Problematic Pre-Surgical Intake of High-Sugar/Low-Fat
and High GI Foods is Associated with Development of
Post-Bariatric Surgery Substance Use Disorders
1
Fowler ,
Hypotheses
1. Participants who report a greater number of
problematic foods that are high sugar and low
fat will be more likely to develop SUD postWLS, and specifically at greater risk for being a
New-Onset user.
2. Participants who select a greater number of
foods that are high on the glycemic index (GI)
will be at greater risk of developing SUD postWLS.
Results Cont.
Measures
Data Analysis Cont.
Pre-Surgical (retrospective):
•Yale Food Addiction Scale (YFAS, Gearhardt et
al., 2009): “Problematic Foods” Section.
Foods
were
classified
according
to
macronutrient content, based on FDA
recommendations.
• The 28 Problem foods were classified as High
Sugar, High Fat, High Carbohydrate, High GI,
or High Sodium based on nutrient content
and USDA standards.
Ex: Pizza = High Fat & High Sodium
Pre-surgical (retrospective) and Current:
• Michigan Assessment Screening Test for
Alcohol and Drugs (MAST-AD, Westermeyer
et al., 2004); MAST-AD scores ≥ 5 were used
as the cutoff for probable SUD.
The percentage of macronutrient specific foods
endorsed on the YFAS was calculated from the
total macronutrient specific foods presented in
the problematic foods section of the survey.
Results
Means for endorsement of pre-surgical
problematic foods classified as high sugar-low
fat and as high GI were significantly different
between the Never SUD (“Never”) group and
New Onset SUD group.
Figure 1: Percentage of high sugar-low fat
and high GI foods endorsed by group
High Sugar-Low Fat
70
Four SUD status groups were created, using
pre- and post-surgical MAST-AD scores, as
summarized below.
60
MAST-AD Pre<5
MAST-AD Pre≥5
MAST-AD Post <5
Never SUD
(n=102; 66.2%)
Recovered
(n=23; 14.9%)
MAST-AD Post ≥5
New Onset SUD
(n=19; 12.3%)
Relapsed
(n=10; 6.5%)
High Glycemic Index
Logistic regression models adding food variables
to established post-WLS SUD predictors
High Sugar-Low Fat Model
β
*Family History
1.543
Pre-surgical BMI
.053
*% of High Sugar/Low Fat
.018
foods endorsed
S.E.
.572
.027
.008
High GI Model
*Family History
β
1.482
S.E.
OR
95% CI
.576 4.402 1.423-13.619
.051
.027 1.052
.998-1.110
.027
.011 1.027
1.004-1.051
Pre-surgical BMI
OR
95% CI
4.677 1.523-14.360
1.055 1.000-1.113
1.018 1.002-1.035
Note: OR = Odds Ratio, CI = Confidence internal, *p < .05
*
Discussion
50
40
30
20
10
0
Never
Logistic regression analyses revealed that
participants who endorsed pre-surgical
problems with high sugar-low fat foods and
those high on the GI were at greater risk for
New Onset SUD in the post-surgical period.
These findings remained significant after
controlling for other known predictors of postsurgical SUD.
*% of GI foods endorsed
*
80
Data Analysis
Method
Secondary data analyses were conducted using
a de-identified database from 154 bariatric
surgery patients (88% female, mean age of
48.7, mean of 2.7 yrs since surgery, 92.9%
Roux-en-Y procedure).
2
Ivezaj
Lauren
Karen K.
& Valentina
1Eastern Michigan University, Ypsilanti, MI
2Yale School of Medicine, New Haven, CT
Introduction
Post-bariatric surgery patients, particularly
those who have had the Roux-en-Y procedure,
are overrepresented in substance abuse
treatment, constituting about 3% of
admissions; about 2/3 of such patients deny
problematic substance use prior to their
weight loss surgery (WLS; Ivezaj et al., 2012;
Saules et al., 2010; Wiedemann et al., 2013).
Therefore, it is important to advance our
understanding of the emergence of substance
use disorders (SUDs) – particularly the New
Onset variant -- after bariatric surgery.
Burgeoning research with both animal models
and humans suggests that “food addiction”
may play a role in certain forms of obesity
(Avena & Gold, 2011; McFadden, 2010), with
particular risk conferred by foods high in sugar
but low in fat.
1
Saules ,
New Onset
Note: *p < .05
Presented at Obesity Week, 2013, Atlanta, GA
Recovered
Relapsed
Results have theoretical implications for the
possibility of addiction transfer among certain
bariatric surgery patients. Our findings also
have practical implications for individuals
considering bariatric surgery who may be atrisk for development of SUD post-bariatric
surgery. Future research should examine the
putative addictive quality of specific
macronutrients, particularly high sugar-low fat
foods, and foods high on the glycemic index.
Our results also provide further evidence for
the existence of differing SUD groups among
WLS patients.
Problematic Pre-Surgical Intake of High-Sugar/Low-Fat
and High GI Foods is Associated with Development of
Post-Bariatric Surgery Substance Use Disorders
1
Fowler ,
1
Saules ,
2
Ivezaj
Lauren
Karen K.
& Valentina
1Eastern Michigan University, Ypsilanti, MI
2Yale School of Medicine, New Haven, CT
References
Avena, N. M., & Gold, M. S. (2011b). Sensitivity to alcohol in obese patients: A possible role for food addiction. Journal of
the American College for Surgeons, 213(3), 451.
Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2009b). Preliminary validation of the Yale Food Addiction Scale.
Appetite, 52(2), 430-6.
Ivezaj, V. (2011). An examination of psychological risk factors for the development of substance abuse among postbariatric surgery patients. (Unpublished doctoral dissertation). Eastern Michigan University, Ypsilanti, MI.
McFadden, K. M. (2010). Cross addition: From morbid obesity to substance use. Bariatric Nursing and Surgical Patient
Care, 5(2): 145-178. doi:10.1089/bar.2010.9922.
Saules, K. K., Reslan, S., & Schuh, L. M. (2012).Which weight loss surgery patients are at risk for development of postsurgical substance use disorders? Poster presentation at the meeting of the Obesity Society, San Antonio, TX.
Westermeyer, J., Yargic, I., & Thuras, P. (2004). Michigan assessment-screening test for alcohol and drugs (MAST/AD):
Evaluation in a clinical sample. The American Journal on Addictions, 13(2), 151-162.
Wiedemann, A., Saules, K.K., & Ivezaj, V. (2012). Are post-bariatric surgery patients at risk for new onset development of
substance use disorders? Poster presentation at the Association of Behavioral and Cognitive Therapies, National
Harbor, MD.
Contact Information: lfowler@gwmail.gwu.edu