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Kenkre JS, Gesell S, Keller A, Milani RM, Scholtz S, Barley EA. Alcohol Misuse post Metabolic and Bariatric Surgery: A Systematic Review of Longer-term Studies with Focus on new Onset Alcohol use Disorder and Differences Between Surgery Types. Curr Obes Rep 2024; 13:596-616. [PMID: 38850501 PMCID: PMC11306568 DOI: 10.1007/s13679-024-00577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Evidence suggests an increased risk of alcohol problems post-surgery where no problematic alcohol use was present prior to surgery which may be different across types of surgery. OBJECTIVE To characterise the risk of new onset alcohol misuse post bariatric surgery, differences between surgeries and the impact over time. METHODS All published studies on new and relapsing alcohol use were reviewed. Data were classed as 'subjective' (clinical interview, self-report questionnaires) and 'objective' (hospital admissions, substance misuse programmes) and further categorised by follow up time - 'shorter-term' (one year), 'medium-term' (one year to two years) and 'long-term' (> two years). RESULTS Twenty-three of the forty-two studies included in the review reported new onset data. Nine studies reported on differences between surgery types. In those reporting objective measures, all of which were long term, RYGB carried a higher risk than SG, followed by LAGB. All but one study using subjective measures reported a small but significant number of new onset concerning alcohol use, and comparisons between surgery types had more varied results than the objective measures. Studies of substance abuse programmes found high rates of new onset cases (17-60%). CONCLUSION This systematic review provides support for the consensus guidance suggesting patients should be informed of a small but significant risk of new onset alcohol use following bariatric surgery, with the strongest evidence in the medium- to long-term and in those who have had RYGB followed by SG.
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Affiliation(s)
- Julia S Kenkre
- Section of Endocrinology and Investigative Medicine, Imperial College, London, UK
| | - Sutapa Gesell
- Central and North West London NHS Foundation Trust, London, UK
| | - Annalise Keller
- School of Human and Social Sciences, University of West London, London, UK
| | - Raffaella M Milani
- School of Human and Social Sciences, University of West London, London, UK
| | - Samantha Scholtz
- Section of Endocrinology and Investigative Medicine, Imperial College, London, UK.
- West London NHS Trust, London, UK.
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Marek RJ, Heinberg LJ. Should presurgical psychological evaluations still be a mandated requirement for metabolic and bariatric surgery? A critique of the literature and thoughts on future directions. Surg Obes Relat Dis 2024:S1550-7289(24)00720-2. [PMID: 39242241 DOI: 10.1016/j.soard.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/19/2024] [Accepted: 08/03/2024] [Indexed: 09/09/2024]
Abstract
For more than 30 years, clinical practice guidelines for the perioperative support of patients who undergo metabolic and bariatric surgery have recommended a formal psychological evaluation before surgery. However, the predictive utility of the evaluation in determining future outcomes has been mixed, leading to controversy regarding whether such evaluations should be required for all potential patients. This empirically based commentary will review the utility and value of the psychological evaluation in addition to the limitations in the extant literature that reduce predictive validity and provide recommendations on how to improve quality of the empirical literature and refinements to increase the utility of preoperative evaluations. Pre-metabolic and bariatric surgery psychological evaluation conducted by an appropriately trained clinician and properly reimbursed by the payor that includes time for psychological testing, integration of data, report writing, medical record review, and feedback to the patient and surgical team, should continue to be the standard of care as it benefits all stakeholders.
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Affiliation(s)
- Ryan J Marek
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, Texas.
| | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Iljin A, Wlaźlak M, Sitek A, Antoszewski B, Zieliński T, Gmitrowicz A, Kropiwnicki P, Strzelczyk J. Mental Health, and Eating Disorders in Patients After Roux-en-Y Gastric Bypass Surgery (RYGB). POLISH JOURNAL OF SURGERY 2024; 96:1-11. [PMID: 38979584 DOI: 10.5604/01.3001.0054.5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
<b>Introduction:</b> Obesity, as one of the main health problems worldwide, is associated with an increased risk of developing mental and eating disorders and negative eating habits. Bariatric surgery allows for rapid weight loss and alleviates the symptoms of concomitant diseases in obese patients.<b>Aim:</b> Pre- and postoperative estimation of mental disorders and eating behaviors in patients after Roux-en-Y Gastric Bypass (RYGB).<b>Material and methods:</b> Analysis of data from up to 5 years of follow-up including clinical examination and questionnaires.<b>Results:</b> Following parameters decreased after RYGB: anxiety and hyperactivity from 32.81% to 21.88%, mood disorders - 31.25% to 20.31%, substance abuse - 40.63% to 28.13%, emotional eating - 76.56% to 29.69%, binge eating - 50% to 6.25%, night eating - 87.5% to 20.31%. Postoperative rates of: negative eating habits, daily intake of calories and sweetened beverages, flatulence, constipation, and abdominal pain decreased, while the rate of food intolerance and emesis increased.<b>Conclusions:</b> In our patients, the occurrence of: mental and eating disorders, negative eating habits, daily calories, sweetened beverages, coffee intake decreased after weight loss (as a result of RYGB), but water, vegetables and fruit consumption increased. Lower rate of flatulence, constipation, and abdominal pain, but higher of food intolerance and emesis were also confirmed after RYGB.
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Affiliation(s)
- Aleksandra Iljin
- Department of Plastic, Reconstructive and Aesthetic SurgeryMedical University of Lodz, Poland
| | - Michał Wlaźlak
- Department of General and Transplant Surgery, Medical University of Lodz, Poland
| | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Poland
| | - Tomasz Zieliński
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Poland
| | | | - Paweł Kropiwnicki
- Department of Adolescent Psychiatry, Medical University of Lodz, Poland
| | - Janusz Strzelczyk
- Department of General and Transplant Surgery, Medical University of Lodz, Poland
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Bramness JG, Lien L, Moe JS, Toft H, Pandey S, Lid TG, Strømmen M, Andersen JR, Bolstad I. Bariatric surgery patients in AUD treatment in Norway-an exploratory cross-sectional study. Alcohol Alcohol 2024; 59:agae007. [PMID: 38369663 PMCID: PMC11445783 DOI: 10.1093/alcalc/agae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
AIMS Patients who have undergone some forms of bariatric surgery have increased risk of developing alcohol use disorder (AUD). In the present observational study, we compared patients with AUD who themselves reported to having undergone bariatric surgery with other patients in treatment for AUD. MATERIALS One-hundred-and-six consecutively enrolled patients in residential treatment for AUD were asked if they had undergone bariatric surgery. Sociodemographics, mental health-related, and alcohol use-related parameters were compared between those who had and those who had not undergone bariatric surgery. RESULTS Of the 106 patients with AUD, seven (6.6%; 95% confidence interval, 2.7%-13.1%) had undergone bariatric surgery. Six of seven patients had undergone such surgery were women (P < .001). The patients with AUD who had undergone bariatric surgery were similar to other patients with AUD on most other parameters, the exception being a larger number of alcohol units ingested to feel an effect of alcohol (adjusted odds ratio 7.1; 95% confidence interval 2.0-12.2; P = .007). CONCLUSION The high number of patients with AUD that reported having undergone bariatric surgery emphasizes the risks following such a procedure. The overrepresentation of women may reflect than more women undergo such procedures. The unexpected finding that patients with AUD having undergone bariatric surgery seemed to need more alcohol to feel intoxicated warrants further research.
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Affiliation(s)
- Jørgen G Bramness
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, P.O.Box 222 Skøyen, 0213 Oslo, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Kjonerud kompetansesenter, Løvstadveien 7, 2312 Ottestad, Innlandet Hospital Trust, Brumunddal, Norway
- Institute Clinical of Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Kjonerud kompetansesenter, Løvstadveien 7, 2312 Ottestad, Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O.Box 400 Vestad, 2418 Elverum, Norway
| | - Jenny S Moe
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, P.O.Box 222 Skøyen, 0213 Oslo, Norway
- Institute Clinical of Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Helge Toft
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O.Box 400 Vestad, 2418 Elverum, Norway
| | - Susmita Pandey
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Kjonerud kompetansesenter, Løvstadveien 7, 2312 Ottestad, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torgeir G Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Telegrafdirektør Heftyes vei 73, 4021 Stavanger, Norway
| | - Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - John R Andersen
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812 Førde, Norway
- Førde Hospital Trust, P.O. Box 1000, 6807 Førde, Norway
| | - Ingeborg Bolstad
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.O.Box 400 Vestad, 2418 Elverum, Norway
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Capelo Vides M, Campello de Oliveira M, Lassi DLS, Malbergier A, Florio L, de Azevedo-Marques Périco C, Abrantes do Amaral R, Torales J, Ventriglio A, Negrão AB, Castaldelli-Maia JM. Bariatric surgery and its influence on alcohol consumption: Differences before and after surgery - A systematic review and meta-analysis. Int Rev Psychiatry 2023; 35:367-376. [PMID: 38299644 DOI: 10.1080/09540261.2023.2223317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/06/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Through new publications on the subject, the main goal of this article is to seek a change in the pattern of alcohol use before and after bariatric surgery. METHODS We searched the National Library of Medicine, CINAHL, and PsycINFO databases. We included original articles regarding alcohol consumption before and after bariatric surgery to conduct the systematic review. RESULTS Our systematic review, which included 18 articles, yielded mixed results. Meta-analysis of six articles did not reveal statistically significant differences in alcohol use behaviours before and one year after bariatric surgery. However, throughout the perspective of follow-up after bariatric surgery, nine out of the twelve articles showed improvement in the pattern of alcohol consumption when evaluated up to two years after the end of the surgical period, and four out of the five articles with monitoring beyond two years showed worsening in consumption, compared to pre-surgery alcohol use behaviours. CONCLUSIONS Conclusions about the relationship between alcohol consumption and bariatric surgery are challenging primarily because of the variety of the methods used and the alcohol consumption measures. Despite that, our research pointed to an increased risk of alcohol use disorders two years after bariatric surgery.
