Differences between Bariatric Patients with and without Problematic Alcohol Use
Seven Years Post-Surgery
Valentina Ivezaj1, Leslie Schuh2, David B. Creel2 , Katharine Hudson2, Karen K. Saules1, Brenda Cacucci2, David Diaz2, Christopher Evanson2, John Huse2, Margaret Inman2, and Douglas Kaderabek2
1Eastern Michigan University (Ypsilanti, MI), 2St. Vincent Carmel Bariatric Center of Excellence (Carmel, IN)
Background: A burgeoning research area has focused on alcohol dependence and
other substance use after bariatric surgery (e.g., Saules et al., 2010). Less is known
about differences between bariatric patients who do and do not have problematic
alcohol use post-surgery. Using a long-term outcome database, the present study
examined problematic alcohol use rates and group differences between those who did
and did not meet criteria for problematic alcohol use.
Methods: Participants (N=419) who had bariatric surgery between January 1, 1999
and June 30, 2005 completed a survey on medical and psychological outcomes.
Results: Participants were primarily White (96%) and female (80%), with a mean age
at surgery of 48.3 years, current BMI of 34.1 units and time since surgery of 7.6 years.
A subgroup (5.3%) met criteria for problematic alcohol use based on the CAGE cut-off
score of ≥ 2. Relative to those without problematic alcohol use, patients who met
criteria post-surgery responded similarly well on various measures of success,
including weight loss, medical conditions, and reported emotional problems.
Nonetheless, those who met criteria for problematic alcohol use post-surgery were
more likely to seek help for mental health conditions than those who did not meet
criteria; however, the problematic alcohol use group was likely to present to treatment
for depression and anxiety, not alcohol use.
Conclusions: Findings highlight a subgroup of post-bariatric patients who appear to
be struggling with alcohol use but presenting to treatment for other comorbid issues.
Mental health providers working with post-bariatric patients should routinely query
about alcohol use. Future research is needed to better understand the potential unique
treatment needs of post-bariatric patients who may be at risk for abusing alcohol postsurgery.
Participants
•A sample of 419 adult patients who had bariatric surgery at the St. Vincent
Materials
The questionnaire included information on weight loss history, current
medical complications and comorbidities, addictive behavior, and
psychological health.
Statistical Analyses
•Descriptive statistics included means and standard deviations for
continuous variables and percentages for categorical variables.
•Problematic alcohol use was defined as a CAGE score ≥ 2.
•Differences between alcohol use groups were examined via t-tests for
continuous variables and Chi-square tests for categorical variables.
Results
•Burgeoning research has focused on alcohol use after bariatric surgery
(King et al., 2012; Saules et al., 2010).
Variable
• Long-term outcome data on rates of problematic alcohol use
•Group differences between those who did and did not meet criteria
for problematic alcohol use.
Primary Objective
To gather outcome data for patients at least 5 years post-surgery, including:
•Weight loss
•Problematic alcohol use
•Obesity-related comorbidities
•Psychological functioning
•Quality of Life
Method
•St. Vincent Carmel Bariatric Center of Excellence patients who underwent
bariatric surgery between 1/1/09 – 6/20/05 were recruited by Center staff to
complete a survey examining medical and psychological outcomes.
Current BMI
%
P value
34.34 ± 8.34
30.51 ± 4.92
.03
5
n
157 (41.1%)
6 (30.0%)
.30
Diabetes
52 (14.4%)
2 (10.5%)
.72
Heart Disease
40 (11.3%)
1 (5.6%)
.42
5 (1.4%)
0 (.0%)
.60
High Cholesterol/
Triglycerides
62 (17.1%)
3 (15.8%)
.71
Sleep Apnea
53 (15.0%)
0 (0.0%)
.14
Osteoporosis
55 (15.6%)
4 (23.5%)
.18
Joint Pain
143 (39.0%)
9 (45.0%)
.84
Back Pain
127 (35.1%)
6 (33.3%)
.53
Stroke
Roux-en-Y
93.2
385
Vertical banded gastroplasty
5.1
21
Depression
Other (DS, band)
1.7
7
Female
80.2
Caucasian
95.9
Surgery
413
Employment Status
3
2
1
0
Depression
Anxiety
Coping/Stress
Alcohol
Mild Bipolar
Reason for Seeking Mental Health Treatment
Of the 22 patients with problematic alcohol use, 9 reported seeking treatment
by a mental health professional. Some patients reported seeking treatment
for more than one condition.
