Can Gastric Bypass Fuel Alcoholism?

Can Gastric Bypass Fuel Alcoholism?  Short answer:  sometimes, too many times. 

Remember when I was shuffled off to NYC a few weeks ago to interview with ABC?

 I wasn’t fibbing, I was there.   The other night, I was in San Diego to attend the ASMBS meeting and my cell-phone rang.  It was the producer of the ABC program that I had interviewed with, she wanted to let me know that a portion of my segment would air that night.  I really did not have a chance to process that, and I saw it while half-asleep in a hotel room in California.

Screen Shot 2012-06-21 at 8.57.17 AM
Screen Shot 2012-06-21 at 8.57.17 AM
They asked me during that interview — what did I see as the biggest challenges in the post weight loss surgery community.  I answered immediately, without consideration:  addiction.  And in my non-professional watching the community for years and years take it for what it’s worth because I am one of you opinion — it is.   

A study was published recently about the prevalance of post gastric bypass alcoholism rates.

JAMA June 20, 2012-

As the prevalence of severe obesity increases in the United States,it is becoming increasingly common for health care providers and their patients to consider bariatric surgery, which is the most effective and durable treatment for severe obesity.Although bariatric surgery may reduce long-term mortality,– and it carries a low risk of short-term serious adverse outcomes,safety concerns remain. Anecdotal reports suggest that bariatric surgery may increase the risk for alcohol use disorders (AUD; ie, alcohol abuse and dependence).6However, only 3 studies have examined AUD before and after bariatric surgery.

Click here for a PDF of the full study –  Download Joc120031_2516_2525

Context  Anecdotal reports suggest bariatric surgery may increase the risk of alcohol use disorder (AUD), but prospective data are lacking.

Objective  To determine the prevalence of preoperative and postoperative AUD, and independent predictors of postoperative AUD.

Design, Setting, and Participants  A prospective cohort study (Longitudinal Assessment of Bariatric Surgery-2) of adults who underwent bariatric surgery at 10 US hospitals. Of 2458 participants, 1945 (78.8% female; 87.0% white; median age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011.

Main Outcome Measure  Past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (indication of alcohol-related harm, alcohol dependence symptoms, or score ≥8).

Results  The prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6% vs 7.3%; P = .98), but was significantly higher in the second postoperative year (9.6%; P = .01). The following preoperative variables were independently related to an increased odds of AUD after bariatric surgery: male sex (adjusted odds ratio [AOR], 2.14 [95% CI, 1.51-3.01]; P < .001), younger age (age per 10 years younger with preoperative AUD: AOR, 1.31 [95% CI, 1.03-1.68], P = .03; age per 10 years younger without preoperative AUD: AOR, 1.95 [95% CI, 1.65-2.30], P < .001), smoking (AOR, 2.58 [95% CI, 1.19-5.58]; P = .02), regular alcohol consumption (≥ 2 drinks/week: AOR, 6.37 [95% CI, 4.17-9.72]; P < .001), AUD (eg, at age 45, AOR, 11.14 [95% CI, 7.71-16.10]; P < .001), recreational drug use (AOR, 2.38 [95% CI, 1.37-4.14]; P = .01), lower sense of belonging (12-item Interpersonal Support Evaluation List score per 1 point lower: AOR, 1.09 [95% CI, 1.04-1.15]; P = .01), and undergoing a Roux-en-Y gastric bypass procedure (AOR, 2.07 [95% CI, 1.40-3.08]; P < .001; reference category: laparoscopic adjustable gastric band procedure).

Conclusion  In this cohort, the prevalence of AUD was greater in the second postoperative year than the year prior to surgery or in the first postoperative year and was associated with male sex and younger age, numerous preoperative variables (smoking, regular alcohol consumption, AUD, recreational drug use, and lower interpersonal support) and undergoing a Roux-en-Y gastric bypass procedure.

The ABC video

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King WC, Chen J, Mitchell JE, et al. Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery. JAMA. 2012;307(23):2516-2525.  doi:10.1001/jama.2012.6147.

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