Monthly Archives: October 2012

Substance Use Following Bariatric Weight Loss Surgery

A new study published in the Archives of Surgery (“Substance Use Following Bariatric Weight Loss Surgery” ) documents an increase in not only alcohol, but drugs, and cigarettes in those that have gastric bypass surgery.     The study began with 155 participants of which about 2/3 had Roux-en-Y and 1/3 had adjustable gastric band.     The study showed a significant increase in alcohol use at 24-months in the RNY patients but not the banded group.    This is in line with Dr. Ostlund’s findings and Dr. King’s findings.

The study also looked at cigarettes and drug use, not just alcohol use.   I’ve written to Dr. Alexis Conason, the clinical psychologist who was the principal author of this study, to ask for additional information and a copy of the study and if she has any additional comments.   Her website indicates she provides counseling on obesity and bariatric issues as well as mindful eating.

Some things that concerned me about the results of this study was the large decrease in responses by year 2.   At year 1, the numbers of respondents was less than half, and by year 2, only 24% had responded.      This problem could be grossly under-reported.    Also, as many of us are aware and as Dr. King found in her study, these problems typically don’t present until year 2.    I don’t know if it is normal to see such losses in your study group, but when people aren’t doing as well as they hoped they may be less inclined to respond.    But when you are doing well, you may be more eager to respond.

I am pleased that this doctor chose to examine these problems in an aggregate (as a group of substances used to self-medicate) versus isolating each problem substance (like alcohol).     Many of the studies so far only looked at alcohol.  The increases in alcohol problems for RNY patients was typically attributed to increased absorption and to psychological transfer.    The root problem, ‘what keeps the person going back?’ isn’t addressed by absorption.    A normal response, after realizing alcohol is more potent, would be to avoid or dilute the substance.    But what drives the person to seem out the feeling the substance of issue provides?   To me, that is the root question.     And why only after RNY surgery and not lap-band surgery?

I think that the whole spectrum of problems (substance use including prescription drugs, alcohol, and illegal drugs, depression and other mood disorders, shopping, gambling, etc) should be looked at and cross-referenced with the specific type of weight loss surgery.    The duodenal switch variations should be able to be isolated from the RNY’s.   Same with lap-band and the gastrectomies.

My thought is the restrictive procedures will likely continue to indicate to increased risk of acquiring these new self-medicating behaviors.    However, as there are differences in the day-to-day life between RNY and DS patients and there are also some different malabsorption issues, it would be fascinating if the increased risks are similar.

Since, it is getting close to Christmas, I’ll continue my wish list.   I would love to see a study where they did tissue nutrient sampling pre-surgery, and at various intervals post-surgery (3, 6, 12, 24+ months out, even 10 yrs).   And for a whole host of nutrients, not just the typical compounds they test for in serum blood samples, which do not necessarily reflect nutrient deficiencies.    The dream would be to get good data on the long-term malabsorption of calcium, magnesium, iron, B-12, as well as other micro-nutrients.   Then to correlate that data against who and who does not develop what problem 2 years later.

Hopefully Dr. Conason will respond.   If so, I will keep you apprised.   Let me know your thoughts.

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