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Affiliation(s)
- Mariana Capelo Vides
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | | | | | - André Malbergier
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ligia Florio
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
| | | | | | - Julio Torales
- Department of Psychological Medicine, School of Medical Sciences, National University of Asuncion, San Lorenzo, Paraguay
| | - Antonio Ventriglio
- Department of Experimental Medicine, Medical School, University of Foggia, Foggia, Italy
| | | | - João Mauricio Castaldelli-Maia
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
- Department of Psychological Medicine, School of Medical Sciences, National University of Asuncion, San Lorenzo, Paraguay
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Romagna EC, Mattos DMF, Lopes KG, Kraemer-Aguiar LG. Screening Risks of Alcohol Abuse, Depressive Symptoms, and Decreased Health-Related Quality of Life in Post-Bariatric Patients and Their Relations to Weight Regain. Obes Surg 2023:10.1007/s11695-023-06605-3. [PMID: 37097429 DOI: 10.1007/s11695-023-06605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Not all patients who underwent bariatric surgery keep their regular medical follow-up. We screened alcohol use, depressive symptoms, and health-related quality of life (HRQoL) in post-bariatric patients who have lost medical follow-up at their first appointment in our healthcare unit. These screened disorders were compared between low vs. high ratios of weight regain (RWR) and correlated with surgical outcomes. MATERIAL AND METHODS Ninety-four post-bariatric patients without medical follow-up (87.2% female, aged 42 ± 9 years, BMI = 32.9 ± 6.5kg/m2) were included. They underwent Roux-en-Y gastric bypass (n = 80) or sleeve gastrectomy (n = 14). They were divided into high RWR (≥ 20%) and low RWR (< 20%) groups. We used Alcohol Use Disorders Inventory Test, Beck Depression Inventory, and 36-Item Short-Form Health Survey. RESULTS Neck and waist circumferences, diastolic blood pressure, and time since surgery were higher in the high than low RWR group (P≤ 0.05). No differences between groups for alcohol use and depressive symptoms were detected (P≥ 0.07), but those who regained more weight exhibited poorer health scores in physical functioning, physical role limitations, bodily pain, and vitality (P≤ 0.05). In the low RWR group, the RWR was inversely correlated to physical/social functioning and vitality. Positive associations were present between RWR vs. depressive symptoms, while negative ones were noted to physical functioning and general health perception in the high RWR group. CONCLUSIONS HRQoL has deteriorated in those post-bariatric patients without medical follow-up who regained more weight, possibly indicating the need for regular long-term health care.
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Affiliation(s)
- Eline Coan Romagna
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diogo Menezes Ferrazani Mattos
- MídiaCom / Postgraduate Program on Electrical and Telecommunications Engineering (PPGEET), Fluminense Federal University, Niteroi, RJ, Brazil
| | - Karynne Grutter Lopes
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Boulevard 28 de setembro, 77, Vila Isabel, Rio de Janeiro, RJ, Brazil.
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Saccaro LF, Rutigliano G, Landi P, Spera M, Kraslavski A, Zappa MA, Mencacci C. Emotional Regulation Underlies Gender Differences in Pathological Eating Behavior Styles of Bariatric Surgery Candidates. WOMEN 2023. [DOI: 10.3390/women3020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Almost a third of bariatric surgery patients present suboptimal weight loss or important weight regain in the first five postoperative years. While the reasons underlying this are not fully understood, it is known that pathological eating styles (such as emotional or binge eating) can thwart efforts to maintain weight loss. However, detailed characterization and understanding of these eating styles have yet to be achieved. In particular, research on gender differences in pathological eating styles and psychiatric symptoms before bariatric surgery is lacking. To characterize gender differences in eating styles and their association with clinical symptoms, we prospectively enrolled 110 bariatric surgery candidates, collecting eating styles and clinical scores. Women displayed a higher frequency of emotional eating as compared to men (x2 = 9.07, p = 0.003), while men showed a higher frequency of quantitative eating behavioral style (x2 = 4.58, p = 0.044). Binge eating style was associated with higher Difficulties in Emotion Regulation Scale (DERS), Hamilton Depression Scale (HAM-D), and Hamilton Anxiety Scale (HAM-A) scores (p < 0.05). Emotional eating style was associated with higher HAM-D and HAM-A scores (p < 0.05). The present findings highlight the importance of understanding the role of gender differences in emotion regulation processes involved in the development and maintenance of pathological eating styles in bariatric surgery candidates. This paves the way to gender- and symptoms-specific interventions on eating behaviors to improve surgery long-term outcomes.
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Affiliation(s)
- Luigi F. Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Grazia Rutigliano
- Institute of Clinical Sciences, Imperial College London, MRI Steiner Unit, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
- Department of Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy
| | - Paola Landi
- Dipartimento di Salute Mentale e Dipendenze, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Milena Spera
- Dipartimento di Salute Mentale e Dipendenze, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Alexandra Kraslavski
- Dipartimento di Salute Mentale e Dipendenze, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Marco Antonio Zappa
- UOC di Chirurgia Generale, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20121 Milano, Italy
| | - Claudio Mencacci
- Dipartimento di Salute Mentale e Dipendenze, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
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Özkan M, Kavak M. Cross-Addiction in Bariatric Surgery Candidates. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sarwer DB, Heinberg LJ. A review of the psychosocial aspects of clinically severe obesity and bariatric surgery. ACTA ACUST UNITED AC 2021; 75:252-264. [PMID: 32052998 DOI: 10.1037/amp0000550] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
For the past 2 decades, clinically severe obesity (operationalized as a body mass index ≥40 kg/m2) has increased at a more pronounced rate that less severe obesity. As a result, the surgical treatment of obesity (bariatric surgery) has become a more widely accepted, yet still underutilized, treatment for persons with severe obesity and significant weight-related health problems. Psychologists play a central role on the multidisciplinary team involved in the preoperative assessment and postoperative management of patients. They also have played a central role in clinical research which has enhanced understanding of the psychosocial and behavioral factors that contribute to the development of severe obesity as well as how those factors and others contribute to postoperative outcomes. This article, written specifically for psychologists and other mental health professionals who currently work with these patients or are considering the opportunity to do so in the future, reviews these contributions over the past 20 years. The article highlights how this work has become a fundamental part of international clinical care guidelines, which primarily focus on preoperative psychosocial screening. The article also outlines avenues for future research in the field, with a specific focus on the need for additional behavioral and psychosocial interventions to promote lifelong success after bariatric surgery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University
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Abstract
PURPOSE OF REVIEW Marijuana use presents a unique challenge to bariatric surgery programs. We review the recent evidence examining marijuana use on outcomes following bariatric surgery. RECENT FINDINGS Recent studies have not demonstrated an increased risk of short-term surgical complications or differences in up to 2-year weight loss following surgery among marijuana users. However, studies have demonstrated increased risks in two areas: pain management and problematic eating behaviors. Additionally, preoperative marijuana use has been linked to increased postoperative marijuana use which may undermine weight loss and increase risk for weight regain. There are still many unanswered questions regarding marijuana use and bariatric surgery, and the limited literature base has produced mixed results when considering marijuana as a contraindication for bariatric surgery. Programs must take into consideration the laws of their state, individual patterns of use, and route of administration when considering whether marijuana is a contraindication for surgery.
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Affiliation(s)
- Allyson Diggins
- Cleveland Clinic Bariatric & Metabolic Institute, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Leslie Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Bariatric & Metabolic Institute, Cleveland, OH, USA
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Fialho MCP, Cunha JBD, Arruda SLDM, Nobrega OT, Camargos EF. Evaluation of depression and anxiety symptoms, alcohol consumption, and binge eating in older adults undergoing bariatric surgery: a 6-year follow-up. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION: The literature remains scarce on the late effects of bariatric surgery on the general health of patients who underwent such procedures at an older age. The present study aimed to evaluate depression and anxiety symptoms, risky alcohol consumption, and binge eating in older adults undergoing bariatric surgery. METHODS: This study used current data (from medical records and tests) to conduct a cross-sectional study. A total of 74 individuals aged 60 years and older who underwent bariatric surgery after 55 years of age at a specialist center for obesity management located in Brazil were included and evaluated by the Beck Depression Inventory, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, and Binge Eating Scale. Demographic and clinical data related to the surgical procedure (weight loss) were also collected. The Cochran-Armitage trend test, Pearson’s χ2 test, and a multiple linear regression model were used as needed. A p < 0.05 was considered significant. RESULTS: The individuals were white (65.70%) and women (78.30%), with a mean age of 65.8 (SD 3.90) years. The mean time elapsed from surgery to evaluation was 75.70 (SD 43.70) months; 10.80% of the participants had moderate to severe depression, 8.10% moderate to severe anxiety, and 5.40% risky or high-risk alcohol consumption. None of the participants had binge eating problems. Weight regain was not associated with depressive symptom severity or risky alcohol consumption, but it was significantly associated (p = 0.034) with few or neither anxiety symptoms. Excess weight loss was not associated with any study variable. CONCLUSION: The results show a low prevalence of mental symptoms in older adults undergoing bariatric surgery compared to data from the literature on younger adults undergoing the same procedure.
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Strømmen M, Klöckner CA, Bjerkan KK, Græslie H, Hoff DAL, Johnsen G, Kulseng B, Mårvik R, Nymo S, Sandvik J. Characteristics of Patients Reporting Presumed Problematic Drinking Behavior After Gastric Bypass: Exploring Long-Term Data From the BAROBS Study. Front Endocrinol (Lausanne) 2021; 12:679006. [PMID: 34226824 PMCID: PMC8253806 DOI: 10.3389/fendo.2021.679006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To explore patients' long-term experiences with drinking alcohol after Roux-n-Y gastric bypass (RYGB) for conceptualizing what may indicate problematic drinking behavior after bariatric surgery. STUDY DESIGN Three-center, observational study. PATIENTS 546 adult patients undergoing RYGB in the period 2003-2009 in Norway. MAIN OUTCOME MEASURES Self-reported data on drinking behavior and experiences related to alcohol collected 10-15 years after surgery. RESULTS Out of the 959 patients undergoing RYGB in the period, 29 were diseased and 546 participated in this follow-up study (58.7%). Focusing on suspicious changes in drinking behavior, 8.8% reported drinking more, 11.5% consumed alcohol at least twice a week, and 10.6% consumed at a minimum of 6 units of alcohol at a frequency of at least once monthly. The nature of hangovers had changed for about a third of the patients, with 21.6% reporting these to feel weaker or absent. Repeated alcoholic blackouts were reported by 11.9%. A subgroup of the patients were categorized as displaying presumed problematic drinking behavior(PPDB). Among the PPDB-men there was a significant association to having had a fall last year (6 (100.0%) PPDB-patients vs. 30 (29.7%) non-PPDB, p<.001). Among the PPDB-women, there was a significant association to having had alcohol problems prior to surgery (7 (70.0%) PPDB-patients vs. 67 (17.7%) non-PPDB, p<.001). Less significant associations to PPDB reported for explorative purposes were lack of patient education (men) (16 (26.2%) PPDB-patients vs. 8 (61.5%) non-PPDB, p=.014); more than 3 months persistent musculoskeletal pain (women) (45 (15.3%) PPDB-patients vs. 29 (24.6%) non-PPDB, p=.026); subjective problems with memory (women) (58 (20.7%) PPDB-patients vs. 10 (9.1%) non-PPDB, p=.006); and, receiving professional help for mental problems last 12 months (women) (29 (22.7%) PPDB-patients vs. 45 (14.7%) non-PPDB, p=.043). CONCLUSION A subset of patients display drinking behaviors that may be consistent with postsurgical alcohol problems. Screening instruments like AUDIT may not be sufficiently specific to capture several risk behaviors occurring after bariatric surgery.
