Alcoholism and Obesity Surgery

If you have surgery to help you combat obesity, are you putting yourself at risk for alcoholism?  That's one potential sobering conclusion (no pun intended) from a study in this week's Journal of the American Medical Association. Rick and I agree in PodMed, though, that the risk presented by the surgery relative to development of alcoholism pales in comparison to the many health risks associated with or known to be caused by obesity.

The study gathered data from almost 2500 people who underwent some type of obesity or bariatric surgery, most commonly the Roux-en-y type of operation but a lesser number with the lap band, where a device is placed via laparoscopy around the stomach to reduce its capacity.  The median body mass index of study participants preoperatively was almost 46, median age 47 years, and almost 80% female. 

All participants were screened prior to surgery using the Alcohol Use Disorders Identification Test, a 10 item questionnaire designed and validated to assess alcohol use and consequences in the previous 12 months.   Another questionnaire was used to assess perceived social support on the part of patients, and use of recreational drugs, smoking and binge eating disorders were also queried. 

Postoperative follow up occurred at one and two years.  This analysis includes data from 1945 participants, and shows that alcohol use disorder or AUD symptoms did not differ from one year before to one year after bariatric surgery (7.6 vs. 7.3%), but then increased in the second postoperative year to 9.6%.  Factors associated with a greater risk of AUD included male gender, younger age, smoking, regular alcohol consumption, AUD prior to surgery, recreational drug use, and lower interpersonal support.  Risk for developing AUD was also seen when Roux-en-Y surgery was employed rather than the lap band.

Why would bariatric surgery be associated with an increased risk for AUD to begin with?  The authors state that there is some evidence that Roux-en-Y surgery and an increasingly popular form of bariatric surgery known as gastric sleeve that was not included in this study, alter the metabolism of alcohol, such that people who consume a standard amount of alcohol reach a higher peak level sooner after surgery than before, and that more time is required to return to sobriety postoperatively compared to preoperatively.  Rick and I agree that such observations require further study to substantiate them.

Should concerns about alcohol use disorders elicit caution regarding the selection of suitable candidates for bariatric surgery?  As stated at the outset, most unlikely.  Cancer, heart disease, diabetes, arthritis...the list of very likely and potentially life-threatening complications of obesity is extensive, and those who need such intervention probably would list concerns about alcohol use disorders as low indeed.  Should healthcare professionals be more vigilant in asking about alcohol use after surgery, and especially in long term follow-up?  That's probably the most practical strategy at this point.

Other topics this week include better cardiovascular risk blood markers, also in JAMA, is chronic kidney disease an equivalent for heart attacks in the Lancet, and the 6 minute walk test in Archives of Internal Medicine.  Until next week, y'all live well.

Why migh

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