Discussion
•While certainly very important, weight loss should not be considered as
the only indicator of success after bariatric surgery.
•A subgroup of post-bariatric patients struggle with problematic alcohol
use. In our sample of patients who had bariatric surgery an average of 7 ½
years before, 5.3% of patients met criteria for problematic alcohol use.
10 (52.6%)
.40
29 (7.6%)
3 (13.6%)
.38
419
Suicidal Thoughts
Experienced
417
Anxiety
75 (21.2%)
5 (25.0%)
.88
Panic Disorder
20 (5.8%)
2 (10.5%)
.69
•Interestingly, our patients with problematic alcohol use had lower BMIs
than patients without problematic alcohol use.
Bipolar Disorder
10 (2.9%)
2 (11.1%)
.13
•Future research is needed to better understand the potentially unique
treatment needs of post-bariatric patients who abuse alcohol post-surgery.
“Emotional
Problems”
82 (21.6%)
8 (36.4%)
.15
Clinical Implications
52 (13.6%)
9 (40.9%)
.001
3.09 ± 0.89
2.91 ± 0.92
.37
•Relative to those who did not meet problematic alcohol use criteria, those
who met problematic alcohol use criteria were more likely to seek
treatment by a mental health provider and had lower post-surgical BMIs.
401
46.6
183
Part-time
8.2
33
Retired
25.2
101
Unemployed
10.0
40
Disabled
11.0
44
Marital Status
4
149 (40.8%)
Full-time
405
Married
74.6
302
Treated by Mental
Health Provider
Divorced
12.6
51
Current Healthb
Single
7.2
29
Widowed
3.2
13
Partnered
2.5
10
13.3
20
Variable
Met
Problematic
Alcohol Use
Criteria
High Blood
Pressure
Self-Reported
Psychological
Comorbidities
Potential alcohol abuse (based on
CAGE cut-off score ≥ 2)
No Problematic
Alcohol Use
Current Medical
Comorbidities
Demographics and Patient Characteristics
• Present study examined:
6
Variable
•Bariatric surgery is the most effective intervention for severe obesity.
•Surgery success is often defined by weight loss; however, other quality of
life/ psychological factors should also be considered.
Reported Reasons for Seeking Treatment by the
Problematic Alcohol Use Group
Bariatric Center of Excellence at least 5 years before completed the study.
Background
• Lack of research focusing on differences between bariatric patients who
do and do not abuse alcohol post-surgery, particularly using long-term
outcome data.
Group Differences between Patients With and
Without Problematic Alcohol Usea
Number of Patients
Abstract
Current Health Relative
to Before Surgeryb
aValues
4.24 ± 1.08
N
•Individuals were initially contacted via telephone or during visits to the
Current Age (yr)
55.9 (9.65)
418
Bariatric Center; those agreeing to complete the survey could do so via an
emailed link, regular mail, telephone, or in person.
Time Since Surgery
7.7 (1.63)
418
.95
are expressed as n (%) or M±SD.
bRated
Mean (S.D.)
4.23± 1.11
on 5-point scales with 1 indicating poor and 5 excellent for Current
Health and 1 indicating much worse and 5 much better for Current Health
Relative to Before Surgery.
Presented at the Obesity Society, San Antonio, TX, September, 2012
•Those with problematic alcohol use were more likely to seek treatment by
a mental health provider, generally for comorbid issues such as
depression and anxiety, not alcohol use.
• Therefore, mental health providers working with post-bariatric patients
should routinely query about and monitor alcohol use. Success after
bariatric surgery should be measured as more than weight loss alone.
References
King, W.C., Chen, J., Mitchell, J.E., Kalarchian, M.A., Steffen, K., Engel, S. G., et al. (2012).
Prevalence of alcohol use before and after bariatric surgery. JAMA, 307(23), 2516-2525.
Saules, K. K., Wiedemann, A., Ivezaj, V., Hopper, J. A., Foster-Hartsfield, J., & Schwarz, D. (2010).
Bariatric surgery history among substance abuse treatment patients: Prevalence and associated
features. Surgery for Obesity and Related Diseases, 6(6), 615-621.