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Affiliation(s)
- Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- *Correspondence: Magnus Strømmen,
| | - Christian Andreas Klöckner
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kirsti Kverndokk Bjerkan
- Faculty of Social Science and History, Volda University College, Volda, Norway
- Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Hallvard Græslie
- Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Dag Arne Lihaug Hoff
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Gjermund Johnsen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Obesity Research Group, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bård Kulseng
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ronald Mårvik
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Obesity Research Group, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siren Nymo
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
- Obesity Research Group, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jorunn Sandvik
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway
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Maciejewski ML, Smith VA, Berkowitz TSZ, Arterburn DE, Mitchell JE, Olsen MK, Liu CF, Livingston EH, Funk LM, Adeyemo A, Bradley KA. Association of Bariatric Surgical Procedures With Changes in Unhealthy Alcohol Use Among US Veterans. JAMA Netw Open 2020; 3:e2028117. [PMID: 33346846 PMCID: PMC7753905 DOI: 10.1001/jamanetworkopen.2020.28117] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Bariatric surgical procedures have been associated with increased risk of unhealthy alcohol use, but no previous research has evaluated the long-term alcohol-related risks after laparoscopic sleeve gastrectomy (LSG), currently the most used bariatric procedure. No US-based study has compared long-term alcohol-related outcomes between patients who have undergone Roux-en-Y gastric bypass (RYGB) and those who have not. OBJECTIVE To evaluate the changes over time in alcohol use and unhealthy alcohol use from 2 years before to 8 years after a bariatric surgical procedure among individuals with or without preoperative unhealthy alcohol use. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed electronic health record (EHR) data on military veterans who underwent a bariatric surgical procedure at any of the bariatric centers in the US Department of Veterans Affairs (VA) health system between October 1, 2008, and September 30, 2016. Surgical patients without unhealthy alcohol use at baseline were matched using sequential stratification to nonsurgical control patients without unhealthy alcohol use at baseline, and surgical patients with unhealthy alcohol use at baseline were matched to nonsurgical patients with unhealthy alcohol use at baseline. Data were analyzed in February 2020. INTERVENTIONS LSG (n = 1684) and RYGB (n = 924). MAIN OUTCOMES AND MEASURES Mean alcohol use, unhealthy alcohol use, and no alcohol use were estimated using scores from the validated 3-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), which had been documented in the VA EHR. Alcohol outcomes were estimated with mixed-effects models. RESULTS A total of 2608 surgical patients were included in the final cohort (1964 male [75.3%] and 644 female [24.7%] veterans. Mean (SD) age of surgical patients was 53.0 (9.9) years and 53.6 (9.9) years for the matched nonsurgical patients. Among patients without baseline unhealthy alcohol use, 1539 patients who underwent an LSG were matched to 14 555 nonsurgical control patients and 854 patients who underwent an RYGB were matched to 8038 nonsurgical control patients. In patients without baseline unhealthy alcohol use, the mean AUDIT-C scores and the probability of unhealthy alcohol use both increased significantly 3 to 8 years after an LSG or an RYGB, compared with control patients. Eight years after an LSG, the probability of unhealthy alcohol use was higher in surgical vs control patients (7.9% [95% CI, 6.4-9.5] vs 4.5% [95% CI, 4.1-4.9]; difference, 3.4% [95% CI, 1.8-5.0])). Similarly, 8 years after an RYGB, the probability of unhealthy alcohol use was higher in surgical vs control patients (9.2% [95% CI, 8.0-10.3] vs 4.4% [95% CI, 4.1-4.6]; difference, 4.8% [95% CI, 3.6-5.9]). The probability of no alcohol use also decreased significantly 5 to 8 years after both procedures for surgical vs control patients. Among patients with unhealthy alcohol use at baseline, prevalence of unhealthy alcohol use was higher for patients who underwent an RYGB than matched controls. CONCLUSIONS AND RELEVANCE In this multi-site cohort study of predominantly male patients, among those who did not have unhealthy alcohol use in the 2 years before bariatric surgery, the probability of developing unhealthy alcohol use increased significantly 3-8 years after bariatric procedures compared with matched controls during follow-up.
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Affiliation(s)
- Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Theodore S. Z. Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - David E. Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - James E. Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo
| | - Maren K. Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Chuan-Fen Liu
- Department of Health Services, University of Washington, Seattle
| | - Edward H. Livingston
- Department of Surgery, University of California, Los Angeles, Los Angeles
- Deputy Editor, JAMA, Chicago, Illinois
| | - Luke M. Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin–Madison, Madison
- William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin
| | - Adenike Adeyemo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
- Department of Health Services, University of Washington, Seattle
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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14
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McGregor M, Hamilton J, Hajnal A, Thanos PK. Roux-en-Y gastric bypass increases GABA-A receptor levels in regions of the rat brain involved in object recognition memory and perceptual acuity. Physiol Behav 2020; 224:113053. [PMID: 32645414 DOI: 10.1016/j.physbeh.2020.113053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/15/2020] [Accepted: 07/04/2020] [Indexed: 01/09/2023]
Abstract
Roux-en-Y gastric bypass surgery (RYGB), one of the most common and successful procedures for combatting obesity, is associated with post-surgery substance use disorder (SUD) and other addictive behaviors in a subset of patients. We investigated the effects of RYGB on GABA-A receptor levels in the rat brain to identify potential mechanisms of this behavior. The GABAergic system is affected in addiction and has been implicated in the pathology of obesity. We assigned male Sprague-Dawley rats to four groups: standard, low fat diet with sham surgery (control), ad libitum HFD with sham surgery (Sham), calorie restricted HFD with sham surgery (Sham-FR), or HFD with RYGB surgery. Surgery was performed after 8 weeks on the control or HFD diet. Rats maintained their respective diets for 9 weeks post-surgery, then were sacrificed for GABA-A receptor autoradiography using the [3H] Flunitrazepam ligand. We identified increased GABA-A binding in the perirhinal cortex of ad-libitum HFD fed rats compared to normal diet controls. RYGB surgery increased GABA-A in the ectorhinal cortex compared to normal diet controls, and increased binding in the jaw region of the primary somatosensory cortex compared to food-restricted rats that received sham surgery. Hypothalamus GABA-A was also negatively correlated with body weight in the RYGB group, where GABA signaling may play a role in obesity regulation. These results suggest that HFD and RYGB modulate GABA signaling in regions important for object recognition memory, and that increased GABA-A levels in the jaw's perceptual field cortex arise from the surgery itself, independent of caloric restriction.
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Affiliation(s)
- Matthew McGregor
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - John Hamilton
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA; Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Andras Hajnal
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA; Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA.
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15
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Freire CC, Zanella MT, Arasaki CH, Segal A, Carneiro G. Binge eating disorder is not predictive of alcohol abuse disorders in long-term follow-up period after Roux-en-Y gastric bypass surgery. Eat Weight Disord 2020; 25:637-642. [PMID: 30859463 DOI: 10.1007/s40519-019-00663-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/26/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Some studies have shown an increase in alcohol use disorders (AUD) after Roux-en-Y gastric bypass surgery (RYGB), but its relationship with binge eating disorder (BED) has not been fully explored. The purpose of this study was to determine the prevalence of AUD and BED after RYGB and also to evaluate if BED is predictive of late postoperative occurrence of AUD or BED. METHODS Patients (n = 46) submitted to RYGB, in a tertiary outpatient weight management service at a Federal University of Sao Paulo, Brazil, were tested for BED and AUD using the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and AUDIT, respectively. BED was tested before surgery, while both disorders were evaluated with a follow-up period of 12 ± 1.6 years after RYGB. RESULTS No patients reported AUD before RYBP. After a mean period of 12 years from surgery, ten patients (21.7%) were diagnosed with AUD. Before surgery, BED was present in 24 patients (52.2%) and it was detected in seven out of these 24 patients (29.2%) after RYGB. Thirteen new cases of BED (28.2%) were detected after surgery; total of 20 patients (43.5%) with BED. No association was found between pre- and postsurgery BED (p = 0.148). After RYGB, four out of 24 patients (16.6%) with presurgery BED developed AUD, and no association was found between presurgery BED and postsurgery AUD (p = 0.384). Seven out of ten patients (70%) with AUD after RYGB also developed BED, but no statistical significance was found between these two disorders (p = 0.061). CONCLUSION The presence of BED before RYGB did not predict AUD and BED after RYGB. Nevertheless, factors involved in a possible association between BED and AUD after surgery remain to be determined. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Cristina Cardoso Freire
- Department of Medicine, Division of Endocrinology and metalolism, Universidade Federal de São Paulo, End: Street Leandro Duprat, 365, São Paulo, 04025-010, Brazil.
| | - Maria Teresa Zanella
- Department of Medicine, Division of Endocrinology and metalolism, Universidade Federal de São Paulo, End: Street Leandro Duprat, 365, São Paulo, 04025-010, Brazil
| | - Carlos Haruo Arasaki
- Department of Surgery, Division of Surgical Gastroenterology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Adriano Segal
- Adriano Segal, Department of Medicine, Obesity and metabolic syndrome outpatient service, Universidade de São Paulo, São Paulo, Brazil
| | - Gláucia Carneiro
- Department of Medicine, Division of Endocrinology and metalolism, Universidade Federal de São Paulo, End: Street Leandro Duprat, 365, São Paulo, 04025-010, Brazil
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16
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Coluzzi I, Iossa A, Spinetti E, Silecchia G. Alcohol consumption after laparoscopic sleeve gastrectomy: 1-year results. Eat Weight Disord 2019; 24:1131-1136. [PMID: 29411323 DOI: 10.1007/s40519-018-0486-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (SG) represents, at present, the most performed bariatric procedure worldwide with excellent long-term results on weight loss and comorbidities control. After the gastrectomy procedure, together with hormonal modification, several changes in taste and habits occur, including the potential modification in alcohol consumption. The aim of this prospective study was to determine the frequency and the amount of alcohol use before and after SG using a modified version of the Alcohol Use Disorder Identification Test (AUDIT) at 1-year follow-up and eventually to evaluate relationships between different ages and sexes. MATERIALS AND METHODS A total of 142 patients were prospectively enrolled and evaluated before and 1 year after SG with a modified AUDIT. The exclusion criteria were as follows: history of alcohol abuse, presence of psychopathology or cognitive impairments, diabetes mellitus type II decompensated, or previous gastrointestinal, liver, and pancreatic resective surgery. Subgroup analyses were performed between male and female and between under and over 40 years old. RESULTS The median AUDIT score decreased from 2.70 (range 1-18) before surgery to 1.38 (range 1-7) after 1 year of SG, indicating a marked reduction in alcohol use. The most consumed alcoholic drink was beer (36.6%/n = 52) while after surgery the consumption of beer decreased considerably (21.1%/n = 30). The frequency of alcohol consumption also decreased: at baseline 45% of patients consumed alcoholic drinks "from 2 to 4 times per month", whereas 26 and 39.4% consumed alcohol "never" and "less than once a month," respectively. After surgery, nobody consumed more then six alcoholic drinks. No differences were found between the subgroups in terms of alcohol consumption and social behavior. CONCLUSIONS The alcohol preference is modified and decreased 1 year after SG and this could be related to the strict nutritional follow-up and to the hormonal changes. Studies with large samples and long-term follow-up are needed to confirm our data. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ilenia Coluzzi
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy
| | - Angelo Iossa
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy
| | - Elena Spinetti
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy
| | - Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy.
