Dietetics — Discharge to GP after Bariatric Surgery Dietary Programme
A specialist bariatric dietitian discharges a 44-year-old man to the GP following a 6-month post-sleeve gastrectomy dietary rehabilitation programme. The proficient challenge is communicating the outcome data, the permanent dietary constraints of post-bariatric anatomy, and the GP monitoring requirements without reproducing the full programme content.
Letter type
Discharge
Write to
General Practitioner
Target length
200–230 words
The case notes
Patient: Mr Emmanuel Tetteh, 44 years old; sleeve gastrectomy 6 months ago; referred for post-operative dietary rehabilitation
Pre-surgery weight / BMI: 134 kg; BMI 43.2
Discharge weight / BMI: 109 kg; BMI 35.1; weight loss 25 kg over 6 months; excess weight loss 47% (on track)
Dietary status at discharge: Tolerating IDDSI Level 7 (regular, easy to chew) diet; 3 small meals per day of 150–200 g each; meeting protein target 60–80 g/day; eating slowly with 20–30 minute meals; no dumping syndrome episodes in past 8 weeks
Supplements: Currently: multivitamin with iron (1 daily), vitamin D 1000 IU daily, B12 sublingual 1000 mcg daily, calcium citrate 500 mg twice daily; these are lifelong requirements post-sleeve gastrectomy
Ongoing dietary constraints (permanent): Portion sizes remain limited (150–200 g meals); no drinking with meals or for 30 minutes after; avoid high-sugar foods and beverages (dumping risk); chew all food thoroughly; eat 3–4 small meals/day — not fewer
GP monitoring requested: Annual blood panel: FBC, iron studies, ferritin, B12, folate, calcium, vitamin D (25-OH), PTH, zinc — micronutrient deficiencies are common post-bariatric and clinically significant; weight monitoring 6-monthly; refer back to bariatric dietitian if weight regain >10 kg from current or any significant micronutrient deficiency
Task: Write a discharge letter to the GP, Dr Josephine Mensah, summarising the programme outcome and requesting the annual monitoring protocol.
Writing task
Write a discharge letter to the GP, Dr Josephine Mensah, summarising the programme outcome and requesting the annual monitoring protocol.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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Weight outcome: 25 kg loss, BMI 43.2 to 35.1, excess weight loss 47% over 6 months
The outcome data justifies the discharge and gives the GP the baseline for future weight monitoring. '47% excess weight loss' is the clinical metric for bariatric outcome assessment.
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The lifelong supplements (multivitamin/iron, vitamin D, B12, calcium citrate) and the annual blood panel requirement
This is the most important GP action item. Post-sleeve gastrectomy micronutrient deficiency is common, progressive, and preventable with monitoring. The GP must know what to test, and that supplementation is permanent — not a temporary post-operative measure.
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The re-referral trigger: weight regain >10 kg or significant micronutrient deficiency
Bariatric discharge is not a permanent discharge — it is a step-down with a defined re-referral pathway. The GP must know the threshold for sending the patient back to specialist dietetics.
Leave out
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The programme content: the phased dietary progression from liquid to puree to soft to regular
The programme is complete. The GP needs the outcome and the forward-looking monitoring — not the 6-month clinical diary.
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Dumping syndrome physiology and pathophysiology
State the constraint: 'avoid high-sugar foods due to dumping risk'. One clause. The GP does not need a physiology lecture on post-gastrectomy carbohydrate absorption.
Criterion in focus · Content
Bariatric dietetic discharge letters are assessed on whether the GP has everything they need to monitor a post-bariatric patient independently. The non-negotiables are: (1) the outcome data (weight and EWL), (2) the lifelong supplement regime, (3) the annual monitoring panel, and (4) the re-referral threshold. A discharge letter that gives the outcome without the monitoring requirements hands the GP a patient they cannot safely manage without follow-up contact.
Now write the letter — and find out what is blocking your Grade B
Write a 200–230 words discharge letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.