight regain. The AHP session was well attended especially considering it was an early morning slot. Denise Thomas gave an excellent presentation about the obesity pathway and the difficulties caused by changes in commissioning. Sadly Amanda Cheesley had to send her apologies but is keen to develop relations between BOMSS and the RCN and raise the profile of the bariatric nurse. Ken Clare is taking this forward.
Focusing on weight problems in Gateshead
We’re happy to say that there will be a BOMSS session at the AUGIS conference (September 19/20 in Gateshead) on ‘The problem of weight regain and how to manage it’ which will be of interest to AHPS. Registration is now open and the cost is greatly reduced for our group. http://www.augis.org.uk/newcastle2013/
Plans are also underway for the 2014 BOMSS conference in Leamington Spa – keep an eye out for details in the near future.
The BOMSS nurse / AHP group is a very diverse group and we have been asked to update our details. We are currently exploring the training needs of members and how best to deliver them. Once the database has been updated we may undertake a training needs analysis. In the past, there have been successful dietetic courses with requests to open these up to the wider MDT. Any suggestions are welcomed.
If you have other suggestions of what you wish us to take forward on your behalf, please do get in contact.
Improving communication between AHPs
The highlight of the year so far was the BOMSS conference held in Glasgow at the end of January. It was good to see AHPs represented amongst participants and speakers. The organising committee did an excellent job of balancing the needs of all disciplines and the afternoon workshops were enjoyed by all.
The welcome from the city of Glasgow and tour of official buildings was warm and stimulating. The main meeting was attended by a record number of AHPs from a large and diverse range of disciplines.
We are now taking soundings to get the number of plenary and AHP sessions in the right balance for future meetings. The conference dinner was again an excellent event and splendid entertainment. If you are a new AHP member we would strongly recommend you attend next year’s Scientific Meeting in Leamington Spa (January 22-24, 2014).
One theme that did emerge during Glasgow was the wish to improve communication amongst AHP members and between council and members. We are considering a closed BOMSS Facebook group and a Linkedin group. Watch this space!
Bariatric Specialist Nurse
AHP update – activities and news
Thank you to everyone who responded to the questionnaire on current practice with respect to nutritional screening, monitoring and vitamin and mineral supplements. Over a third of the membership responded, Mary O’Kane is busy analysing the results and will produce a report before starting on the guidelines.
Gail Pinnock has taken the lead accompanied by Nerissa Walker and Mary at writing the bariatric surgery chapter for Manual of Dietetic Practice. They have also written an insert on bariatric surgery and requirements for the PENG handbook. These will be useful resources for dietitians and students.
The NCEPOD report, ‘Too Lean a Service’ was launched in autumn and Mary O’Kane spoke at the launch. Several recommendations were made in the report including access to appropriate health professionals, good dietetic support and the multidisciplinary team.
The BOMSS dietetic study day held in November was initially was aimed at dietitians new to bariatric surgery or working in other areas, but was opened up to other AHPs and nurses. Feedback has been excellent. In addition there has been a request to make the advanced course multidisciplinary too and include nurses and other AHPs. We would welcome ideas for the day from you and also volunteers to speak!
Discussions are ongoing with Nutrition and Diet Resources (NDR-UK) about the sleeve gastrectomy diet sheet. The diet sheet would be endorsed by BOMSS and the BDA. Nerissa Walker has been leading on this but there are considerable delays on the NDR-UK side. Meanwhile, the gastric band and gastric bypass diet sheets are still on sale. (Contact Mary O’Kane for further details and an order form).
Finally, please do let us know how you would like to be more involved and what areas you feel we should be taking forward.
Nutritional monitoring, vitamins, minerals and bariatric surgery
BOMSS Council member Mary O’Kane is asking members to take a few minutes to complete a questionnaire on the current practice of nutritional monitoring, vitamins and minerals and bariatric surgery. Please click on the link:
She would also like to see copies of any protocols used locally for treatment and monitoring of bariatric patients. Mary can be contacted at Mary O’Kane, Clinical Specialist Dietitian (Obesity), Dietetic Department
The General Infirmary, Leeds, Great George Street, Leeds LS1 3EX, email: mary.o’firstname.lastname@example.org
BOMSS council has agreed there should be a position statement regarding vitamins, minerals and nutritional monitoring. Consequently, a small working group is taking the lead on this work. This short audit of current practice and your protocols and views regarding the monitoring of patients will be used to influence this work.
