For better health
For better health
In the Netherlands, each year about 12,000 people with morbid obesity undergo bariatric surgery with the goal to lose weight. Rijnstate Hospital, Vitalys and Wageningen University & Research are working together to achieve optimal nutritional care for these patients, before and after surgery.
In bariatric surgery, the stomach is reduced in size; sometimes the intestines are also diverted. The procedure is a solution for people with morbid obesity who have already tried everything to lose weight. Vitalys, part of Rijnstate Hospital, is one of the largest clinics in the Netherlands for bariatric surgery; their surgeons perform over 1,250 surgeries every year.
Bariatric surgeon Eric Hazebroek is extraordinary professor of Nutrition and Obesity Treatment at Wageningen University & Research (WUR). Under his supervision, various PhD candidates are working on parttime studies within our research line Obesity.
The project aims to tackle overweight via the National Prevention Agreement and the activities of the Nutrition and Healthcare Alliance within this initiative.
Every bariatric surgery affects to a greater or lesser extent the anatomy and physiology of the gastrointestinal system. As a result, patients have an increased risk of nutritional deficiencies, which can lead to, for example, anaemia, osteoporosis or undernutrition. PhD candidate Laura Heusschen has been researching nutritional status after bariatric surgery since April 2018.
Optimal vitamin supplementation: As part of the VITAAL studies, colleagues have researched the optimal composition of multivitamins for patients who have undergone a gastric bypass and sleeve. Together with researchers from the Catharina Hospital, Franciscus Gasthuis & Vlietland and the OLVG, the researchers are also examining how compliance to supplements can be improved. In addition, they are studying alternative methods of vitamin supplementation, such as giving injections.
Pregnancy: The NEWBIE study is a multicenter cohort study following women who get pregnant after bariatric surgery. This study is being conducted at the Rijnstate Hospital, Gelderse Vallei Hospital and the Maxima Medical Center. The researchers are examining the nutritional status and its influence on the course of the pregnancy and the development of the unborn child.
Preoperative weight loss: Weight loss prior to surgery can lead to liver shrinkage and a decrease in fat tissue in the abdomen (abdominal fat). This may have a positive effect on the feasibility of the surgery and weight loss in the long term. The PREBA study investigates whether this is actually the case. Patients are randomly assigned to a diet group and a control group. The diet group follows a 'low-calorie diet' two weeks prior to surgery.
Eetscore (Eating Score): Researchers have examined the extent to which nutritional screening and monitoring tool ‘Eetscore’ (Eating Score) is applicable to bariatric patients. The quality of the diet before and after bariatric surgery has been investigated as well.
The main cause of weight loss after bariatric surgery is probably that people eat less. There are several theories about how this happens exactly. Since October 2019, PhD student Yonta van der Burgh has been unraveling some of the mechanisms behind weight loss in order to further improve the treatment.
Food preference: In collaboration with prof. dr. Marco Bueter, surgeon and professor at the University of Zurich, Yonta examines food preference with a for this goal specifically developed 'drinking meter'. Pre- and postoperatively, patients are offered different types of drinks that vary in fat and sugar content. The drinking meter indicates how much and how quickly they consume it. Taste changes before and after bariatric surgery are also examined, using data from a taste database developed by WUR.
Gastric emptying: Research on gastric emptying after bariatric surgery is being done in collaboration with WUR and the nuclear medicine and radiology department of the Rijnstate Hospital. The 3T-MRI scanner of Gelderse Vallei Hospital is also being used. Together with dr. Paul Smeets (WUR) and Laura Deden (Rijnstate), Yonta determines the speed of food passage through the smaller stomach, the gastric pouch, using an MRI scanner. This measurement is being done in people who have either lost a lot or very little weight after a gastric bypass. The study is being repeated in patients who have undergone gastric sleeve surgery.
Gastrointestinal problems: Bariatric surgery changes the anatomy of the gastrointestinal tract, leading to abdominal pain in almost one in three patients. This may be due to a reduced release of digestive enzymes and the more frequent occurrence of, for example, lactose intolerance and bacterial overgrowth. However, abdominal pain can also have other causes. The QUINT study, a large study into abdominal complaints and nutritional intake 5 years after surgery, should provide clarity. Participants fill out questionnaires about abdominal complaints and other complaints before and after surgery. The BARICO study, a collaboration between TNO and Radboud University, is examining the relationship between abdominal complaints and changes in the microbiome in the gastrointestinal tract.
Permanent weight loss and increased health is the goal of gastric bypass surgery, but this is not a guarantee. Certainly in the longer term, there are many factors that can make it difficult to maintain or further improve weight, health and quality of life. Biological and psychological factors, but also lifestyle and environmental factors play a role in this. At the moment, a pre- and post-operative process with coaching from among others a doctor, nurse, psychologist and dietician, is regarded as best practice. However, it is still unclear which composition, intensity and timing is optimal. Since 2021, PhD candidate at Vitalys Nadia Botros is researching this coaching trajectory before and after bariatric surgery. Among others, Nadia is examining the needs, experiences and expectations of people who have followed the coaching trajectory at Vitalys.
For many morbidly obese patients, bariatric surgery is the most effective treatment. Still, about 25% of patients gain weight again after a few years. Since November 2019, PhD candidate Sietske Okkema has been investigating whether improving surgical techniques can prevent this.
Maintaining weight loss: Researchers have been studied various gastric bypass modifications, such as lengthening and narrowing the gastric pouch or placing a strap around the gastric pouch. After three years, the results are promising and data will also be collected about the situation after 4 and 5 years. It is also being researched if placing a strap around the reduced stomach can counteract weight gain after gastric sleeve surgery. This study is being carried out in collaboration with the St. Antonius Hospital in Nieuwegein and the Zuyderland Hospital in Heerlen.
Dumping syndrome: Improved surgical techniques may also reduce the risk of so-called 'dumping syndrome', a problem that mainly occurs after a gastric bypass. It is characterized by complaints such as palpitations, dizziness, a feeling of having a full stomach and abdominal pain. Placing a strap around the gastric pouch can delay gastric emptying and possibly reduce the symptoms. This mechanism is being researched.
In all studies, the researchers work closely with experts and researchers at other hospitals and institutions, both nationally and internationally. In addition, prof. dr. Eric Hazebroek supervises several other PhD candidates in their research into bariatric surgery: Claudia Berends (Vitalys/ Rijnstate) studies obstructive sleep apnea syndrome (OSAS) and Marieke Smelt (Catharina Hospital) studies vitamin deficiencies. Ralph Gadiot (Franciscus Gasthuis & Vlietland) is doing his PhD on surgical techniques.
Laura Heusschen (PhD)
Amongst others: prof. dr. Eric Hazebroek (WUR/ Rijnstate/ Vitalys), prof. dr. Ellen Kampman (WUR), dr. Agnes Berendsen (WUR), Laura Deden (Rijnstate), Laura Heusschen (WUR/ Rijnstate), Yonta van der Burgh (WUR/ Rijnstate), Sietske Okkema (WUR/ Rijnstate)
