Post-surgical substance abuse by gastric bypass patients predicts poor
weight loss beyond that predicted by eating-related variables.
Summar Reslan1, Karen K. Saules1, & Leslie M. Schuh2
1
Eastern Michigan University, Department of Psychology, Ypsilanti, MI
2
St. Vincent Bariatric Center of Excellence, Carmel, IN
Predictors of %TWL
Results
Introduction
Posttoperative weight loss and SUD classification
Predictors of %TWL
• Mean %EWL = 70.67% (SD = 22.34)
• Mean %TWL = 35.54% (SD = 10.43)
• 20 participants (14%) met criteria for a probable post-WLS SUD
Model 1
Dietary Restraint
Dietary Disinhibition
35
Emotional Eating
30
15
Sample Characteristics [mean ± SD, or n (%)]
Age, years
Education, years
Gender: Female
Ethnicity: Caucasian
Time since surgery, years
Total (n = 141)
53.40 (10.33)
14.50 (2.61)
112 (79%)
130 (93%)
6.13 (2.69)
Procedure
All participants were at least 24 months
post-Roux-en-Y WLS. Subjects were
recruited from four different sites (Table
2). If interested in participating,
candidates were sent the URL to an
online survey deployed via survey
monkey. Coordinating with the staff at
the St. Vincent Bariatric Center of
Excellence, those participants who did
not feel comfortable or did not have
internet access to complete the study
online were sent a paper-and-pencil
survey questionnaire.
Measures
~MAST/AD
(Westermeyer et al., 2004): Score of five
used as the minimum criteria cut-off score
indicating probable post-WLS SUD
~%Excess Weight loss (%EWL)
((Presurgical excess weight - Current excess
weight) / Presurgical excess weight) x 100.
~Postoperative eating-behavior
Food addiction (Gearhardt et al., 2009),
binge eating (QEWP-R; Spitzer et al., 1993),
TFEQ (Stunkard & Messick, 1985), Power of
Food, food craving, grazing, night time
eating, emotional eating, and appetite for
palatable foods.
Probable post-WLS SUD
45
40
35
30
25
20
15
10
5
0
Recruitment
Table 2
Recruitment Site
General Survey Link
St. Vincent Bariatric Center of Excellence (online)
St. Vincent Bariatric Center of Excellence (Hard-copy)
Henry Ford Hospital
Number of Participants
37
42
47
15
[0.08, 0.77]
[-1.50, -0.33]
.044
[-0.06, 0.14]
.045
[-0.05, 0.14]
-5.61*
[-10.24, -0.97]
.142
.177
7.49***
7.24***
∆R2
.035
∆F
5.73*
The eating-related variables accounted for 14.2% of the variance in %TWL,
F(3,139) = 7.49, p = .0001. When SUD classification was added to the model, a
total of 17.7% of the variability in %TWL was explained, F(4,139) = 7.24, p =
.0001. When the effects of all other predictors were held constant, post-WLS SUD
significantly predicted %TWL (B = -5.61, p = .018).
No post-WLS SUD
Figure 1. Amount of postoperative weight loss among those with and
without a probable post-WLS SUD. Those meeting criteria for a
probable post-WLS SUD achieved a lower %TWL than those who did
not meet criteria for a post-WLS SUD , t (138) = 2.67, p=.009
~%TWL
(Weight change / Presurgical weight) x 100
.421*
-.918**
Note. N = 139. CI = Confidence interval.
*p <.05, **p < .01, *** p < .001
5
Percentage
Table 1
[0.05, 0.75]
[-1.59, -0.41]
F
10
Patient characteristics
.403*
R2
20
0
95% CI
B
-.998**
Post-surgical SUD
25
Methods
Model 2
95% CI
B
Variables
40
%TWL
•
Parallels
have been drawn between overeating and substance use disorders
(SUDs), and there is theoretical and empirical support that weight loss surgery
•
(WLS)
patients may experience difficulty in both domains.
Following might
bariatric
•
s, oncologists
surgery, patients may be at heightened risk for substance abuse and dependence,
and
• there may be an over-representation of post-bariatric surgery patients in
substance abuse treatment (Saules et postal., 2010), with over 90% of those patients
having
had the Roux-en-Y gastric bypass procedure. Some suggest that
•
post-bariatric surgery SUDs may not adversely affect weight loss outcomes among
• in a substance abuse treatment facility (Pulcini et al., 2011) or among those
those
before
with a history of substance
abuse treatment (Clark et al., 2003), while others have
found that post-WLS patients who drink large volumes of high-calorie liquids (e.g.,
•
alcohol) lose
less weight following surgery (Yale & Weiler, 1991). We assessed
•
whether post-WLS
SUDs influence percent total weight loss (%TWL) using a
community sample of post-bariatric surgery patients.
Of the eating-related variables assessed, emotional eating (r = -.16, p = .04),
dietary restraint (r = .25, p = .003), and dietary disinhibition (r = -.33, p = .0001)
were significantly associated with %TWL.
Figure 2. Those meeting criteria for a post-WLS SUD most often
reported using opioids, sedatives, and alcohol. A SUD diagnosis
could not be provided for tobacco.
Presented at the 2012 Annual Meeting of The Obesity Society
Following bariatric surgery, patients find themselves abruptly confronted with an inability to eat, but perhaps limited resources for managing food urges through other means, which can create conditions that foster drug and/or alcohol dependence.
Discussion
• WLS, patients are abruptly unable to consume large quantities of food, and if
After
paired with limited coping skills for managing food urges, this may create conditions
that foster drug and/or alcohol dependence. In this general population sample of
•
WLS patients, post-surgical
SUD predicted poor weight loss, beyond that
• was predicted by eating-related variables. In non-WLS samples, alcohol
which
intake is associated with increased caloric intake and lipid consumption (Kesse et
al., 2001). In WLS patients, alcohol may decrease the tone of the lower esophageal
•
sphincter
and increase gastric emptying, especially for liquids (Bujanda, 2000), as
well as reduce inhibitory control (e.g., Easdon
post- & Vogel-Sprott, 2000), thus allowing
post-WLS
patients to consume larger amounts of food, which may decrease postop•
erative weight loss.
Following bariatric surgery, patients find themselves abruptly confronted with an inability to eat, but perhaps limited resources for managing food urges through other means, which can create conditions that foster drug and/or alcohol dependence.
Results
suggest strongly advising WLS patients to avoid substance use.
•
Specifically, opioids, sedatives, tobacco, and alcohol may be particularly problematic substances for WLS patients.
Factors other
• than the rigid adherence to post-surgical guidelines can increase
postoperative weight loss. For example, body contouring can greatly impact %TWL,
• generally factored into analyses, including our own. Future research
but it is not
should assess if those who undergo elective body contouring surgery differ in any
meaningful way from those who do not have this procedure.
Contact information:
shabhab1@emich.edu