High-risk alcohol use after weight loss surgery

Abstract

Background Bariatric or weight loss surgery (WLS) may alter alcohol metabolism resulting in a higher prevalence of problem drinking post-operatively. Few studies distinguish those who report improvements in drinking from those who report worsening behavior after surgery. Objectives To characterize high risk alcohol use before and after WLS and according to surgery type. Setting 2 academic WLS centers in the United States. Methods We interviewed patients before and annually after WLS. High risk alcohol use as assessed via a modified version of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Results Of 541 participants who underwent WLS, 375 (69% retention) completed the 1-year and 328 (63% retention) completed the 2-year interview. At 1 year, 13% reported high risk drinking compared to 17% at baseline, p=0.10; at Year 2, 13% reported high risk drinking compared to 15% at baseline, p=0.39; 7% and 6% of patients, respectively, reported new high risk drinking at 1- and 2-year follow-up. At both follow-up time points, more than half of those who reported high risk drinking at baseline no longer did so; A larger proportion of gastric bypass patients (71%) reported amelioration in high risk drinking than gastric banding (48%) at Year 1, but this difference did not reach statistical significance (p=0.07); the difference largely dissipated by Year 2 (50% vs. 57%). Conclusion Although 7 % of patients report new high risk alcohol use 1 year after WLS, more than half who reported high risk alcohol use prior to surgery discontinued high risk drinking.

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

“…Thus, it is not surprising that regular alcohol consumption pre-operatively increases the likelihood of an alcoholic disease postoperatively. Although Wee et al [144] could show that more than half of the weight loss patients, who reported alcohol abuse before surgery, discontinued high-risk drinking, and 7% of the patients in this study reported new high-risk drinking 1 year after the intervention. Interestingly, the prevalence of alcohol misuse significantly increases in the 2nd year after surgery as demonstrated by King et al [145].…”

“…Besides, several anatomical or physiological changes upon surgery may also contribute to altered alcohol absorption and/or metabolism [143]. The increased risk of alcohol misuse after surgery could also be due to a shift of addictions, wherein alcohol substitutes food as coping mechanism [144]. Obviously, the pattern of alcohol use pre-operatively also play a role in this addiction transfer.…”

The gut in the brain: the effects of bariatric surgery on alcohol consumption

“…On the other hand, more than half of the patients who reported high-risk alcohol consumption before surgery reduced drinking. However, none of these changes were statistically significant, nor did the two surgical techniques differ each other, although there was a trend toward a higher proportion of RYGB patients, compared to gastric banding, that reduced alcohol use at the year 1 follow-up (Wee et al 2014). …”

A Mixed-Methods Examination among Young Adult Racially/Ethnically Diverse Bariatric Surgery Patients

“…These data could suggest an alleviation of problematic alcohol use post WLS. This finding is similar to that of Wee and colleagues (2014), who reported that over half of WLS patients who reported "high-risk" drinking prior to surgery, no longer did so at 1 and 2 years postsurgery (Wee et al, 2014). However, it is important to interpret these findings within the context of what was reported earlier having a pre-operative AUD was associated with a higher number of drinking days in the past 30.…”