Is Substance Use Disorder Subsequent to Bariatric Surgery
Related to Weight Loss Outcome?
Melissa E. Pulcini, Karen K. Saules, Ashley A. Wiedemann, & Valentina Ivezaj
Eastern Michigan University, Department of Psychology
Introduction
Results
Discussion
Although bariatric surgery is the most effective treatment for
morbid obesity, a substantial minority of patients fail to achieve
or maintain a satisfactory level of weight loss. It is unknown
whether substance use disorder (SUD) subsequent to bariatric
surgery negatively impacts weight loss outcome. This question
may be of particular importance given the recent finding that
post-bariatric patients may be overrepresented in inpatient
substance abuse treatment programs (Saules et al., 2010).
Participants yielded an average %EWL of 75.3 ± 23.8% (corresponding
to a mean total body weight change of -37.5 ± 11.2%) at 6.4 ± 3.2 years
post-surgery. Six participants (15.8%) met criteria for surgical failure.
There was a significant inverse correlation between %EWL and
average number of alcoholic drinks per day in the group of
participants with only alcohol use diagnoses (r = -.49, p = .03), but not
in the group with mixed (i.e. alcohol and drug) diagnoses (r = .05 p =
.91). There was a trend toward lower %EWL in participants with only
alcohol use diagnoses when compared to those with drug only or
mixed diagnoses (68.4 ± 22.1% vs. 83.1 ± 24.5%, p < 0.07). There was
also a trend towards greater number of alcoholic drinks per day
consumed by participants with only alcohol use diagnoses compared
with those with drug only or mixed diagnoses (20.4 ± 7.6 vs. 10.3 ±
12.5, p < 0.06).
The %EWL achieved by the total sample is comparable to the 66-77%
EWL reported in the general RYGB population literature at 4-8 years
post-surgery (Christou, Look, & MacClain, 2006; Kofman, Lent, &
Swencionis, 2010; Valezi, Mali, Junior, de Menezes, de Brito & de
Souza, 2010). The surgical failure rate in this sample (15.8%) is
somewhat higher than that reported in the general RYGB literature by
some (e.g. 7.1%: Valezi, Mali, Junior, de Menezes, de Brito & de Souza,
2010) but lower than that reported by others (e.g. 41%: Kruseman,
Leimgruber, Zumbach, & Golay, 2010). Contrary to expectation, results
suggest that substance use disorder subsequent to RYGB surgery is
not associated with poor long-term postsurgical weight loss outcome.
PARTICIPANTS/ PROCEDURES:
The sample consisted of 39 newly admitted inpatients at a
Midwestern substance abuse detoxification and rehabilitation
hospital with a history of Roux-en-Y gastric bypass (RYGB)
surgery. Post-bariatric patients were identified during the
admission history and physical, during which weight and height
were measured. Preoperative weight and current diagnoses
were obtained through a questionnaire and a chart review,,
respectively. Participants had a mean age of 45.9 ± 9.2 years,
and the majority were female (71.8%) and Caucasian (92.3%).
Excess weight at time of surgery was calculated as
preoperative weight - weight if BMI were 25.0 kg/m2.
Percent Excess Weight Loss (%EWL) was defined as
((preoperative weight - current weight) / amount of excess
weight at time of surgery )* 100.
Surgical failure was defined as < 50% EWL.
Based on an interview, each participant was categorized as
either a new onset user or a relapser:
Relapsers reported a pre-surgical history of heavy substance
use (n = 15, 38.5%).
Preoperative BMI and %EWL were inversely correlated, although this
correlation did not reach significance (r = -0.25, p = 0.13). %EWL did
not differ significantly by sex or relapser/NOU status, and was not
significantly correlated with age at the time of surgery (r = 0.05, p =
0.77).
Percent Excess Weight Loss in post Roux-en-Y Gastric
Bypass Patients in Treatment for Substance Use Disorders
120
p < 0.07
100
80
83.1
80.3
78.6
72.4
67.4
% EWL
Method
68.4
60
40
20
0
Female
Male
Relapser
NOU
Alcohol Drug Only/
Only Dx Mixed Dx
New onset users (NOUs) denied a pre-surgical history of
substance abuse (n = 24, 61.5%).
Presented at the 2011 Annual Meeting of the Society of Behavioral Medicine
Little is known about the role of alcohol consumption in weight
change, as findings have been inconsistent. Gastric bypass patients
comprise a unique population in which to study this question since
this type of surgery is associated with reduced absorption of calories
and impaired alcohol metabolism marked by higher and more quickly
occurring peak blood alcohol values (Woodard, Downey, HernandezBoussard, & Morton, 2010). In this study, mean number of alcoholic
drinks consumed per day was inversely correlated with %EWL in
those with only alcohol use diagnoses. Despite the high caloric
content of mean daily alcoholic beverages consumed by this group
(20.4 drinks = roughly 2040 calories), however, the average %EWL
yielded by the alcohol only group (68.4%) is within the typical range of
rates of EWL reported in the general RYGB literature. Potential
contributors may include impaired appetite associated with alcohol
dependence and an increase in resting metabolic rate immediately
following the consumption of alcohol, as was found among a group of
young, female social drinkers (Klesges, Mealer, & L. Klesges, 1994).
Future research should evaluate these metabolic factors.
Study limitations include the lack of a control group matched on
variables known to be related to weight loss outcome in RYGB
patients (e.g. age, race, and preoperative BMI). Future studies
(prospective or matched-controlled) are needed to clarify the
relationship between postoperative substance use disorders and
weight loss outcome in bariatric surgery patients.
Contact: mpulcini@emich.edu
Is Substance Use Disorder Subsequent to Bariatric Surgery
Related to Weight Loss Outcome?
Melissa E. Pulcini, Karen K. Saules, Ashley A. Wiedemann, Valentina Ivezaj
Eastern Michigan University, Department of Psychology
References
Christou, N. V., Look, D., & Maclean, L. D. (2006). Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Annals of surgery, 244(5), 734-40.
Klesges, C., Mealer, Z., & Klesges, L. (1994). Effects of alcohol intake on resting energy expenditure in young women social drinkers. American Journal of Clinical Nutrition, 59, 805-9.
Kofman, M. D., Lent, M. R., & Swencionis, C. (2010). Maladaptive Eating Patterns, Quality of Life, and Weight Outcomes Following Gastric Bypass: Results of an Internet Survey. Obesity,
18(10), 1938-1943.
Kruseman, M., Leimgruber, A., Zumbach, F., & Golay, A. (2010). Dietary, weight, and psychological changes among patients with obesity, 8 years after gastric bypass. Journal of the American
Dietetic Association, 110(4), 527-34.
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, 615-21.
Valezi, A. C., Junior, J. M., de Menezes, M. A., de Brito, E. M., & de Souza, S. A. F. (2010). Weight loss outcome after silastic ring Roux-en-Y gastric bypass: 8 years of follow-up. Obesity
surgery, 20(11), 1491-5.
Woodard, G. A., Downey, J., Hernandez-Boussard, T., & Morton, J. M. (2010). Impaired Alcohol Metabolism after Gastric Bypass Surgery: A Case-Crossover Trial. Journal of the American College
of Surgeons, 1-6. American College of Surgeons.