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17
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Brutman JN, Sirohi S, Davis JF. Recent Advances in the Neurobiology of Altered Motivation Following Bariatric Surgery. Curr Psychiatry Rep 2019; 21:117. [PMID: 31707546 DOI: 10.1007/s11920-019-1084-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW There is compelling evidence in the clinical population that long-term weight loss secondary to bariatric surgery is mitigated by the reemergence of maladaptive feeding behaviors and in some cases new onset substance abuse. RECENT FINDINGS A review of the current literature suggests that physical restructuring of the GI tract during WLS alters secretion of feeding peptides and nutrient-sensing mechanisms that directly target the brain's endogenous reward system, the mesolimbic dopamine system. Post-surgical changes in GI physiology augment activation of the mesolimbic system. In some patients, this process may contribute to a reduced appetite for palatable food whereas in others it may support maladaptive motivated behavior for food and chemical drugs. It is concluded that future studies are required to detail the timing and duration of surgical-induced changes in GI-mesolimbic communication to more fully understand this phenomenon.
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Affiliation(s)
- Julianna N Brutman
- Department of Integrative Physiology and Neuroscience, College of Veterinary Medicine, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA
| | - Sunil Sirohi
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Jon F Davis
- Department of Integrative Physiology and Neuroscience, College of Veterinary Medicine, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA.
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18
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Smith KE, Engel SG, Steffen KJ, Garcia L, Grothe K, Koball A, Mitchell JE. Problematic Alcohol Use and Associated Characteristics Following Bariatric Surgery. Obes Surg 2019; 28:1248-1254. [PMID: 29110243 DOI: 10.1007/s11695-017-3008-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Evidence suggests that a significant minority of individuals who undergo Roux-en-Y gastric bypass (RYGB) experience problematic alcohol and substance use following surgery. However, little research has examined characteristics, drinking patterns, and possible risk factors within this population. To provide descriptive information of a sample of adults with self-identified alcohol use problems following bariatric surgery, this study examined (1) alcohol and substance use symptoms using standardized assessments, (2) current and past psychiatric comorbidity, (3) subjective changes in alcohol sensitivity following surgery, and (4) specific patterns of alcohol use prior to and following bariatric surgery. MATERIALS AND METHODS Adult participants (N = 26) completed a series of structured diagnostic interviews and self-report assessments (e.g., Alcohol Use Disorders Identification Test [AUDIT], Michigan Alcohol Screening Test [MAST], Drug Abuse Screening Test [DAST]) by telephone 1 to 4 years following a RYGB or sleeve gastrectomy. RESULTS All participants met objective criteria for current problematic alcohol use based on AUDIT and MAST cutoff scores, reported increased subjective sensitivity to alcohol following surgery, and evidenced significant current and past psychiatric comorbidities, most notably previous major depression (45.5%). Approximately one third of participants evidenced new-onset Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) alcohol use or dependence following surgery. Preoperative drinking frequencies and quantities were similar to those reported during the period of the heaviest postoperative alcohol use. CONCLUSIONS Findings have implications for pre- and postoperative prevention and intervention efforts. Additional research is needed to further elucidate risk factors for problematic alcohol use following bariatric surgery.
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Affiliation(s)
- Kathryn E Smith
- Neuropsychiatric Research Institute, 120 South 8th St, Fargo, ND, 58103, USA.
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
| | - Scott G Engel
- Neuropsychiatric Research Institute, 120 South 8th St, Fargo, ND, 58103, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Kristine J Steffen
- Neuropsychiatric Research Institute, 120 South 8th St, Fargo, ND, 58103, USA
- Department of Pharmaceutical Sciences, College of Pharmacy, Nursing, and Alliances, North Dakota State University, Fargo, ND, USA
| | - Luis Garcia
- Neuropsychiatric Research Institute, 120 South 8th St, Fargo, ND, 58103, USA
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
- Sanford Health, Fargo, ND, USA
| | - Karen Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Afton Koball
- Department of Behavioral Medicine, Gundersen Health System, La Crosse, WI, USA
| | - James E Mitchell
- Neuropsychiatric Research Institute, 120 South 8th St, Fargo, ND, 58103, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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19
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Smith NK, Hackett TA, Galli A, Flynn CR. GLP-1: Molecular mechanisms and outcomes of a complex signaling system. Neurochem Int 2019; 128:94-105. [PMID: 31002893 PMCID: PMC7081944 DOI: 10.1016/j.neuint.2019.04.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/26/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022]
Abstract
Meal ingestion provokes the release of hormones and transmitters, which in turn regulate energy homeostasis and feeding behavior. One such hormone, glucagon-like peptide-1 (GLP-1), has received significant attention in the treatment of obesity and diabetes due to its potent incretin effect. In addition to the peripheral actions of GLP-1, this hormone is able to alter behavior through the modulation of multiple neural circuits. Recent work that focused on elucidating the mechanisms and outcomes of GLP-1 neuromodulation led to the discovery of an impressive array of GLP-1 actions. Here, we summarize the many levels at which the GLP-1 signal adapts to different systems, with the goal being to provide a background against which to guide future research.
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Affiliation(s)
- Nicholas K Smith
- Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Troy A Hackett
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aurelio Galli
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Charles R Flynn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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20
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Ivezaj V, Benoit SC, Davis J, Engel S, Lloret-Linares C, Mitchell JE, Pepino MY, Rogers AM, Steffen K, Sogg S. Changes in Alcohol Use after Metabolic and Bariatric Surgery: Predictors and Mechanisms. Curr Psychiatry Rep 2019; 21:85. [PMID: 31410716 PMCID: PMC7057935 DOI: 10.1007/s11920-019-1070-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This review synthesized the literature on predictors and mechanisms of post-bariatric alcohol problems, in order to guide future research on prevention and treatment targets. RECENT FINDINGS Consistent evidence suggests an elevated risk of developing problems with alcohol following bariatric surgery. While there is a paucity of empirical data on predictors of problematic alcohol use after bariatric surgery, being male, a younger age, smoking, regular alcohol consumption, pre-surgical alcohol use disorder, and a lower sense of belonging have predicted alcohol misuse post-operatively. This review synthesizes potential mechanisms including specific bariatric surgical procedures, peptides and reinforcement/reward pathways, pharmacokinetics, and genetic influences. Finally, potential misperceptions regarding mechanisms are explored. Certain bariatric procedures elevate the risk of alcohol misuse post-operatively. Future research should serve to elucidate the complexities of reward signaling, genetically mediated mechanisms, and pharmacokinetics in relation to alcohol use across gender and developmental period by surgery type.
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Affiliation(s)
- Valentina Ivezaj
- Yale School of Medicine, 301 Cedar Street, 2nd Floor, New Haven, CT, 06519, USA.
| | | | - Jon Davis
- Washington State University, Pullman, WA, 99164, USA
| | | | - Celia Lloret-Linares
- Maladies Nutritionnelles et métaboliques, Ramsay-Générale de Santé, Hôpital Privé Pays de Savoie, 74105, Annemasse, France
| | - James E Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND, 58202, USA
| | - M Yanina Pepino
- University of Illinois at Urbana Champaign, Urbana, IL, 61801, USA
| | - Ann M Rogers
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, 17033, USA
| | | | - Stephanie Sogg
- Massachusetts General Hospital Weight Center, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
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21
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Suter PM, Perger L. [Alcohol and the Bariatric Patient: When One Drink Becomes Two Drinks]. PRAXIS 2019; 108:655-662. [PMID: 31387501 DOI: 10.1024/1661-8157/a003280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Alcohol and the Bariatric Patient: When One Drink Becomes Two Drinks Abstract. Moderate consumption of alcohol is a risk factor for weight gain and obesity. Alcohol affects all components of the energy balance. Alcohol consumption is - as in the general population - also a widespread phenomenon in obese and bariatric patients. As a function of the bariatric surgery technique, alcohol metabolism is altered: gastric bypass surgery and sleeve gastrectomy lead to a faster absorption of alcohol, higher peak alcohol concentration and a longer alcohol persistence in the circulation. Further reward mechanisms for alcohol are changed, so that alcohol consumption is enhanced and promoted, with an increased risk to develop alcohol dependency. It is time to address these issues in the daily practice and to fill the existing research gaps.
