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Bariatric/weight loss surgery malpractice and malnutrition

There is a significant risk of malnutrition after some types of bariatric procedures, but some surgeons tend to ignore the signs until it is too late

In my law practice as a Houston, Texas medical malpractice attorney, I have handled a lot of cases involving bariatric/weight loss surgery.

Why weight loss surgery is popular

I guess it should not be surprising that bariatric surgery has become rather popular. Statistics show that around 35% of U.S. adults are obese and over 67% are overweight or obese. To make matters worse, as we age, it is harder to lose and keep weight off because of a significant decrease in the number of calories we burn (called the basal metabolic rate).

Experts say that the basal metabolic rate decreases about 1-2% per decade, after age 20. That means that our bodies use around 150 fewer calories on a daily basis every decade. So, a typical 50 year old will burn 450 fewer calories than a 20 year old. Those calories can add up, making weight gain a health and lifestyle issue.

Many people who have been unsuccessful in tackling their weight through diet and exercise have turned to bariatric surgery for help in managing their weight. There are many procedures available these days, including lap band, gastric sleeve, gastric imbrication, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.

Bariatric surgery malpractice

From my experience in investigating and filing bariatric surgery malpractice lawsuits, I have a seen a number of things that can go wrong.

First, I have seen a number of cases where the patient had weight loss surgery despite not meeting the criterion for obesity. Using the body mass index (BMI) method, the cutoff for obesity is a BMI of 30 for obesity, and 40 for morbid obesity. Most bariatric surgeons encourage weight loss surgery before a patient becomes morbidly obese, out of their experience that the procedures have better long-term success.

For patients with a BMI of less than 30, though, experts recommend a physician-assisted diet and exercise program to avoid the risks of bariatric surgery. In my experience, though, some Texas weight loss surgeons take a more liberal (and profitable) approach and will perform procedures on paying patients who are not even obese.

Second, I have frequently seen complications where patients, after surgery, cannot keep down food or water and experience violent nausea and vomiting. Bear in mind that any weight loss surgery involves either modifying the normal gastrointestinal anatomy or restricting or reducing the size of the stomach pouch. Sometimes, though, improper, negligent surgical technique can cause a kink or obstruction in the digestive system, which allows little to nothing to pass through it. The shoddy techniques include things like making the stitches too tight or removing too much of the stomach.

Many bariatric surgery practices, in my observation, are run like an assembly line. Therefore, when a patient complaints of nausea and vomiting, the reply is quite often something like, “Don’t worry about it. That’s normal at this stage.” Instead, what is really needed is a thorough evaluation, perhaps including diagnostic radiology imaging, if the nausea and vomiting persist more than two or three days. Medical experts that we have retained to review bariatric cases have testified that with kinking, stitching, and other gastric outlet obstruction problems, taking the patient surgery back to surgery quickly is the best solution.

A third type of problem that I have seen people experience after weight loss surgery is so common that I want to address it independently. This complication is malnutrition.

Malnutrition after weight loss surgery

If you think about it, it should come as no surprise that modifying the design of our digestive system’s anatomy and physiology may create nutritional challenges. After all, the gastrointestinal tract’s role is to absorb nutrients. Bariatric surgery changes the system by reducing the amount of food eaten, and then even a lesser amount of that already-reduced volume is absorbed.

Malnutrition can develop in the months or years after weight loss surgery. Common symptoms include weakness, apathy, fatigue, dry skin, dull or brittle hair, change in fingernail appearance, bleeding gums, and changes in the eyes (like dryness and itchiness).

Studies have shown that the absorption of the fat-soluble vitamins, such as Vitamins A, D, E, and K, can be severely reduced after certain malabsorptive bariatric surgery procedures, including Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. The surgery can also create an iron deficiency.

The standard of care requires bariatric surgeons to provide or arrange post-surgical dietary counseling and instructions for patients before a procedure. The American Society for Metabolic and Bariatric Surgery recommends that bariatric surgical patients take at least the following dietary supplements in the months after surgery:

∙ 1-2 adult multivitamins with minerals including iron, folic acid, and thiamine

∙ 1200-1500 mg of elemental calcium

∙ 3000+ international units (IU) of vitamin D 

∙ Vitamin B12

∙ 45-60 mg of an iron supplement 

I have seen first-hand a lot of my bariatric surgery medical malpractice clients struggle with life-threatening malnutrition. One of my clients got down to 90 pounds, and I was so happy and relieved when she finally turned the corner and survived her malpractice ordeal. My advice to post-surgical patients is to get help from an experienced dietician quickly if you start seeing symptoms of malnutrition.

We are here to help

If you or someone you care for has been seriously injured from medical negligence related to bariatric or weight loss surgery or follow-up, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free evaluation of your potential case.


Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator and represents patients and family members in medical malpractice and wrongful death cases against hospitals, doctors, surgeons, and other healthcare providers. He has been recognized with a 10/10 rating by Avvo and the prestigious AV rating by Martindale-Hubbell.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.

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