Anemia or low levels of hemoglobin remains a potential adverse effect of bariatric surgery, even after a decade.

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Long-term follow-up with a bariatric specialist is important to lessen the risk for anemia.
The average rate of preoperative anemia was 20 percent; the rate increased 10 years after RYGB to 47 percent. At 10 years after RYGB, the anemia rate in the group without bariatric specialist follow-up increased to 57 percent, from 22 percent before surgery.
The rate of anemia in the group with bariatric specialist follow-up did not increase significantly after 10 years (19 percent vs 13 percent). Compared with patients with bariatric specialist follow-up, patients without bariatric specialist follow-up had significantly higher odds of anemia at 10 years after adjusting for preoperative anemia.
The major limitation of this study was the size of the group with bariatric specialist follow-up, which may be too small to identify a significant difference in the 10-year anemia rates compared with preoperative rates.
"Our study suggests that follow-up with bariatric specialists more than 5 years after surgery, rather than with specialists with no bariatric expertise, can decrease long-term anemia risk. This finding may demonstrate the bariatric specialist's specific understanding of the long-term risk for nutritional deficiency after RYGB and the importance of vitamin and mineral supplementation," the authors write.
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