CASE STUDY: PCN Dietitians Support Post Bariatric Surgery Care
Jenny Ward PCN Dietitian at Unity PCN Coventry
Case Study 4: Post-Bariatric and Complex Symptom Review
1) Patient Background
Ms. A, a 45-year-old female, was referred by her GP to the PCN dietitian and seen within a week. She had a complex history including a gastric sleeve in 2019, chronic acid reflux, asthma, and a new diagnosis of fibromyalgia. Her initial post-surgery weight loss had plateaued for two years (current BMI 33.7), and she was keen for further loss. She felt overwhelmed, tearful, and felt she lacked adequate post-operative support from secondary care, which she attributed partially to COVID-19. She was confused about the cause of her current GI symptoms (bloating, reflux) and described her diet as "all over the place."
2) Dietetic Intervention and Plan
The initial consultation focused on supportive education post-gastric sleeve to address her perceived support gap:
Dietary Structure and Technique:
-
Agreed on post-sleeve eating techniques (small bites, chewing thoroughly, no drinking with meals).
-
Established a target pattern of three small, structured meals/day.
-
Emphasised protein at two main meals for satiety and adherence to post-bariatric principles.
Micronutrient Supplementation:
-
Recommended starting an over-the-counter complete multivitamin and mineral supplement.
-
Requested the GP prescribe Vitamin D and calcium, and iron in line with BOMSS guidelines.
Monitoring:
The plan was to first establish a regular eating pattern to see if GI symptoms improved, which would help differentiate their cause before extensive dietary changes.
3) Outcome and Follow-up
At the one-month follow-up, Ms. A reported an initial weight loss of 3 kg. Crucially, her symptoms had started to improve with the more structured, regular eating pattern. Next steps included reviewing blood tests and integrating OT assessment findings.
Benefit of PCN Dietitian: The PCN dietitian provided individualised, practical, and timely post-operative support and structure that Ms. A felt was missing from secondary care. This led to a positive initial outcome in both weight loss and improved symptom management, restoring her confidence and providing clarity on her complex symptoms.