Veterans who Undergo Bariatric Surgery May Be at Greater Risk of Unhealthy Alcohol Use

BACKGROUND:
Nearly 2 in 5 adults in the United States are obese. Bariatric surgical procedures are associated with well-documented advantages, including sustained weight loss; however, several studies have reported they have been associated with an increase in unhealthy alcohol use. This retrospective cohort study evaluated the changes over time in alcohol use and unhealthy alcohol use from 2 years before to 8 years after a bariatric surgical procedure among Veterans with and without pre-operative unhealthy alcohol use. Using VA data, investigators identified 2,608 Veterans (1,964 men and 644 women) who had undergone a bariatric surgical procedure from October 2008 through September 2016. Among those without unhealthy alcohol use at baseline, investigators matched 1,539 patients who underwent a laparoscopic sleeve gastrectomy (LSG) to 14,555 non-surgical control patients – and 854 patients who underwent a Roux-en Y gastric bypass (RYGB) to 8,038 non-surgical control patients. Among those with unhealthy alcohol use at baseline, investigators matched 145 patients who underwent an LSG to 1,091 non-surgical control patients – and 70 patients who underwent an RYGB to 548 non-surgical control patients.

FINDINGS:

• Among Veterans 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.
  • The probability of unhealthy alcohol use in surgical patients was much higher than in control patients at 8 years of follow-up for those who underwent an LSG (8% vs. 5%), as well as for patients who underwent an RYGB (9% vs 4%). Surgical patients were also more likely than non-surgical controls to drink at any level after surgery.
• Among Veterans with unhealthy alcohol use at baseline, the prevalence of unhealthy alcohol use after surgery was higher for patients who underwent an RYGB than for matched controls.

IMPLICATIONS:

• The clinical implications suggest that patients undergoing bariatric surgical procedures should be cautioned that drinking alcohol can escalate after bariatric surgery, even in those with no previous evidence of drinking alcohol above recommended limits. VA's longstanding alcohol screening program makes unhealthy alcohol use easier to identify than in other health systems that have not yet implemented this population-based screening.

LIMITATIONS:

• The study relied entirely on alcohol screening documented in the VA electronic health record system, which may underestimate the prevalence of unhealthy alcohol use.

AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. Maciejewski, Smith, and Berkowitz are part of HSR&D’s Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) in Durham, NC

Maciejewski M, Smith V, Berkowitz T, et al. Association of Bariatric Surgical Procedures with Changes in Unhealthy Alcohol Use among US Veterans. JAMA Network Open. December 21, 2020.