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Affiliation(s)
- Paolo M Suter
- 1 Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
| | - Ludwig Perger
- 1 Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
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22
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Kauppila JH, Tao W, Santoni G, von Euler-Chelpin M, Lynge E, Tryggvadóttir L, Ness-Jensen E, Romundstad P, Pukkala E, Lagergren J. Effects of Obesity Surgery on Overall and Disease-Specific Mortality in a 5-Country Population-Based Study. Gastroenterology 2019; 157:119-127.e1. [PMID: 30940524 DOI: 10.1053/j.gastro.2019.03.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Bariatric surgery might reduce overall mortality from obesity. We investigated whether the survival times of patients who have had bariatric surgery are similar to those of the general population and are longer than of obese individuals who did not receive surgery. METHODS We performed a population-based cohort study of persons with a diagnosis of obesity listed in nationwide registries from Nordic countries from 1980 through 2012. Bariatric surgery was analyzed in relation to all-cause mortality and the obesity-related morbidities cardiovascular disease, diabetes, cancer, and suicide. Poisson models provided standardized mortality ratios (SMRs) with 95% confidence intervals (CIs). Multivariable Cox regression provided hazard ratios (HRs) for mortality in participants who did and did not have surgery. RESULTS Among 505,258 participants, 49,977 had bariatric surgery. Overall all-cause SMR was increased after surgery (1.94; 95% CI, 1.83-2.05) and increased with longer follow-up, to 2.28 (95% CI, 2.07-2.51) at ≥15 years after surgery. SMRs were increased for cardiovascular disease (2.39; 95% CI, 2.17-2.63), diabetes (3.67; 95% CI, 2.85-4.72), and suicide (2.39; 95% CI, 1.96-2.92) but not for cancer (1.05; 95% CI, 0.95-1.17); SMRs increased with time. In obese participants who did not have surgery, all-cause SMR was 2.15 (95% CI, 2.11-2.20), which remained stable during follow-up. Compared with obese participants who did not have surgery, patients who had bariatric surgery had decreased overall mortality from all causes (HR, 0.63; 95% CI, 0.60-0.66), cardiovascular disease (HR, 0.57; 95% CI, 0.52-0.63), and diabetes (HR, 0.38; 95% CI, 0.29-0.49) but increased mortality from suicide (HR, 1.68; 95% CI, 1.32-2.14). Cancer mortality was decreased overall (HR, 0.84; 95% CI, 0.76-0.93) but increased at ≥15 years of follow-up (HR, 1.20; 95% CI, 1.02-1.42). CONCLUSIONS In a study of persons with a diagnosis of obesity listed in nationwide registries of Nordic countries, we found that obese patients who have bariatric surgery have longer survival times than obese individuals who did not have bariatric surgery, but their mortality is higher than that of the general population and increases with time. Obesity-related morbidities could account for these findings.
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Affiliation(s)
- Joonas H Kauppila
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Wenjing Tao
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Giola Santoni
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Denmark
| | - Laufey Tryggvadóttir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland; Faculty of Medicine, Laeknagardur, University of Iceland, Reykjavik, Iceland
| | - Eivind Ness-Jensen
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Romundstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
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Roux-en-Y gastric bypass in rat reduces mu-opioid receptor levels in brain regions associated with stress and energy regulation. PLoS One 2019; 14:e0218680. [PMID: 31220174 PMCID: PMC6586324 DOI: 10.1371/journal.pone.0218680] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/06/2019] [Indexed: 12/23/2022] Open
Abstract
Roux-en-Y gastric bypass surgery (RYGB) is the most common and effective weight loss procedure for severe obesity. However, a significant increase in addictive behaviors and new-onset substance use disorder (SUD) are sometimes observed post-surgery. The endogenous opioid system is known to play a major role in motivated behavior and reward, as well as the abuse of substances, including alcohol, tobacco, opioids and highly palatable foods. Here, we examined the effects of RYGB on mu-opioid receptor levels in the brain. Male Sprague-Dawley rats were assigned to one of four groups: standard diet with sham surgery (control), ad libitum high-energy high-fat (HF) diet with sham surgery, calorie restricted HF diet with sham surgery (Sham-FR), or HF diet with RYGB surgery. Control and HF groups were fed their respective diets for 8 weeks, with surgery performed on the eighth week. After 9 weeks on their respective diets post-surgery, animals were sacrificed for mu-opioid receptor autoradiography using the [3H] [D-Ala2,N-Me-Phe4-Gly5-ol]- enkephalin (DAMGO) ligand. Rats with RYGB showed reduced DAMGO binding in the central amygdala compared to sham-operated HF diet controls, and in the hypothalamus compared to high-fat fed Sham-FR. Diet alone did not change [3H] DAMGO binding in any region. These findings show that RYGB surgery, independent of diet or caloric restriction, decreases mu opioid signaling in specific regions important for stress and energy regulation. Thus, RYGB surgery may lead to greater stress sensitivity via downregulated mu opioid signaling in the central amygdala, which may contribute to the observed increased risk in some subjects for addictive behavior.
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Developing an Efficient Screening Tool for Alcohol Use Disorder in Roux-en-Y Gastric Bypass Patients. Ann Surg 2019; 269:1010-1011. [PMID: 31082894 DOI: 10.1097/sla.0000000000003246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Sarwer DB, Allison KC, Wadden TA, Ashare R, Spitzer JC, McCuen-Wurst C, LaGrotte C, Williams NN, Edwards M, Tewksbury C, Wu J. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Relat Dis 2019; 15:650-655. [PMID: 30858009 DOI: 10.1016/j.soard.2019.01.029] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 02/08/2023]
Abstract
Outcomes of bariatric surgery, while frequently impressive, are not universal and vary between patients and across surgical procedures. Between 20% and 30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. The reasons for this are not fully understood, but likely involve both physiologic processes, behavioral factors, and psychological characteristics. Evidence suggests that preoperative psychosocial status and functioning can contribute to suboptimal weight losses and/or postoperative psychosocial distress. Much of this work has focused on the presence of recognized psychiatric diagnoses and with particular emphasis on mood disorders as well as binge eating disorder. Several studies have suggested that the presence of preoperative psychopathology is associated with suboptimal weight losses, postoperative complications, and less positive psychosocial outcomes. Contemporary psychological theory suggests that it may be shared features across diagnoses, rather than a discrete diagnosis, that better characterizes psychopathology. Mood and substance use disorders as well as binge eating disorder, share common features of impulsivity, although clinicians and researchers often use complementary, yet different terms, such as emotional dysregulation or disinhibition (i.e., loss of control over eating, as applied to food intake), to describe the phenomenon. Impulse control is a central factor in eating behavior and extreme obesity. It also may contribute to the experience of suboptimal outcomes after bariatric surgery, including smaller than expected weight loss and psychosocial distress. This paper reviews the literature in these areas of research and articulates a direction for future studies of these complex relationships among persons with extreme obesity.
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania.
| | - Kelly C Allison
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacqueline C Spitzer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Courtney McCuen-Wurst
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caitlin LaGrotte
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Edwards
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Colleen Tewksbury
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
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Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know? ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 63:344-369. [PMID: 29214946 DOI: 10.13109/zptm.2017.63.4.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUBJECT In view of the epidemic increase in severe obesity and the ineffectiveness of conservative weight-loss interventions, bariatric surgery delivers compelling results for patients with class II (BMI ≥ 35 kg/m²) and class III obesity (BMI ≥ 40 kg/m²), not only in reducing weight over the long term, but also in reducing obesity-related somatic comorbidity and improving psychosocial functioning and quality of life. Investigations into the psychosocial aspects of obesity surgery have proliferated over the last 15 years, providing a huge amount of essential research data. Yet the results are partly contradictory and highly dependent on the duration of follow-up. METHODS Based of a narrative review, this article provides an overview of the current status and recent developments of the reciprocal effects between bariatric surgery and psychosocial functioning. The review focused on eight domains representing important psychosomatic and psychosocial aspects of bariatric surgery. RESULTS Especially in cases of class II and III obesity, bariatric surgery is the only means to reduce bodyweight significantly and permanently, though they carry with them the associated risk factors of metabolic, cardiovascular, and oncological diseases.With regard to psychosocial and psychosomatic aspects, studies with a short-term catamnesis (approx. 3 years) speak in favor of an improvement in the quality of life including mental disorders. If we consider studies with longer follow-ups, however, the results are not as uniform. In particular, we observe an increase in harmful alcohol consumption, self-harm behavior, and suicide risk. CONCLUSIONS In light of mental well-being and thus also quality of life, bariatric surgery would appear to convey an elevated risk for a minority of patients.Yet identifying these patients before surgery has so far been insufficient.
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How Do Individuals Develop Alcohol Use Disorder After Bariatric Surgery? A Grounded Theory Exploration. Obes Surg 2018; 28:717-724. [PMID: 29032488 DOI: 10.1007/s11695-017-2936-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for severe obesity. However, following Roux-en-Y gastric bypass (RYGB) surgery, a small minority of patients develop new-onset alcohol use disorder (AUD), the aetiology of which is poorly understood. AIM The aim is to construct a theory to explain the development of AUD among a sample of individuals who reported problematic drinking following RYGB. METHOD Semi-structured interviews were conducted with eight RYGB patients diagnosed with AUD attending a multi-disciplinary outpatient weight management service at a public hospital in the Republic of Ireland. A constructivist grounded theory methodology was used to analyse interview transcripts. RESULTS Participants' main concern was identified as 'unresolved psychological issues' which were managed by 'external coping mechanisms', namely, 'eating to cope'. After RYGB, comfort eating was no longer possible to the same extent. Following a 'honeymoon period', participants' need for an external coping mechanism resurfaced. 'Filling the void' provides a framework to explain how participants managed the symptoms of their unresolved psychological issues through 'behavioural substitution', that is, drinking alcohol instead of eating. CONCLUSION The theoretical framework of 'filling the void' adds to contemporary research that conceptualises AUD behavioural substitution as 'addiction transfer' by describing the process by which the phenomenon occurs as well as the characteristics of participants. The clinical implication of this research is to advocate for a reshaping of treatment of RYGB patients, with increased psychological input following surgery.
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28
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Hamilton J, Swenson S, Hajnal A, Thanos PK. Roux-en-Y gastric bypass surgery normalizes dopamine D1, D2, and DAT levels. Synapse 2018; 72. [PMID: 29992624 DOI: 10.1002/syn.22058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 02/28/2024]
Abstract
Roux-en-Y gastric bypass surgery (RYGB) is one of the most effective treatments for morbid obesity. However, increased substance abuse following RYGB has been observed clinically. This study examined the effects of RYGB on the dopamine system to elucidate these observed changes in reward-related behavior. Rats were assigned to four groups: normal diet with sham surgery, ad libitum high fat (HF) diet with sham surgery, restricted HF diet with sham surgery, and HF diet with RYGB surgery. Following surgeries, rats were kept on their respective diets for 9 weeks before they were sacrificed. [3 H]SCH 23390, [3 H]Spiperone, and [3 H]WIN35 428 autoradiography was performed to quantify the effects of diet and RYGB surgery on dopamine type 1-like receptor (D1R)-like, dopamine type 2-like receptor (D2R)-like, and dopamine transporter (DAT) binding. Rats on a chronic HF diet became obese with reduced D1R-like binding within the ventrolateral striatum and the nucleus accumbens core, reduced D2R-like binding in all areas of the striatum and nucleus accumbens core and shell, and reduced DAT binding in the dorsomedial striatum. Restricted HF diet rats showed similar reductions in D1R-like and D2-R-like binding as the obese rats, and reduced DAT binding within all areas of the striatum. Both RYGB and restricted HF diet rats showed similar weight reductions, with RYGB rats showing no difference in binding compared to controls. The observed changes in binding between non-treated obese rats and RYGB rats demonstrates that HF dietary effects on the dopamine system were reversed by RYGB.
