Abstract

AIMS
The central aim of the thesis is to provide evidence for the claim of recognition for retrospective doctoral level work focused on the missing or “unseen” integration of nutrition with metabolic and bariatric surgery (MBS) and the potential pathophysiological impact when it is not addressed. The strategic objectives of the study are threefold:
1. To provide evidence of the retrospective creation of optimal resources for use by international interdisciplinary healthcare professionals in the assessment, diagnosis, management, and prevention of nutrient deficiencies (both short and long-term) in patients who are in the pre-and post-operative stages of MBS.
2. To highlight the relative clinical invisibility, yet salience, of the term ‘metabolic’ within the context of post-bariatric surgical nutrition and the avoidance of medical complications.
3. To highlight innovative best practices in optimal and individualised bariatric nutritional care in addressing the conceptual basis of ‘M’ metabolism and to raise awareness of its consequential significance in MBS, specifically micronutrient deficiencies.
METHODS
This thesis represents the cumulation of eight peer-reviewed publications specifically identified, justified, and developed to facilitate medical and healthcare practitioners’ ability to educate, assess, diagnose and manage very specific and otherwise unidentified nutrient deficiencies in patients who are either planning to have metabolic and bariatric surgery (MBS) or living post-operatively with its impact. Bronfenbrenner’s Ecological Systems theory is modified to provide a theoretical lens through which various complex adaptive systems have been investigated and evaluated. This is articulated within a pragmatist paradigmatic approach, enabling the highest level of systematic rigour of both the methodological approach adopted and the articulation of research findings. This approach also permits a pluralist positionality vis a vis what are optimally valid and positive clinical interventions. One additional peer-reviewed work is provided as a mechanism for contextualising and further evidencing the global impact of this work to date. The taxonomy used to classify these specific works is as follows:
• Clinical practice guidelines (Publications 1 - 2)
• Best Practices (Publications 3 - 5)
• Primary Research (Publications 6 - 8)
• Context (Appendix 1)
RESULTS
Micronutrient deficiencies (MND) persist and have continued to increase even though there are three nutrition-related Clinical Practice Guidelines (CPG) from the United States, including the two presented here as context and foundation of nutrition care in MBS (2008) and as an update with a focus on MND (2017) and the international CPG (2022) a collaboration between the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) and the World Gastroenterology Organization (WGO) to revise the 2010 WGO Obesity Guidelines..
MBS alters both the functional anatomy and physiology of the gastrointestinal tract, altering the metabolism of nutrients, thus creating the potential for micronutrient deficiencies.
The evidence provided contextually frames the vital need for assessing, diagnosing, and managing nutrient deficiencies as metabolic complications of surgery, not simply nutritional or behaviour-related issues.
CONCLUSION
This thesis provides a series of key resources for optimal nutritional care and advice for patients living with MBS, representing the culmination of my clinically impactful career trajectory. It also has the potential to facilitate medical and healthcare clinicians’ ability to address specific micronutrient (MN) complications as part of the metabolic nature of MBS by including micronutrient deficiencies as an additional differential diagnosis when working with patients who had MBS many years ago (10 or more years).

“Life can only be understood backwards, but it must be lived forwards.”
Sǿren Kierkkegaard