Overweight/Obesity/Gastric Bypass Care
 SSESSMENT
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Anthropometrics
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Height, weight, BMI
Waist circumference, hip circumference, waist-to-hip ratio
% body fat, % lean body mass
Determine android, gynoid, or mixed body typing
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Biomarkers/Labs
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Assess basic health markers along with hormone evaluation,
thyroid, adrenal and markers of insulin resistance and
inflammation by the following: CBC, CMP, thyroid panel,
B12, 25-OH vitamin D, RBC magnesium, fasting insulin, 2hr
GTT, fasting lipid panel, hsCRP, DHEA-S, male or female
hormone panel
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IgG food allergy/sensitivity testing, salivary cortisol, stool
testing for dysbiosis markers, organic acids
RBC fatty acids
Endocrine disruptor evaluation: detoxification markers,
pesticide levels, organochlorine baseline, RBC
micronutrients
If history of yo-yo dieting or disordered eating, check resting
metabolic rate; check amino acid panel post-gastric bypass
for malnutrition
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Consider weight management panel, steroid hormone panel,
detoxification panel, COMT
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Clinical Indicators
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Nutrition-focused physical exam
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Diet/Lifestyle Histories
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Comprehensive intake form
Medical Symptoms Questionnaire
Toxic Chemical Exposure Questionnaire, if indicated
Eating behavior questionnaire, if not part of comprehensive
intake form
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 IAGNOSIS
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Overweight (BMI 25-29.9) or Obesity (BMI 30-39.9) or Morbid Obesity (BMI ≥40 )
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 NTERVENTION
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Core Food Plan
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Balanced Core Food Plan, unless otherwise indicated
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Food Plan Modifications
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Modify Core Food Plan based on laboratory and clinical
indicators after complete assessment and diagnosis
Include daily breakfast and healthy snacks between meals to
control hunger and boost metabolism
Calcium-rich foods: dairy products, dark-green leafy
vegetables, legumes, lime-processed corn tortillas,
broccoli, calcium-set tofu, almonds
Fiber-rich foods: oat/oat bran, legumes, brown rice, fruits,
vegetables, nuts and seeds
Green tea, 2-4 cups/d
Cayenne pepper, 6-10 gm/meal, 28 gm/d
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Medical Foods
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Consider pea/rice- or whey protein-based medical food to
support protein/calorie needs during weight loss
Cayenne –see dosing below
Green tea –see dosing below
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Dietary Supplements
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High quality daily multivitamin with minerals while on
calorie-controlled meal plan
Vitamin D beyond multivitamin if deficiency/suboptimal
levels indicated
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Additional minerals beyond multivitamin, if labs indicate
Consider calcium, 600-1200 mg/d
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These supplements may be helpful:
Conjugated linoleic acid (CLA), 1800-4000 mg/d
5HTP, 100-300 mg/d, initiate at 50 mg/d
Glucomannan, 2-4 gm/d, divided doses before meals
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Food/Medication/Dietary
Supplement Interactions
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Check interactions based on individual medication and
supplement selected
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Lifestyle Recommendations
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Daily activity, as tolerated, preferably outdoors (sunshine)
Strong emphasis on regular exercise and active lifestyle
Aerobic exercise: 5 -7 times per week 30-60 min duration
Resistance training: 2-3 times per week – all-body routine
Flexibility training: daily stretching, regular yoga, Tai Chi,
and/or Pilates
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Full complement, as determined for individual patient
7-8 hours most nights is recommended for optimal weight
control
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Encourage social connections, activities that are meaningful
and pleasurable for the individual
Consider eating behavioral counseling if not making progress
with intervention strategies above
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 ONITORING and  VALUATING
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Follow-up Plan
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Periodic contact by functional nutrition practitioner
Return to clinic every 2 weeks for first 6 weeks, then
monthly until weight loss goals achieved
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Key Resources:
Natural Standard Database or Natural Medicine Comprehensive Database for supplement information
Keithley J, Swanson B. Glucomannan and obesity: a critical review. Altern Ther Health Med. 2005;11:30-4.
Kring SI, Werge T, Holst C, et al. Polymorphisms of serotonin receptor 2A and 2C genes and COMT in relation to obesity and type 2 diabetes. PLoS One. 2009;4:e6696.
Lyon MR, Reichert RG. The effect of a novel viscous polysaccharide along with lifestyle changes on short-term weight loss and associated risk factors in overweight and obese adults: an observational retrospective clinical program analysis. Altern Med Rev. 2010;15:68-75.
Nagao T, Hase T, Tokimitsu I. A green tea extract high in catechins reduces body fat and cardiovascular risks in humans. Obesity 2007;15:1473-83.
Shapses SA, Heshka S, Heymsfield SB. Effect of calcium supplementation on weight and fat loss in women. J Clin Endocrinol Metab. 2004;89:632–7.
Zemel MB, Thompson W, Milstead A, et al. Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults. Obes Res 2004;12:582–90.
GASTRIC BYPASS CARE:
Recommendations apply to malabsorptive bariatric surgical procedures
Sources:
Koch TR, Finelli FC, Postoperative metabolic and nutritional complications of bariatric surgery.
Gastroenterol Clin North Am. 2010;39:109-124.
Mechanick JI, Kushner RF, Sugerman HJ, et al. Endocr Pract. 2008;14 Suppl 1:1-83.
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