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Affiliation(s)
- John Hamilton
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, New York
- Department of Psychology, University of Buffalo, Buffalo, New York
| | - Sabrina Swenson
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, New York
| | - Andras Hajnal
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Panayotis K Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, New York
- Department of Psychology, University of Buffalo, Buffalo, New York
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29
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Gregorio VD, Lucchese R, Vera I, Silva GC, Silva A, Moraes RCC. THE ALCOHOL CONSUMPTION IS AMENDED AFTER BARIATRIC SURGERY? AN INTEGRATIVE REVIEW. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 31:e1378. [PMID: 29972406 PMCID: PMC6044189 DOI: 10.1590/0102-672020180001e1378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/06/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bariatric surgery has been an alternative when conservative methods of weight loss fail. Patients undergoing bariatric surgery have an increased risk of up to 6.5% of problems related to alcohol. OBJETIVE To review the literature about the changes on alcohol consumption in this public. METHOD Database was accessed from June of 2015 to January of 2016 by searching "bariatric surgery" AND "alcoholism", and their Portuguese equivalents. Science Direct, PubMed, Lilacs and Medline, besides manual search, were searched. To be included, the paper should have been published between 2005-2016 and related to bariatric surgery and alcoholism. Theses, dissertations, unpublished papers, case reports and theoretical studies were excluded. In 2005 there was only one review of change in alcohol metabolism in patients undergoing bariatric surgery. There were no publications in 2006. In 2007, only one study was published, and it did not meet the inclusion criteria. In 2010, there was an increase of 13% in publications and of 20% in 2012, reaching 40% in 2013. CONCLUSION The prevalence and incidence of alcohol consumption in relation to the postoperative time was six months to three years with higher incidence in men. Roux-en-Y gastric bypass showed greater association with increased alcohol consumption during the postoperative period. This and other studies showed that the pattern of alcohol consumption is important to be faced as a problem in bariatric surgery follow-up.
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Affiliation(s)
| | | | - Ivânia Vera
- Universidade Federal de Goiás , Goiânia, GO, Brazil
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Orellana ER, Jamis C, Horvath N, Hajnal A. Effect of vertical sleeve gastrectomy on alcohol consumption and preferences in dietary obese rats and mice: A plausible role for altered ghrelin signaling. Brain Res Bull 2018; 138:26-36. [PMID: 28802901 PMCID: PMC6537102 DOI: 10.1016/j.brainresbull.2017.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/05/2017] [Accepted: 08/07/2017] [Indexed: 12/13/2022]
Abstract
Vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) are the most common surgical options for the treatment of obesity and metabolic disorder. Whereas RYGB may result in greater and more durable weight loss, recent clinical and pre-clinical studies in rats have raised concerns that RYGB surgery may increase risk for alcohol use disorder (AUD). In contrast, recent clinical reports suggest a lesser risk for AUD following VSG, although no preclinical studies have been done to confirm that. Therefore, the present study sought to determine the effects of VSG on ethanol intake and preferences in rodent models using protocols similar to those previously used in animal studies for RYGB. Male Sprague Dawley rats and male C57B6 mice were made obese on a high fat diet (60%kcal from fat) and received VSG or no surgery (controls). All animals then were given access to increasing concentrations of ethanol (2%, 4%, 6%, and 8%), presented for few days each. Compared to controls, VSG rats consumed significantly less of 2, 6 and 8% ethanol and showed significantly reduced preferences to 6 and 8% ethanol over water. VSG mice also displayed reduced intake and preference for 6 and 8% ethanol solutions. After a two-week period of forced abstinence, 8% ethanol was reintroduced and the VSG rats and mice continued to exhibit reduced consumption and less preference for ethanol. Regarding the underlying mechanism, we hypothesized that the removal of the ghrelin producing part of the stomach in the VSG surgery is a possible contributor to the observed reduced ethanol preference. To test for functional changes at the ghrelin receptors, the VSG and control rats were given IP injections of acyl-ghrelin (2.5nmol and 5nmol) prior to ethanol access. Neither concentration of ghrelin resulted in a significant increase in 8% ethanol consumption of VSG or control subjects. Next, the rats were given IP injections of the ghrelin receptor antagonist, JMV (2.5mg/kg body weight). This dose induced a significant reduction in 8% ethanol consumption in the VSG group, but no effect on ethanol intake in the controls. While ghrelin injection was uninformative, increased sensitivity to subthreshold doses of the ghrelin receptor antagonist may indicate reduced ghrelin signaling following VSG. Overall, these findings suggest that bariatric patients with increased susceptibility to AUD may benefit from receiving VSG instead of RYGB surgery, and that changes in ghrelin signaling, at least in part, may play a role in the differential AUD risks between the two most commonly performed bariatric surgical procedures.
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Affiliation(s)
- Elise R Orellana
- Department of Neural and Behavioral Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, 17033, USA
| | - Catherine Jamis
- Department of Neural and Behavioral Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, 17033, USA
| | - Nelli Horvath
- Department of Neural and Behavioral Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, 17033, USA
| | - Andras Hajnal
- Department of Neural and Behavioral Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, 17033, USA.
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Azam H, Shahrestani S, Phan K. Alcohol use disorders before and after bariatric surgery: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:148. [PMID: 29862237 DOI: 10.21037/atm.2018.03.16] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background There have been increasing reports of increased risk of alcohol use disorder (AUD) in the post bariatric surgery patient. The aim of this systematic review and meta-analysis is to observe the rate of AUD in the postoperative period following bariatric surgery for weight management. Methods Electronic searches were performed using six databases from their dates of inception to January 2017. Studies observing the trend in AUD post bariatric surgery were identified. Data for relevant endpoint was extracted and analysed. Results Ten studies were identified for inclusion of analyses. One year post operatively pooled odds were 1.004 [95% confidence interval (CI), 0.921-1.094; P=0.935], with no significant difference found in the proportion of patients with AUD at 1 year vs. pre-surgery. Two years post operatively pooled odds were 0.981 (95% CI, 0.843-1.142; P=0.806), with no significant difference found in the proportion of patients with AUD at 2 years vs. pre-surgery. Three years post operatively pooled odds were 1.825 (95% CI, 1.53-2.178; P<0.001) with a significant increase in AUD particularly with gastric bypass surgery. Conclusions In conclusion, prevalence of AUD increases in patients undergoing gastric bypass surgery but not gastric banding. The risk of AUD was found to not be significantly increased in the first 2 years postoperatively but increasing after this period.
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Affiliation(s)
- Hamza Azam
- Faculty of Medicine, Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Sara Shahrestani
- Faculty of Medicine, Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Kevin Phan
- Faculty of Medicine, Westmead Clinical School, University of Sydney, Sydney, Australia.,Liverpool Hospital, Liverpool, Sydney, Australia
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Vogel E. Operating (on) the self: transforming agency through obesity surgery and treatment. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:508-522. [PMID: 29235133 DOI: 10.1111/1467-9566.12654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, I describe the processes through which patients diagnosed with 'morbid obesity' become active subjects through undergoing obesity surgery and an empowerment lifestyle programme in a Dutch obesity clinic. Following work in actor-network theory and material semiotics that complicates the distinction between active and passive subjects, I trace how agency is configured and re-distributed throughout the treatment trajectory. In the clinic's elaborate care assemblage - consisting of dieticians, exercise coaches and psychologists - the person is not only actively involved in his/her own change, the subject of intervention is the self as 'actor': his/her material constitution, inclinations and feelings. The empirical examples reveal that a self becomes capable of self-care only after a costly and laborious conditioning through which patients are completely transformed. In this work, the changed body, implying a new, potentially disruptive reality that patients must learn to cope with, is pivotal to what the patient can do and become. Rather than striving to be disembodied, self-contained liberal subjects that make sensible decisions for their body, patients become empowered through submission and attachment and by arranging support.
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Affiliation(s)
- Else Vogel
- Department of Thematic Studies - Technology and Social Change, Linköping University, Sweden
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Boyle M, Masson S, Anstee QM. The bidirectional impacts of alcohol consumption and the metabolic syndrome: Cofactors for progressive fatty liver disease. J Hepatol 2018; 68:251-267. [PMID: 29113910 DOI: 10.1016/j.jhep.2017.11.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 12/12/2022]
Abstract
Current medical practice artificially dichotomises a diagnosis of fatty liver disease into one of two common forms: alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). Together, these account for the majority of chronic liver diseases worldwide. In recent years, there has been a dramatic increase in the prevalence of obesity and metabolic syndrome within the general population. These factors now coexist with alcohol consumption in a substantial proportion of the population. Each exposure sensitises the liver to the injurious effects of the other; an interaction that drives and potentially accelerates the genesis of liver disease. We review the epidemiological evidence and scientific literature that considers how alcohol consumption interacts with components of the metabolic syndrome to exert synergistic or supra-additive effects on the development and progression of liver disease, before discussing how these interactions may be addressed in clinical practice.
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Affiliation(s)
- Marie Boyle
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Steven Masson
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Quentin M Anstee
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Jerlhag E. GLP-1 signaling and alcohol-mediated behaviors; preclinical and clinical evidence. Neuropharmacology 2018; 136:343-349. [PMID: 29337226 DOI: 10.1016/j.neuropharm.2018.01.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/18/2017] [Accepted: 01/09/2018] [Indexed: 12/20/2022]
Abstract
Alcohol addiction, affecting approximately four percent of the population, contributes significantly to the global burden of diseases and is a substantial cost to the society. The neurochemical mechanisms regulating alcohol mediated behaviors is complex and in more recent years a new physiological role of the gut-brain peptides, traditionally known to regulate appetite and food intake, have been suggested. Indeed, regulators of alcohol-mediated behaviors. One of these gut-brain peptides is the annorexigenic peptide glucagon-like peptide-1 (GLP-1), Preclinical studies show that GLP-1 receptor activation, either by GLP-1 or analogues, attenuate the ability of alcohol to activate the mesolimbic dopamine system as well as decrease alcohol consumption and operant self-administration. In further support for the endogenous GLP-1 system in addiction processes are the experimental data showing that a GLP-1 receptor antagonist increases alcohol intake. Moreover, GLP-1 receptor agonists prevent the ability of other addictive drugs to activate the mesolimbic dopamine system. The number of clinical studies is limited, but show i) that genetic variation in the GLP-1 receptor gene is associated with alcohol addiction as well as increased alcohol infusion in humans, ii) that plasma levels of GLP-1 are associated with the subjective experience of cocaine and iii) that a GLP-1 receptor agonist reduces alcohol intake in patients with type-2 diabetes mellitus. These experimental and clinical studies raises the concern that clinically available GLP-1 receptor agonists deserves to be tested as potential treatments of patients with addictive disorders including alcohol addiction. This article is part of the Special Issue entitled 'Metabolic Impairment as Risk Factors for Neurodegenerative Disorders.'