The BOMSS 2012 conference saw two excellent presentations in the nurse / AHP session. Dr Aasheim spoke about the nutritional monitoring following bariatric surgery and Prof Finer discussed the management of reactive hyperglycaemia. These are challenging areas in the management of patients and generated much discussion.
The nurse / AHP seats on council have increased to three in recognition of benefits of multidisciplinary working. Andi Fox-Hiley has stood down from council but will continue to be active in the background. She was thanked for her work on council raising the profile of AHPs and nurses and her large contribution to education and training. Ken Clare and Gail Pinnock were elected to council and are looking forward to progressing work on your behalf. We welcome suggestions, ideas and contributions.
Mary O’Kane – Mary.O’Kane@leedsth.nhs.uk
Message from BOMSS Nurses/AHPs Representative
The dietitians have held two successful study days over the last year. One was aimed at dietitians new to bariatric surgery or working in the community. With the growth in bariatric surgery, more dietitians are becoming exposed to patients who are considering bariatric surgery or who have already had a procedure. With most centres only being able to offer two years follow up there is a move towards shared care. The other study was a more advanced course and included active participation in a workshop discussing vitamins, minerals and monitoring after bariatric surgery. It is important that within BOMSS, we work to a consensus about nutritional supplements and monitoring. A further study day was organised to and aimed at all health professionals involved in the care of bariatric patients. Unfortunately, there were insufficient numbers to go ahead but we will look to running it again. The diet sheets for the gastric bypass and the gastric band continue to sell well.
A further diet sheet on the sleeve gastrectomy should be available soon. BOMSS was invited to be involved in the peer review of bariatric services within the West Midlands. Surgical. dietetic and nursing representatives visited the different centres. It was an interesting experience and a great opportunity to see initiatives undertaken by other units. We are grateful to Mr Alberic Fiennes for including the affiliates in the visits. We are looking forward to the BOMSS annual conference particularly to the presentations from Prof Nick Finer and Dr Erlend Aasheim in the affiliate sessions. Please contact Andi or Mary with any ideas, suggestions of areas that you wish the affiliate members to be involved in.
Andrea Fox-Hiley – email@example.com
Mary O’Kane – Mary.O’Kane@leedsth.nhs.uk
Welcome to the Allied Health Professionals page of the BOMSS website
Mary O’Kane was elected as the second AHP council member in May 2011. We have placed a short profile of both Mary and I below which includes our thoughts on how we can develop not only the website, but also the Annual Meeting to enhance the AHP contribution to the Society and in support of each other’s practice and professional development.
The 2012 annual meeting will have an AHP Parallel session on the second day and, as usual, there will be an opportunity to contribute to the free paper session on the first day.
If anyone would like to discuss their ideas for submission Mary and I would be happy to work with you or put individuals who are willing and able to offer support in touch with each other.
Contained within the AHP section you will be able to see information on upcoming educational events. We would welcome your comments and suggestions on this or any ideas and contributions you have for future meetings, the website or indeed anything at all which you may wish to contribute.
Mary is a clinical specialist dietitian in obesity and is based in Leeds Teaching Hospitals. She has extensive experience in dietetic management of patients undergoing bariatric surgery. She is keen to facilitate the development of nutritional standards and resources.
Andi is Education and Training Development Manager for Medical Education Leeds. She has a Nursing background, and has extensive experience in the design and delivery of education programmes across healthcare disciplines. She is keen to promote and support education, training and research in order to maximise AHP involvement and participation in the work of the society.
Andrea Fox-Hiley BOMSS Council Member, allied health sciences firstname.lastname@example.org
Mary O’Kane BOMSS Council Member, clinical specialist dietitian