Gastric bypass surgery may elevate risk for nonalcohol substance use disorders
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Key takeaways:
- Gastric bypass surgery was linked to an increased risk for nonalcohol substance use disorder compared with no surgery.
- No increased risk for substance use was observed for other bariatric surgery types.
Adults with obesity who undergo gastric bypass surgery may have a higher risk for nonalcohol substance use disorder than those who do not undergo bariatric surgery, according to a study published in Obesity.
In data from the prospective Swedish Obese Subjects study, which enrolled adults who underwent bariatric surgery as well as control participants who did not have surgery, the risk for nonalcohol substance use was more than 2.5 times higher with gastric bypass compared with no surgery. However, no increased risk was observed with other bariatric surgery procedures.
“This study contributed knowledge on this topic, but further studies are needed before clinical recommendations potentially should be changed,” Per-Arne Svensson, PhD, professor in the department of molecular and clinical medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg in Sweden, told Healio.
Svensson and colleagues enrolled 4,047 adults aged 37 to 60 years with a BMI of at least 34 kg/m2 for men and 38 kg/m2 for women from September 1987 to January 2001. Of the participants, 376 had gastric banding performed, 1,369 underwent vertical banded gastroplasty and 265 had gastric bypass surgery. Those undergoing bariatric surgery were matched with 2,037 adults who received usual obesity care without bariatric surgery. Substance use disorder diagnoses were obtained through the Swedish National Patient Register. Researchers did not include diagnoses for alcohol or tobacco use. Follow-up continued until Dec. 31, 2020.
Gastric bypass increases risk for nonalcohol substance use disorder
During a median 23.8 years of follow-up, nonalcohol substance use was diagnosed in 24 adults in the control group, nine who underwent gastric bypass, 21 who underwent vertical banded gastroplasty and seven who had gastric banding performed. The most common diagnoses reported were other psychoactive substance-related disorders; sedative, hypnotic or anxiolytic-related disorders; and opioid-related disorders.
In a multivariable-adjusted model, adults who underwent gastric bypass had a higher risk for nonalcohol substance use disorder than controls (adjusted HR = 2.54; 95% CI, 1.14-5.65; P = .022). There was no difference in nonalcohol substance use risk between controls and adults who had vertical banded gastroplasty or gastric banding. There was also no difference in substance use risk between the three bariatric surgery types when compared with each other.
Svensson said the study was not designed to explore the mechanisms behind the increased risk for nonalcohol substance use disorder among adults receiving gastric bypass and added the researchers did not know of a clear mechanism behind the finding.
“Findings of this study need to be confirmed by other long-term studies and additional studies of potential mechanisms are needed,” Svensson said.
Providers need to monitor for substance use disorders
In a related commentary, James E. Mitchell, MD, chairman and professor in the department of psychiatry and behavior science at the University of North Dakota, Fargo, and Devika Umashanker, MD, system medical director of obesity medicine at Hartford Health Care, said one limitation of the study is it did not include adults who underwent sleeve gastrectomy. The study instead included vertical banded gastroplasty and gastric banding, which the authors said are rarely performed today.
However, the authors concluded that the study adds to previously published studies revealing adults who undergo bariatric surgery may struggle with both alcohol and nonalcohol substance use disorder. They said providers should warn adults considering bariatric surgery about the potential risk for substance use.
“All health care professionals, not just bariatric surgery clinics, who encounter these patients should be aware of substance use disorders and carefully monitor for them,” the authors wrote.
Reference:
- Mitchell JE, et al. Obesity. 2023;doi:10.1002/oby.23850.
For more information:
Per-Arne Svensson, PhD, can be reached at per-arne.svensson@gu.se.
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