Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2012; 307(23):2516-25. DOI: 10.1001/jama.2012.6147
Source: PubMed


Anecdotal reports suggest bariatric surgery may increase the risk of alcohol use disorder (AUD), but prospective data are lacking.
To determine the prevalence of preoperative and postoperative AUD, and independent predictors of postoperative AUD.
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.
Past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (indication of alcohol-related harm, alcohol dependence symptoms, or score ≥8).
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).
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.

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    • "Because pre-surgical psychological factors have been associated with weight regain and recurrence of behavioral problems after surgery (Conceição et al., 2014; de Zwaan et al., 2011; de Zwaan et al., 2010; King et al., 2012), the American Association of Clinical Endocrinologists (AACE), the American Society for Metabolic and Bariatric Surgery (ASMBS), and The Obesity "
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    ABSTRACT: Bariatric surgery is a viable treatment option for patients with extreme obesity and associated medical comorbidities; however, optimal surgical outcomes are not universal. Surgical societies, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), recommend that patients undergo a pre-surgical psychological evaluation that includes reviewing patients’ medical charts, conducting a comprehensive clinical interview, and employing some form of objective psychometric testing. Despite numerous societies recommending the inclusion of self-report assessments, only about two-thirds of clinics actively use psychological testing – some of which have limited empirical support to justify their use. This review aims to critically evaluate the psychometric properties of self-report measures when used in bariatric surgery settings and provide recommendations to help guide clinicians in selecting instruments to use in bariatric surgery evaluations. Recommended assessment batteries include use of a broadband instrument along with a narrowband eating measure. Suggestions for self-report measures to include in a pre-surgical psychological evaluation in bariatric surgery settings are also provided.
    Full-text · Article · Dec 2015 · Psychological Assessment
    • "Rates of AUDs among a large sample of bariatric surgery patients enrolled in the Longitudinal Assessment Bariatric Surgery 2 (LABS-2) study have been reported (King et al., 2012). Among 1945 participants, the prevalence of AUDs as assessed by the Alcohol Use Disorders Identification Test (AUDIT) did not differ between presurgery (7.6%) and 1 year postsurgery (7.3%). "
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    ABSTRACT: Bariatric surgery is currently the most effective intervention for significant and sustained weight loss in obese individuals. While patients often realize numerous improvements in obesity-related comorbidities and health-related quality of life, a small minority of patients have less optimal outcomes following bariatric surgery. The literature on the emergence of alcohol use disorders (AUDs) following bariatric surgery has grown in the past several years and collectively provides convincing evidence that a significant minority of patients develop new-onset AUDs following bariatric surgery. Rouxen-Y gastric bypass (RYGB) has generally been associated with the risk of developing an AUD, while laparoscopic adjustable gastric banding generally has not, in several large studies. One theory that has been discussed at some length is the idea of ‘addiction transfer’ wherein patients substitute one ‘addiction’ (food) for a new ‘addiction’ (alcohol) following surgery. Animal work suggests a neurobiological basis for increased alcohol reward following RYGB. In addition, several pharmacokinetic studies have shown rapid and dramatically increased peak alcohol concentrations following RYGB. The prevalence of alcohol and other addictive disorders and potential etiological contributors to post-operative AUDs will be explored. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    No preview · Article · Oct 2015 · European Eating Disorders Review
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    • "These include medical comorbidity improvement or resolution, quality of life and psychosocial adjustment and functioning. Increasing reports of potential psychosocial complications of WLS, such as body image dissatisfaction due to excess skin (Biörserud, Olbers, & Fagevik Olsén, 2011), maladaptive eating patterns (de Zwaan et al., 2010), new or recurring addictions (King et al., 2012) and even suicide (Peterhansel, Petroff, Klinitzke, Kersting, & Wagner, 2013), have also contributed to a more holistic and comprehensive view of what comprises a successful surgical 'outcome'. "
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    ABSTRACT: A thorough and specialized pre-operative psychosocial assessment is an important part of a comprehensive bariatric treatment protocol. Over time, the presurgical psychosocial evaluation has evolved from a cut-and-dried process of recommending whether a patient should or should not undergo surgery to a more nuanced and multifaceted process that serves multiple functions. In this article, we review the many ways in which the pre-operative psychosocial evaluation can enhance patient outcomes and adjustment and even the functioning of the interdisciplinary bariatric surgery team. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    Full-text · Article · Aug 2015 · European Eating Disorders Review
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