Dietitians' perspectives and current practice on micronutrient management in metabolic and bariatric surgery in Australia: A mixed-method study

Background: Dietitians play significant roles in care for patients electing metabolic and bariatric surgery including micronutrient management. Inconsistent preoperative practices are reported among Australian dietitians, and deeper exploration of perspectives is lacking.

Aim: To explore current practice and perspectives on micronutrient management in metabolic and bariatric surgery among Australian dietitians.

Methods: A mixed-methods study (cross-sectional survey and semi-structured interviews) was conducted. Eligible participants were dietitians working with patients undergoing surgery. A 20-item practice survey was distributed through Dietitians Australia e-newsletter. Quantitative responses were analysed descriptively. Interview recruitment occurred at the end of the survey or via professional networks. Interviews were conducted in-person or remotely, audio-recorded, and transcribed. An inductive thematic analysis was applied including coding, categorisation, and development of themes. Quantitative and qualitative data were integrated to identify potential divergence.

Results: N = 45 eligible dietitian survey responses were received and n = 8 dietitian interviews were conducted (n = 5 recruited from survey). Widespread micronutrient deficiencies at different surgery stages were reported. There was variability in practice and the clinical sources used by dietitians to manage micronutrients particularly in private vs public services. This was supported by the developed preliminary themes: (1) relying on experience due to insufficient evidence; (2) managing micronutrients for patients' future needs and actions; (3) Diverging focus of longer-term clinical endpoints and surgical weight loss.

Conclusion: Practice and evidence utilised by dietitians in managing micronutrient status in metabolic and bariatric surgery varies widely. A national evidence-based guideline for pre- and post-surgery nutrition care may standardise practice and improve care.