Author Insight: After Bariatric Surgery, Patients Have a Greater Risk of Alcohol Problems

Wendy C. King, PhD, of the University of Pittsburgh School of Public Health, and her colleagues found that bariatric surgery may be associated with increased risk of alcohol problems in the years after surgery. (Image: University of Pittsburgh)

Patients who undergo bariatric surgery for severe obesity may be at increased risk of developing alcohol use problems in the years following the surgery, according to an article published today in JAMA.

Some surgeons and patients have expressed concern that bariatric surgery may increase a patient’s risk of developing an alcohol use disorder, based on anecdotal reports. To test whether such a relationship exists, Wendy C. King, PhD, of the University of Pittsburgh School of Public Health, and her colleagues conducted a prospective cohort study of 2458 bariatric surgery patients who completed both preoperative and postoperative assessments between 2006 and 2011. They found no difference in the level of problematic alcohol use among patients 1 year before and 1 year after surgery; however, by the second year after surgery, a significantly higher number of patients reported symptoms of an alcohol use disorder—9.6%, compared with 7.6% reporting such symptoms during the year before surgery. In particular, having undergone the Roux-en-Y gastric bypass procedure was associated with an elevated risk of alcohol problems compared with other types of bariatric surgery.

Dr King discussed the findings with news@JAMA.

news@JAMA: How might bariatric surgery affect alcohol use?

Dr King: [The surgery] makes a small pouch of the stomach. So when an individual who has undergone the surgery drinks alcohol, the alcohol spends less time in the stomach and has less exposure to alcohol dehydrogenase, the enzyme that breaks down alcohol. The alcohol is also more quickly absorbed into the bloodstream. Patients who have lost a lot of weight might also experience alcohol differently than they did before losing weight. Patients who have undergone bariatric surgery are also advised to avoid drinking when they eat, so individuals who were accustomed to consuming alcohol with food may feel differently when they drink on an empty stomach.

Studies show a higher peak alcohol level in patients after surgery, and that it takes longer for patients to get back to a sober state.

news@JAMA: How would you like physicians and patients to use this information?

Dr King: Patients should discuss all risks and benefits of surgery with their physician. Surgery is the best treatment we have for severe obesity. It really depends on the individual whether this should affect their decision to have surgery or their future drinking habits if they have the surgery.

news@JAMA: Were other types of bariatric surgery also associated with a greater risk of drinking problems?

Dr King: We also looked at laparoscopic adjustable gastric banding, and there wasn’t a significant difference in alcohol use disorders after surgery. But the gastric banding patients did report drinking more in the second year after surgery.

news@JAMA: Is there any evidence that patients who had compulsive eating problems prior to surgery developed drinking problems afterward?

Dr King: In the media, there has been a lot of attention paid to the idea of addictive transfer, but there hasn’t been much study of it. We tried to look at patients who had binge eating disorders prior to surgery and didn’t see a connection with alcohol use afterward.

news@JAMA: Does this study raise any other concerns?

Dr King: In addition to thinking about alcohol use disorders, it’s important to think about drinking behavior after surgery. One in 8 patients reported drinking 3 or more drinks at a sitting in the second year after surgery and 1 in 6 reported drinking even more per sitting. Those levels of alcohol consumption are not ideal. They may have effects on weight, liver function, and nutrient absorption. It’s important for surgeons and surgical teams to talk about alcohol and appropriate levels of drinking after surgery.

Categories: Bariatric Surgery, Obesity, Substance Abuse/Alcoholism