High-Risk Alcohol Use and Disordered Eating Behavior Before and 1 Year After Sleeve Gastrectomy

Abstract

Background Evidence suggests a rise in alcohol misuse after some bariatric procedures. Whether undergoing sleeve gastrectomy raises the risk of high-risk alcohol use is unclear. Objective To characterize the risk of high-risk alcohol use 1 year after sleeve gastrectomy and collect preliminary data on potential associations between disordered eating and high-risk drinking post-surgery. Methods We interviewed 97 patients before and 1 year after sleeve gastrectomy and assessed for high-risk alcohol use via a modified version of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Eating behavior was assessed using the Three Factor Eating Questionnaire Revised-18 (TFEQ-R18). ResultsThe prevalence of high-risk drinking increased from 13.4% prior to surgery to 22.7% 1 year after sleeve gastrectomy; 16.5% of our sample reported new high-risk drinking equivalent to an incidence of 19.0%. New high-risk drinkers appeared more likely to report lower cognitive restraint scores and higher scores for emotional and uncontrolled eating at baseline and had larger improvements in disordered eating scores post-surgery although these differences approached, but did not reach, statistical significance. Conclusion One in five non-high-risk drinkers developed new high-risk alcohol intake 1 year after sleeve gastrectomy. New high-risk drinkers appear to have greater disordered eating at baseline and reported greater improvement in eating behavior than those who did not develop new high-risk drinking. These results are consistent with the addiction transfer hypothesis postulating that some patients may replace disordered eating with alcohol misuse after sleeve gastrectomy.

‘We're outside the norm again because of the thing that allowed us to be inside the norm’: An interpretative phenomenological analysis of the experience of developing an alcohol use disorder after bariatric surgery

“…The first superordinate theme indicated that all participants reported they had developed AUD post‐surgery, without preoperative antecedents of problematic alcohol consumption. This is consistent with previous studies suggesting patients with postoperative AUD sometimes develop the disorder de novo after surgery 8,11,16–18,29 . Research indicates that AUD appears about 2 years after surgery and patients first seek treatment 5 years postoperatively 7,8,39 .…”

“…This is consistent with previous studies suggesting patients with postoperative AUD sometimes develop the disorder de novo after surgery. 8,11,[16][17][18]29 Research indicates that AUD appears about 2 years after surgery and patients first seek treatment 5 years postoperatively. 7,8,39 This coincides with our participants' testimonies.…”

“…The prevalence of new-onset AUD cases varies greatly between studies, and there is no consensus in the literature on this specific issue. 8,11,[16][17][18] In recent years, several studies have also found a higher incidence of AUD-related diseases after bariatric surgery. Bariatric surgery is associated with an increased risk of alcohol-related liver disease (e.g., alcohol hepatitis and cirrhosis) and AUD-related hospitalizations.…”

“…Recent research also demonstrates an increase in AUD prevalence and high‐risk drinking after sleeve gastrectomy (SG) 6,8–10 . Wong et al 11 found the prevalence of high‐risk drinking increased from 13.4% before SG to 22.7% one year afterward. Recent data suggest there is no difference between RYGB and SG regarding the risk of postoperative problematic alcohol use 8–10,12 .…”

“…Interestingly, studies suggest a subgroup of individuals who have AUD or high‐risk drinking after surgery develop the disorder de novo postoperatively that is, without having antecedents of problematic drinking preoperatively. The prevalence of new‐onset AUD cases varies greatly between studies, and there is no consensus in the literature on this specific issue 8,11,16–18 …”