Weight loss surgery linked to alcohol abuse
Bariatric surgery has been proven to be extremely effective for reducing obesity in individuals who have been unsuccessful with a diet and exercise program. Many return to a normal weight; furthermore, hypertension and type 2 diabetes is either reversed or decreased in intensity. Unfortunately, the procedure has been reported to carry a risk of substance abuse. Alexis Conason and colleagues affiliated with the New York Obesity Nutrition Research Center at St. Luke’s-Roosevelt Hospital Center published their findings online on October 15 in Archives of Surgery.
Bariatric surgery markedly reduces the size of the stomach; thus, eating large amounts of food is severely impacted; however, the procedure does not affect liquid intake to the same extent. The objective of the study was to assess substance use before and after bariatric weight loss surgery. The investigators noted that the medical literature contains very little research investigating the occurrence of substance use following bariatric surgery. They hypothesized that patients who underwent the procedure would exhibit an increase in substance use (drug use, alcohol use, and cigarette smoking) following surgery to compensate for a major decrease in food intake.
The study group comprised 155 subjects (132 women and 23 men) who underwent bariatric surgery. The subjects were recruited from a preoperative information session at a bariatric surgery center. The subjects underwent either laparoscopic Roux-en-Y gastric bypass surgery (100 patients) or laparoscopic adjustable gastric band surgery (55 patients). The participants completed questionnaires to assess eating behaviors and substance use at preoperative baseline and 1, 3, 6, 12, and 24 months after surgery. The main outcome measure was the assessment of substance use via the Compulsive Behaviors Questionnaire.
The researchers found that the participants reported significant increases in the frequency of substance use (a composite of drug use, alcohol use, and cigarette smoking) 24 months postoperatively. The investigators referred to use of the three substances as composite substance use. Specifically, the subjects experienced a significant increase in the frequency of composite substance use from baseline to 24 months after surgery, as well as significant increases from 1 month, 3 months, and 6 months to 24 months after surgery. Furthermore, participants who underwent laparoscopic Roux-en-Y gastric bypass surgery reported a significant increase in the frequency of alcohol use from baseline to 24 months after surgery. Interestingly, the increased use of alcohol primarily occurred for patients who underwent gastric bypass surgery, not banding. On a scale from 0 to 10 of drinking frequency, where 0 represented never, 5 was sometimes and 10 always, gastric bypass patients reported an increase from 1.86 before surgery to 3.08 two years later. The authors noted that the response rate to the survey was 61% at 1-month follow-up, 41% at 3-month follow-up, 43% at 6-month follow-up, 49% at 12-month follow-up, and 24% at 24-month follow-up.
The authors concluded that patients who undergo bariatric weight loss surgery may be at increased risk for substance abuse. In particular, patients who undergo laparoscopic Roux-en-Y gastric bypass surgery may be at increased risk for alcohol use following the procedure. They noted that their study is among the first to document significant increases in substance use following bariatric surgery using longitudinal data.
Take home message:
This study points to another reason to try alternatives before resorting to bariatric surgery. Deaths have occurred during or shortly after the procedure. Leakage from the incisions can result in serious or fatal infections. Complications include ulcers, inability to properly absorb certain vitamins and minerals, and dehydration. Group therapy has benefited many obese individuals. Others have been able to lose weight with medications such as Qsymia, which was recently released on the marketplace.
Reference: Archives of Surgery