Patient population

Patients 40 years of age or older who were scheduled to have a SG were recruited from the Wake Forest Baptist Health Weight Management Clinic in Winston Salem, North Carolina. Patients had to meet standard criteria for bariatric surgery, including a BMI ≥40 kg/m², or a BMI ≥35 kg/m² with associated complications of obesity such as poorly controlled type 2 diabetes mellitus or obstructive sleep apnea, in addition to being medically cleared as safe for surgery with normal electrolytes, mineral and vitamin levels, and blood counts.^{( 17 )}

Patients adhered to the following clinic visit schedule postsurgery: one overnight hospital stay; 30‐day nutrition and surgeon follow‐up; 3‐month nutrition and blood‐draw follow‐up; 6‐month surgeon, resting metabolic rate, and exercise follow‐up; 9‐month nutrition follow‐up; and 12‐month surgeon and resting metabolic rate follow‐up. Participants were asked to establish an exercise routine preoperatively that was done for at least 30 minutes, 3‐to‐5 days per week, with exercise recommendations postsurgery including daily walking and strength training beginning after their 30‐day follow‐up visit. The American Society of Metabolic and Bariatric Surgery (ASMBS) recommendations for the perioperative nutrition, metabolic, and nonsurgical support of patients who had had bariatric surgery were followed.^{( 16 )} Briefly, patients were recommended to consume (typically in the form of a multivitamin, though one was not provided) at least 3000 IU/d of vitamin D (if serum levels were below 30 ng/mL), 1200 to 1500 mg/d of calcium, and 90 to 120 mg/d of vitamin K. Protein recommendations were based on height and sex, ranging from 65 to 110 g/d: slightly higher than the ASMBS recommended intake of 46 g/d for women and 56 g/d for men.