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Affiliation(s)
- Elisabet Jerlhag
- Department of Pharmacology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Medicinaregatan 13A, SE-405 30 Gothenburg, Sweden.
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Blackburn AN, Hajnal A, Leggio L. The gut in the brain: the effects of bariatric surgery on alcohol consumption. Addict Biol 2017; 22:1540-1553. [PMID: 27578259 DOI: 10.1111/adb.12436] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 12/19/2022]
Abstract
Obesity represents a major medical and public health problem worldwide. Efforts have been made to develop novel treatments, and among them bariatric surgery is used as an effective treatment to achieve significant, long-term weight loss and alleviate medical problems related to obesity. Alcohol use disorder (AUD) is also a leading cause of morbidity and mortality worldwide. Recent clinical studies have revealed a concern for bariatric surgery patients developing an increased risk for alcohol consumption, and for AUD. A better understanding of the relationship between bariatric surgery and potential later development of AUD is important, given the critical need of identifying patients at high risk for AUD. This paper reviews current clinical and basic science research and discusses potential underlying mechanisms. Special emphasis in this review is given to recent work suggesting that, alterations in alcohol metabolism/pharmacokinetics resulting from bariatric surgery are unlikely to be the primary or at least the only explanation for increased alcohol use and development of AUD, as changes in brain reward processing are also likely to play an important role. Additional studies are needed to clarify the potential role and mechanisms of how bariatric surgery may increase alcohol use and lead to AUD development.
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Affiliation(s)
- Ashley N. Blackburn
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology; National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health; Bethesda MD USA
| | - Andras Hajnal
- Department of Neural and Behavioral Sciences; Pennsylvania State University College of Medicine; PA USA
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology; National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health; Bethesda MD USA
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences; Brown University; Providence RI USA
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Taylor VH, Hensel J. Multimorbidity: A Review of the Complexity of Mental Health Issues in Bariatric Surgery Candidates Informed by Canadian Data. Can J Diabetes 2017. [DOI: 10.1016/j.jcjd.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ivezaj V, Stoeckel LE, Avena NM, Benoit SC, Conason A, Davis JF, Gearhardt AN, Goldman R, Mitchell JE, Ochner CN, Saules KK, Steffen KJ, Stice E, Sogg S. Obesity and addiction: can a complication of surgery help us understand the connection? Obes Rev 2017; 18:765-775. [PMID: 28429582 DOI: 10.1111/obr.12542] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/12/2017] [Accepted: 02/28/2017] [Indexed: 12/15/2022]
Abstract
Obesity is a multifactorial, chronic disease that has proven difficult to treat. An increased understanding of aetiological mechanisms is critical to the development of more effective obesity prevention and treatment strategies. A growing body of empirical evidence has demonstrated parallels between obesity, overeating and substance abuse, including shared behavioural, psychological and neurophysiological factors implicated in the excessive intake of both food and substances of abuse. Several different lines of research have recently emerged that hold the potential to shed light on the connection between obesity, food reward and addiction, with studies examining changes in alcohol use/misuse after weight loss surgery providing a particularly interesting perspective on these interrelationships. However, these lines of investigation have proceeded in relative isolation, and relevant research findings have yet to be integrated in a synthesized, comprehensive manner. To provide an opportunity to achieve such a synthesis, a scientific symposium was convened at the Radcliffe Institute in Cambridge, Massachusetts. Invited participants were researchers working in diverse domains related to the intersection between obesity and addiction. Extensive discussion was generated suggesting novel research directions. In this article, we summarize and synthesize the symposium participants' ongoing research in this area, incorporating additional relevant research holding potential clues regarding the connections between obesity, weight loss surgery and addiction.
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Affiliation(s)
- V Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - L E Stoeckel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - N M Avena
- Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S C Benoit
- Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - A Conason
- Division of Endocrinology, Diabetes, and Metabolism, Mt. Sinai West, New York, NY, USA
| | - J F Davis
- Department of Integrative Physiology & Neuroscience, Washington State University College of Veterinary Medicine, Pullman, WA, USA
| | - A N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - R Goldman
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - J E Mitchell
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.,Neuropsychiatric Research Institute, Fargo, ND, USA
| | - C N Ochner
- Kendall Regional Medical Center, Hospital, Corporation of America - Physician Services Group, Miami, FL, USA
| | - K K Saules
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - K J Steffen
- Neuropsychiatric Research Institute, Fargo, ND, USA.,School of Pharmacy, North Dakota State University, Fargo, ND, USA
| | - E Stice
- Oregon Research Institute, Eugene, OR, USA
| | - S Sogg
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Weight Center, Boston, MA, USA
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Gregorio VD, Lucchese R, Vera I, Silva GC, Silva A, Moraes RCC. THE ALCOHOL CONSUMPTION IS AMENDED AFTER BARIATRIC SURGERY? AN INTEGRATIVE REVIEW. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 29Suppl 1:111-115. [PMID: 27683790 PMCID: PMC5064260 DOI: 10.1590/0102-6720201600s10027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/03/2016] [Indexed: 11/27/2022]
Abstract
Background Bariatric surgery has been an alternative when conservative methods of weight loss fail. Patients undergoing bariatric surgery have an increased risk of up to 6.5% of problems related to alcohol Objective: Integrative review out to analyze the change of alcohol consumption in this public Method: Database was accessed from June of 2015 to January of 2016 by searching "bariatric surgery" AND "alcoholism", and their Portuguese equivalents. ScienceDirect, PubMed, Lilacs and Medline, besides manual search, were searched. To be included, the paper should have been published between 2005-2016 and related to bariatric surgery and alcoholism. Theses, dissertations, unpublished papers, case reports and theoretical studies were excluded, and a database was subsequently composed Results: In 2005 there was only a review of change in alcohol metabolism in patients undergoing bariatric surgery. There were no publications in 2006. In 2007, only one study was published, and it did not meet the inclusion criteria. In 2010, there was an increase of 13% in publications and of 20% in 2012, reaching 40% in 2013 Conclusion: The prevalence and incidence of alcohol consumption in relation to the postoperative time was six months to three years with higher incidence for follow-up treatment by men. Roux-en-Y gastric bypass showed greater association with increased consumption of alcohol during the postoperative period. Alcohol consumption proved to be essential to be faced in bariatric surgery.
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Affiliation(s)
| | - Roselma Lucchese
- Universidade Federal de Goiás (Federal Univesity of Goiás), Goiânia, GO Brazil
| | - Ivânia Vera
- Universidade Federal de Goiás (Federal Univesity of Goiás), Goiânia, GO Brazil
| | - Graciele C Silva
- Universidade Federal de Goiás (Federal Univesity of Goiás), Goiânia, GO Brazil
| | - Andrecia Silva
- Universidade Federal de Goiás (Federal Univesity of Goiás), Goiânia, GO Brazil
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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Abstract
BACKGROUND Prevalence of obesity has increased dramatically. Obese individuals may undergo bariatric surgery to lose excessive body fat and mitigate obesity-related comorbidities. However, bariatric patients are particularly vulnerable to substance use problems. We conducted a review to examine the prevalence change and factors associated with substance use and determine the association between substance use and health status after weight loss among bariatric patients. METHODS We searched peer-reviewed articles published between January 1990 and January 2015 in several databases (PubMed, PsycINFO, Cochrane Library, Google Scholar) using different keywords combinations. Studies that focused on pre-surgery substance use only or without reported effect measurements were excluded. RESULTS Overall, 40 studies were included in the review. Preoperative history of substance use was a reliable correlate of postoperative substance use. The prevalence of postoperative alcohol use was higher among patients with preoperative history of alcohol use than those without. Postoperative prevalence of alcohol use ranged from 7.6% to 11.8%. No significant prevalence change in cigarette smoking from pre-to postoperative period was observed. Time effect was not observed on smoking or drug use prevalence, while an increase in alcohol consumption was inconsistent across studies. The proportion of new-onset substance users among bariatric patients after surgery ranged from 34.3% to 89.5%. CONCLUSION Substance use is associated with poor health among bariatric patients. Preoperative assessment and postoperative follow-up should include interventions to reduce relapse among users and prevent substance use initiation.
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Affiliation(s)
- Linlin Li
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016; 12:731-749. [DOI: 10.1016/j.soard.2016.02.008] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 12/20/2022]
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Parikh M, Johnson JM, Ballem N. ASMBS position statement on alcohol use before and after bariatric surgery. Surg Obes Relat Dis 2016; 12:225-30. [DOI: 10.1016/j.soard.2015.10.085] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Marek RJ, Ben-Porath YS, Heinberg LJ. Understanding the role of psychopathology in bariatric surgery outcomes. Obes Rev 2016; 17:126-41. [PMID: 26783067 DOI: 10.1111/obr.12356] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 09/28/2015] [Accepted: 10/16/2015] [Indexed: 12/01/2022]
Abstract
Bariatric surgery is the most effective treatment for morbid obesity; however, a subset of patients who undergo this procedure regain weight or achieve suboptimal weight loss results. A large number of studies have examined whether psychological variables play a role in weight loss surgery outcome. Although presurgical psychopathology has been found to be associated with suboptimal results in some studies, this literature is equivocal. These inconsistent findings are reviewed and considered in the context of contemporary models of psychopathology. More specifically, the review focuses on the limitations of atheoretical, descriptive diagnostic systems and examines whether comorbidity within the mood/anxiety disorders, impulse control/substance use disorders and thought disorders can account for the inconsistent findings reported to date. Contemporary models of psychopathology are highlighted and linked to the Research Domain Criteria, which have been advanced by the National Institute of Health. Means for assessing psychological constructs congruent with these models are reviewed. Recommendations are made for standardizing approaches to investigating how psychopathology contributes to suboptimal bariatric surgery outcomes.
