One in five people who undergo a popular weight loss surgery is likely to develop an alcohol use disorder within five years, according to a new study from the University of Pittsburgh.
Epidemiology professor Wendy King and her colleagues followed more than 2,000 patients in six cities who received Roux-en-Y gastric bypass surgery. Unlike other procedures that use bands and sleeves and can later be modified, the Roux-en-Y procedure more permanently reduces the size of the stomach so people feel full more quickly, consume fewer calories, and ultimately lose weight.
Results published in 2012 showed that about 9 percent of patients who did not report having an alcohol use disorder before their surgery did develop symptoms within two years.
By year five, that proportion had jumped to 20.8 percent.
“So this study with the longer follow up, what we found is that people that hadn’t developed symptoms of alcohol use disorder in the first two years may in year three, may in year five, may in year seven,” King said. “There’s not really just a short period that people need to be monitored, but they need to be monitored over the long term.”
King said symptoms of alcohol use disorders include not being able to stop drinking once starting, drinking in the morning just to get going and failing to meet expectations at work or school because of alcohol use.
The American Society for Metabolic and Bariatric Surgery recommends that patients be screened for alcohol use disorder before the surgery, and that people who have an active alcohol use disorder not be candidates for the procedure.
The group also recommends that people considered at “high risk” for alcohol use disorder indefinitely abstain from drinking after surgery, but King said that definition of “high risk” is unclear.
“I think the findings of our studies and a few other recent studies indicate that, really, anybody undergoing the Roux-en-Y gastric bypass should be considered in the high risk group simply by the surgical procedure alone,” she said.
King said earlier research has shown that the procedure is associated with higher elevation of alcohol in the blood over a shorter time period. She said animal studies have suggested that the surgery might also increase sensitivity in areas of the brain associated with reward.
A less popular and less invasive form of weight loss surgery, called laparoscopic adjustable gastric banding, has not been shown to correlate with alcohol use disorders, though patients were shown to increase alcohol consumption. In this procedure, an adjustable band is used to diminish the amount of food the stomach can hold.
A third form of bariatric surgery, which uses a sleeve to reduce the size of the stomach, has increased in popularity since this study began. King said it will be important to study that procedure in the future as well.
In 2015, the most recent year for which data is available, about 196,000 people had bariatric surgery, up from about 158,000 in 2011. In that time, the percentage of people opting for Roux-en-Y surgery has shrunk from 37 percent in 2011 to 23 percent in 2015.