Case Scenario Holly is a 22 year old woman who had a gastric bypass (Roux-en Y)

Case Scenario Holly is a 22 year old woman who had a gastric bypass (Roux-en Y) procedure three months ago to assist her in managing her weight. She is being seen in clinic for her routine 3 month post-operative visit. Patient had presented for an initial consult to discuss the possibility of weight loss surgery ~ 4 months prior to her gastric bypass. At that time her past medical history was reviewed and included the following diagnoses: morbid obesity, hypothyroidism and hypertension. Medications included: Levothyroxine – 50 mcg/day, and Carvedilol – 1.75 mcg/day. Patient’s anthropometric measurements were as follows: Ht. = 5’8″, Wt. = 277 lbs., BMI = 42, BF% = 44. Vitals: blood pressure = 132/96 Patient’s anthropometric measurements at her 3 month post-operative visit are as follows: Ht = 5’8′, Wt. = 197 lbs., BMI = 30, BF% = 33. Total weight loss since her initial consultation = 80 lbs. Vitals: blood pressure = 124/80 Patient reports that she is still taking her Levothyroxine – 50 mcg/day, however, is no longer taking any blood pressure medication.

Patient reports that she is unable to tolerate “normal diet”. She has begun to consuming a “soft diet” – however, does report intolerance to chicken and some red meats with occasional nausea and vomiting when she consumes them. She continues to report early satiety with most meals measuring from two tablespoon to a maximum of half cup volume. Patient states that she is currently consuming 3 meals/day. However, the frequency of meals may not be sufficient Patient does report some additional concerns during our visit – she complains of hair thinning/loss and at times fatigue. She is concerned about possible nutritional deficiencies. Patient is due to have her 3 month nutritional labs completed; however, she has not gotten them drawn yet at this time. Patient also reports that she has not had her thyroid levels checked since her surgery. Nutrition Diagnostic Statement Patient is concerned about menu planning to meet dietary needs. Also, need to address long-term implications of micronutrient deficiencies

3. On the basis of the type of gastric bypass procedure that Holly has undergone, which micronutrients would you consider are of the greatest concern in regards to deficiency? List the micronutrient and possible clinical symptoms or condition of concern from the deficiency?