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Affiliation(s)
- R J Marek
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Y S Ben-Porath
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - L J Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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44
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45
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Himes SM, Grothe KB, Clark MM, Swain JM, Collazo-Clavell ML, Sarr MG. Stop regain: a pilot psychological intervention for bariatric patients experiencing weight regain. Obes Surg 2015; 25:922-7. [PMID: 25750006 DOI: 10.1007/s11695-015-1611-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND A subset of bariatric patients fails to achieve or maintain long-term successful weight loss. Psychological and behavioral factors contributing to poor long-term outcomes include decreased adherence to surgical eating guidelines, life stressors that derail weight maintenance, unhealthy eating patterns, and substance use. OBJECTIVES A 6-week pilot group behavioral intervention utilizing techniques of cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) was developed to treat bariatric patients experiencing weight regain. SETTING Patients were treated at a large Midwestern academic medical center. METHODS Twenty-eight patients (93% female, 100% Caucasian) with a mean age of 53 and a mean BMI of 35.6 had regained an average of 17 kg or 37% of the weight lost after initially successful Roux-en-Y gastric bypass (RYGB). All patients completed the Structured Clinical Interview for DSM-IV-TR (SCID I) modules assessing mood and substance dependence, and completed a series of questionnaires before and after group treatment, with weekly assessment of depressive symptoms, binge eating, and alcohol use. Results were analyzed utilizing repeated measures ANOVA. RESULTS Weight decreased during the intervention by an average of 1.6 ± 2.38 kg (p ≤ 0.01). Level of depressive symptoms improved for treatment completers (p ≤ 0.01). Food records indicated that grazing patterns decreased (p ≤ 0.01) and subjective binge eating episodes decreased (p ≤ 0.03). CONCLUSIONS A 6-week pilot group behavioral intervention demonstrated an ability to help patients reverse their pattern of weight regain. Tailored behavioral interventions may be a useful treatment to enhance maintenance of long-term weight loss.
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Affiliation(s)
- Susan M Himes
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine at Brown University, Providence, RI, 02904, USA,
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46
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Steffen KJ, Engel SG, Wonderlich JA, Pollert GA, Sondag C. Alcohol and Other Addictive Disorders Following Bariatric Surgery: Prevalence, Risk Factors and Possible Etiologies. EUROPEAN EATING DISORDERS REVIEW 2015; 23:442-50. [DOI: 10.1002/erv.2399] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Kristine J. Steffen
- Department of Pharmaceutical Sciences, College of Pharmacy, Nursing, and Allied Sciences; North Dakota State University; Fargo ND USA
- Neuropsychiatric Research Institute; Fargo ND USA
| | | | | | | | - Cindy Sondag
- Department of Neuroscience; University of North Dakota; ND USA
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Spadola CE, Wagner EF, Dillon FR, Trepka MJ, De La Cruz-Munoz N, Messiah SE. Alcohol and Drug Use Among Postoperative Bariatric Patients: A Systematic Review of the Emerging Research and Its Implications. Alcohol Clin Exp Res 2015; 39:1582-601. [PMID: 26241357 PMCID: PMC4608681 DOI: 10.1111/acer.12805] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/08/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Emerging research suggests that some bariatric surgery patients are at a heightened risk for developing substance use problems, especially alcohol use problems. METHODS An exhaustive literature review was conducted in January 2015 to investigate all articles published that included data on postoperative alcohol use, alcohol use disorders, and illicit drug use among bariatric surgery patients. RESULTS Twenty-three studies reported on alcohol and/or substance use among bariatric patients. Six studies longitudinally assessed alcohol use behaviors; 3 of these studies found an increase in alcohol use following surgery. Six studies were cross-sectional, and 2 studies assessed medical records. Five studies investigated the prevalence of admissions to substance abuse treatment, and 3 studies combined alcohol and drug use data in a single index. Six studies reported on illicit drug use and reported low-postoperative use. The studies' samples were primarily non-Hispanic white females in their upper 40s, and only 11 of the 23 studies utilized validated assessment instruments. CONCLUSIONS Studies employing longitudinal designs and large sample sizes indicate that bariatric patients who had the gastric bypass procedure are at an elevated risk for alcohol use problems postoperatively. Research also indicates that bariatric surgery patients might be overrepresented in substance abuse treatment facilities. Risk factors for problematic postoperative alcohol use include regular or problematic alcohol use presurgery, male gender, younger age, tobacco use, and symptoms of attention deficient and hyperactivity disorder. As a whole, however, studies indicate bariatric surgery patients demonstrate a low prevalence of problematic alcohol use, and studies about gastric bypass patients are not entirely conclusive. Prospective, longitudinal studies are needed, utilizing standardized and validated alcohol assessment instruments that follow postoperative bariatric patients well beyond 2 years, and account for types of bariatric procedure. Finally, study samples with greater racial/ethnic diversity and wider age ranges are needed.
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Affiliation(s)
- Christine E Spadola
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Eric F Wagner
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Frank R Dillon
- Department of Educational and Counseling Psychology, University at Albany, State University of New York, Albany, New York
| | - Mary Jo Trepka
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | | | - Sarah E Messiah
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida
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Increased intravenous morphine self-administration following Roux-en-Y gastric bypass in dietary obese rats. Brain Res Bull 2015; 123:47-52. [PMID: 26304761 DOI: 10.1016/j.brainresbull.2015.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 12/30/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) surgery is a commonly performed and very effective method to achieve significant, long-term weight loss. Opioid analgesics are primarily used to manage postoperative pain as fewer alternative medication options are available for bariatric surgery patients than for the general population. Recent clinical studies support a greater risk for substance use following bariatric surgery, including an increased use of opioid medications. The present study is the first to study morphine self-administration in a rat model of RYGB. High fat diet-induced obese (HFD-DIO) rats underwent RYGB (n=14) or sham-surgery with ad libitum HFD (SHAM, n=14) or a restricted amount that resulted in weight matched to the RYGB cohort (SHAM-WM, n=8). An additional normal-diet (ND, n=7), intact (no surgery) group of rats was included. Two months after the surgeries, rats were fitted with jugular catheters and trained on a fixed ratio-2 lick task to obtain morphine intravenously. Both morphine-seeking (number of licks on an empty spout to obtain morphine infusion) and consumption (number of infusion) were significantly greater in RYGB than any control group beginning on day 3 and reached a two-fold increase over a period of two weeks. These findings demonstrate that RYGB increases motivation for taking morphine and that this effect is independent of weight loss. Further research is warranted to reveal the underlying mechanisms and to determine whether increased morphine use represents a risk for opioid addiction following RYGB. Identifying risk factors preoperatively could help with personalized postoperative care to prevent opioid abuse and addiction.
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49
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Rummell CM, Heinberg LJ. Assessing marijuana use in bariatric surgery candidates: should it be a contraindication? Obes Surg 2015; 24:1764-70. [PMID: 24913244 DOI: 10.1007/s11695-014-1315-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Research has demonstrated negative effects of both alcohol and tobacco use after bariatric surgery. However, no research to date has examined effects of cannabis use after bariatric surgery, even though cannabis is the most commonly used illicit drug in the USA. Literature review reveals that many practitioners generalize from data regarding alcohol abuse to all substances. Further, many screening protocols fail to differentiate between varying levels of cannabis use. The current report aims to (1) review the relevant literature on marijuana use and its potential consequences among bariatric patients, (2) discuss relevant problems and gaps in this literature, and (3) make preliminary recommendations regarding the assessment and treatment planning of bariatric candidates who disclose marijuana use.
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Affiliation(s)
- Christina M Rummell
- Bariatric and Metabolic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/M61, Cleveland, OH, 44195, USA,
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50
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Thanos PK, Michaelides M, Subrize M, Miller ML, Bellezza R, Cooney RN, Leggio L, Wang GJ, Rogers AM, Volkow ND, Hajnal A. Roux-en-Y Gastric Bypass Alters Brain Activity in Regions that Underlie Reward and Taste Perception. PLoS One 2015; 10:e0125570. [PMID: 26039080 PMCID: PMC4454506 DOI: 10.1371/journal.pone.0125570] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/25/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) surgery is a very effective bariatric procedure to achieve significant and sustained weight loss, yet little is known about the procedure's impact on the brain. This study examined the effects of RYGB on the brain's response to the anticipation of highly palatable versus regular food. METHODS High fat diet-induced obese rats underwent RYGB or sham operation and were then tested for conditioned place preference (CPP) for the bacon-paired chamber, relative to the chow-paired chamber. After CPP, animals were placed in either chamber without the food stimulus, and brain-glucose metabolism (BGluM) was measured using positron emission tomography (μPET). RESULTS Bacon CPP was only observed in RYGB rats that had stable weight loss following surgery. BGluM assessment revealed that RYGB selectively activated regions of the right and midline cerebellum (Lob 8) involved in subjective processes related to reward or expectation. Also, bacon anticipation led to significant activation in the medial parabrachial nuclei (important in gustatory processing) and dorsomedial tegmental area (key to reward, motivation, cognition and addiction) in RYGB rats; and activation in the retrosplenial cortex (default mode network), and the primary visual cortex in control rats. CONCLUSIONS RYGB alters brain activity in areas involved in reward expectation and sensory (taste) processing when anticipating a palatable fatty food. Thus, RYGB may lead to changes in brain activity in regions that process reward and taste-related behaviors. Specific cerebellar regions with altered metabolism following RYGB may help identify novel therapeutic targets for treatment of obesity.
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Affiliation(s)
- Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Lab, Department of Psychology, Stony Brook University, Stony Brook, NY, United States of America
| | - Mike Michaelides
- Department of Neurosciences, Mt. Sinai Medical Center, NY, NY, United States of America
| | - Mike Subrize
- Behavioral Neuropharmacology and Neuroimaging Lab, Department of Psychology, Stony Brook University, Stony Brook, NY, United States of America
| | - Mike L. Miller
- Department of Neurosciences, Mt. Sinai Medical Center, NY, NY, United States of America
| | - Robert Bellezza
- Behavioral Neuropharmacology and Neuroimaging Lab, Department of Psychology, Stony Brook University, Stony Brook, NY, United States of America
| | - Robert N. Cooney
- Department. of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, NIAAA, NIH, Bethesda, MD, United States of America
- Intramural Research Program, NIDA, NIH, Baltimore, MD, United States of America
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States of America
| | - Gene-Jack Wang
- NIAAA Intramural Research Program, NIH, Bethesda, MD, United States of America
| | - Ann M. Rogers
- Department of Surgery, Penn State University, Hershey, PA, United States of America
| | - Nora D. Volkow
- NIAAA Intramural Research Program, NIH, Bethesda, MD, United States of America
| | - Andras Hajnal
- Department of Neural and Behavioral Sciences, Penn State University, Hershey, PA, United States of America
- Department of Surgery, Penn State University, Hershey, PA, United States of America
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