Bypass presents risk for alcohol issues
eating — have been cited as related to the observed higher alcohol consumption.
However, the long-term study found food-addiction behaviors were not associated with substance use disorder (alcohol and/or drug use) that was reported after surgeries.
A co-investigator in the study until he left UPMC in 2013, Allegheny Health Network bariatric surgeon George M. Eid said there have been two theories about alcohol problems after surgery.
“Some think it’s food addiction … that when you do bariatric surgery you’re trading one addiction for another.”
He said studies have shown after bypass, alcohol is absorbed at a higher level and faster and patients say they feel its effects more.
“Some data says the effect of one glass before surgery feels like four glasses after surgery,” Dr. Eid said. Drinking more in both groups in the seven-year study supports the theory that some patients enjoy the effects of drinking and some are feeling more social after weight loss, he said.
“In my opinion, it’s multifactorial — absorption, more social openness.”
Reduced nutrient absorption because of the bypass may also be a factor, said research psychologist Melissa A. Kalarchian, Ph.D., a co-author of the follow-up study and now at Duquesne University. Binge eating before surgery and amount of weight loss were not related to substance use after, she said.
The study recommends that future research explore post-surgery changes in the endocrine system, possibly involving the appetite-related hormone ghrelin, as a risk factor for substance use disorder.
Since the earlier research that found the risk was higher after Roux-en-Y, the American Society for Bariatric Surgery has recommended screening before surgery and making patients aware of the risk. High-risk groups are advised to abstain from drinking alcohol after the bypass surgery.
“This recent study [concerns] anybody who undergoes Roux-en-Y bypass,” Ms. King said. “I would advocate for stronger recommendation for abstaining, for anyone who gets a Rouxen-Y bypass.
We need the word to go out to primary care physicians. Those doctors really have to know how to screen.” And if treatment is needed, to recommend it, she added.
Study authors cited the size and diversity of the groups of patients studied and the length of the followup — gathering detailed data — as its strengths.
“I think this is one of the largest, most comprehensive studies to date,” Ms. Kalarchian said. Among limitations of the study are the comparison with the outdated banding method, she said, and patients weren’t given full clinical evaluations — the study relied on patients’ own reports of alcohol and drug use.
The increase in alcohol consumption in both surgery groups is a concern, Ms. King said. “It may affect weight loss, dumping syndrome [food passing too rapidly through the stomach] and vitamin deficiency.
Those are all concerns with heavy drinking. Because we have more people drinking regularly … we strongly support a routine assessment for alcohol use disorder.”
Dr. Eid said long-term followup is recommended as part of the AHN bariatric surgery program. He said obesity experts worldwide are concluding that obesity is a chronic relapsing disease and it calls for continuing care.