Substance Use Following Bariatric Weight Loss Surgery

Regular readers will know that I am all for bariatric surgery in appropriate patients but that I am also the first to warn about possible psycho-social complications of “successful” surgery.

A study by Alexis Conason and colleagues from St Luke’s–Roosevelt Hospital Center, New York, just published in JAMA reports a marked increase in the risk of substance use post bariatric weight loss surgery.

The paper reports on 155 participants (132 women and 23 men) who underwent either laparoscopic Roux-en-Y gastric bypass surgery (n = 100) or laparoscopic adjustable gastric band surgery (n = 55).

In the 24 months following surgery, self-reported use of drugs, alcohol, and cigarette smoking increased significantly from baseline. Laparoscopic adjustable gastric banding was particularly associated with increased alcohol consumption, a finding perhaps attributable to the decreased alcohol tolerance commonly seen after roux-en-Y surgery.

For clinicians, the authors have the following piece of advice:

“patients should be screened at their follow-up visits with surgeons and other medical professionals to determine whether they have developed substance use problems by using simple, easy-to-use screening measures, such as the Alcohol Use Disorders Test, the Brief Alcohol Screening Instrument for Medical Care, or the Michigan Alcohol Screening Test. Evaluation should focus on the time period starting 1 year after RYGB surgery, when alcohol problems seem most likely to develop.”

Here is what I had to say about addictions in a recent talk on obesity and mental health.

AMS
Toronto, Ontario

Conason A, Teixeira J, Hsu CH, Puma L, Knafo D, & Geliebter A (2013). Substance use following bariatric weight loss surgery. JAMA surgery, 148 (2), 145-50 PMID: 23560285

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