Challenges for The Future, Iron Deficiency and Anemia in Bariatric Surgery

Iron deficiency and obesity are global epidemiological problems affecting billions of people worldwide. In the last 30 years, the prevalence of obesity in Europe has risen to 23% and continues to increase. The unequivocal molecular-level connection between obesity and iron deficiency has been demonstrated. Due to the lifestyle and diet of modern humans, obesity and iron deficiency are no longer limited to industrialized countries; developing and underdeveloped nations are also affected by these issues. The most common form of anemia is iron-deficiency anemia. Although all recommendations unanimously advocate for iron correction before and after bariatric surgery, current guidelines are at level C and need improvement. Similarly, there is a growing emphasis in the literature on administering intravenous iron to patients during the first two weeks of hospitalization after bariatric surgery, followed by oral supplements upon discharge, although the specific type of oral supplements remains unclear. According to current protocols, patients are expected to be monitored for the next twelve months for anemia correction. Yet, after bariatric surgery the majority of patients do not receive additional information and advice on nutrition and iron supplementation, leaving them more or less to their own. Considering the numerous side effects associated with non-hem iron, a significant number of patients abandon iron therapy, which can undoubtedly impact the ultimate treatment outcome. Given the much better tolerance and high efficacy, the introduction of hem iron preparations may open a completely new chapter for research in this field.