Substance Use Following Bariatric Weight Loss Surgery
Tuesday, April 9, 2013
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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Tuesday, April 9, 2013
Just read your article in the G&M on The Obese already pay more.
Great article, thank you.
It seems that the time has arrived to cease the epidemic knee-jerking need to find someone to beat up on.
Whether it be obese children, smokers, drinkers, elderly drivers, some of which definitely are problematic, solutions for which have perhaps yet to be found.
However the “born again”, evangelical knee jerker, reformed smoker, who never found a cause they could not join, there truly is where there is a need for a cure.
Keep up the good work.
Wednesday, April 10, 2013
Dear Dr. Sharma,
In your post, today, you indicate the need to “…warn about possible psycho-social complications of “successful” surgery…”—i.e., potentially increased risk for substance use following weight loss surgery—however, I hypothesize that additional and equally (or more) relevant physiological factors (associated with post-weight loss surgery) are perhaps being OBSCURED by the specific semantic (rhetorical) choices that researchers decide to employ when discussing their findings.
In other words, if the more relevant alteration which occurs is LOSS OF ADIPOSE TISSUE (presumably the key reason for calling the bariatric surgery “successful”) then by choosing to focus on the SURGERY itself, a technological procedure, rather than focusing on the physiological alteration—the “successful” significant loss of adipose tissue—the researchers (and those who uncritically report the findings) subvert reality, in a sense, by subtly DIRECTING the reader’s attention AWAY from a rather obvious physiological process (e.g. the loss of adipose tissue) while SHIFTING the reader’s FOCUS onto a “psycho-social” alteration or MENTAL HEALTH consequence.
My observation may seem semantically unimportant (“you say potato…” etc). And perhaps the rhetorical choices of medical and scientific discourses are simply unintended, unfortunate forms of collateral damage.
However, if (following “successful” surgery) the loss of adipose tissue creates a homeostatic alteration that represents a neuro-endocrine alteration (a PHYSIOLOGICAL imbalance), then it may be misleading or even disingenuous to focus attention on the apparent “psycho-social” alteration that results—as if THAT outcome (potentially increased risk for substance use) arises from the individual’s (pre-surgical) pathological proclivities to behave in “addictive” ways. Linking these complex behavioral responses to the person’s (pre-surgical) MENTAL or EMOTIONAL health status (“addict”)—rather than linking these alterations in behavior to the physiological imbalances that have occurred following the significant loss of endocrine (fat) tissue—would be like linking complex behavioral responses following the surgical removal of testicular, ovarian or thyroid tissue to (pre-surgical) MENTAL HEALTH issues.
As long as researchers and other professionals keep FOCUSING attention on so-called mental health issues (“psycho-social complications”) of individuals, in connection with adipose tissue-loss, rather than FOCUSING on the physiological alterations (neuro-endocrine changes post adipose loss), the responsibility for MANAGING (and coping with) the highly COMPLEX physiological alterations will continue to remain on individuals—to seek mental health “treatment” after bariatric surgery, for instance, to “manage” their so-called underlying “addiction” issues (personal or psycho-social pathology).
Thus, once again, the physiological alterations resulting from significant adipose loss (following “successful” surgery) are rhetorically framed (indeed, socially constructed) as MENTAL HEALTH (aka “psycho-social”) issues or “addictions”—rather than complex neuro-endocrine imbalances—and therefore the physiological complications of adipose tissue loss become additional UNEARNED burdens of guilt for formerly obese persons to shoulder and to feel responsible for.
It’s tragic that the paradigm and rhetoric of the so-called “addiction recovery” movement (based largely on mysticism and religion) are now being used to oppress a whole new group of innocent people—now being used to blame formerly obese people and to hold them responsible for “managing” (through prayer, etc) COMPLEX physiological (neuro-endocrine) alterations that result from significant adipose tissue loss that follows “successful” treatment (surgery). Indeed, it is tragic and cruel and—yes, I believe—morally irresponsible.