Identification of Nutrition-Focused Physical Exam and Other Nutrition Assessment Components Specific to Bariatric Surgery: A Modified Delphi Study

Bariatric surgery (BS) is effective for treating obesity but carries significant nutritional risks. Patients often develop micronutrient deficiencies, loss of muscle mass, and other physiological complications. Standardized methods such as the Nutrition-Focused Physical Exam (NFPE) may not adequately capture physical findings specific to BS. This study aimed to develop an expanded and modified bariatric-specific NFPE tool and achieve expert consensus on its essential components using a modified Delphi methodology. A literature review identified clinical signs of malnutrition and nutritional complications unique to patients undergoing BS, which informed proposed BS-NFPE components. A three-round modified Delphi study with expert bariatric dietitians (n = 25) achieved consensus (≥75% agreement) on 43 BS-NFPE components, including physical signs of micronutrient deficiencies and toxicities, changes in muscle and fat stores, indicators of surgical complications, gastrointestinal symptoms, and mental health effects. Experts also supported incorporating functional considerations and social determinants of health. This study introduces the first evidence-informed modified BS-NFPE tool to address limitations of the standard NFPE in bariatric populations. Use of BS-specific features may help clinicians identify malnutrition earlier, tailor care, and improve long-term patient support. Future research should evaluate this tool in clinical practice.