Answer: Statement D is False
Statement D ("her record of weight loss should not be included in her health history") is definitively false—a comprehensive health history for women who have had bariatric surgery must include their weight loss trajectory, surgical details, nutritional status, and ongoing monitoring needs. 1
Why Statement D is Incorrect
Essential Documentation Requirements
Weight loss records are medically critical for women post-bariatric surgery because they directly inform risk assessment for nutrient deficiencies, metabolic complications, and pregnancy planning 1
Nutritional surveillance depends on weight trajectory—women require assessment for deficiencies in vitamins A, D, E, K, C, B, B12, folic acid, and iron, with supplementation needs varying based on weight loss patterns and surgical type 1
Pregnancy timing recommendations (12-18 months post-surgery) are based on weight stabilization status, making weight loss documentation essential for reproductive counseling 1, 2
Medication absorption is altered after bariatric surgery, particularly with malabsorptive procedures, requiring documentation of surgical type and weight changes to guide prescribing 1, 3
Clinical Utility of Weight Documentation
Five distinct weight change trajectory groups have been identified after bariatric procedures, each with different implications for long-term outcomes and comorbidity resolution 4
Weight regain is a recognized long-term risk requiring longitudinal monitoring—median weight loss after RYGB is 31.5% at 3 years, but variability exists and tracking is essential 4
Comorbidity resolution correlates with weight loss—67.5% diabetes remission after RYGB versus 28.6% after LAGB at 3 years, making weight documentation prognostically important 4
Why Statements A, B, and C are True
Statement A: Non-judgmental Approach is Essential
Weight bias research demonstrates that both experienced and internalized weight stigma are associated with negative psychosocial, behavioral, and medical outcomes in bariatric patients 5
Clinicians must actively work to provide non-judgmental care, as the bariatric population faces heightened risk of weight stigma 5
Statement B: Subtle Unintentional Bias Exists
Implicit bias manifests even among well-intentioned clinicians caring for women with obesity and those who have undergone bariatric surgery 5
Both experienced and internalized weight bias have been documented in bariatric populations, affecting treatment outcomes 5
Statement C: Obesity Evokes Negative Clinical Responses
Documented barriers include negative clinician attitudes and responses toward women with obesity, particularly affecting African-American women seeking bariatric care 6
Obesity has been shown to trigger biased responses from healthcare providers, creating barriers to appropriate care 1, 6
Clinical Implications
Comprehensive Documentation Should Include
Surgical procedure type (RYGB, sleeve gastrectomy, LAGB) as this determines malabsorption risk and supplementation needs 1, 3
Time since surgery and weight trajectory to guide contraceptive counseling (oral contraceptives may be less effective after malabsorptive procedures) 1
Current supplementation regimen—typically two multivitamins daily plus iron (65 mg), folic acid (400 mcg), vitamin D (400-800 IU), and B12 (350 mcg) 1
Baseline and serial nutrient assessments including complete blood count to monitor for deficiencies 1
Common Pitfalls to Avoid
Never omit surgical history from documentation—this creates dangerous gaps in care continuity, particularly for medication prescribing and pregnancy planning 1, 3
Do not assume all bariatric procedures are equivalent—malabsorptive procedures (RYGB, duodenal switch) carry higher nutritional risks than purely restrictive procedures (sleeve gastrectomy, LAGB) 3, 4
Avoid focusing solely on weight numbers without addressing the psychosocial context and potential weight bias the patient has experienced 5