Cirugía bariátrica y trastorno por abuso de alcohol y otras sustancias: una revisión sistemática

IntroductionBariatric surgery is a relatively safe surgical procedure with a high success rate. However, recent reports indicate a higher prevalence of alcohol or substance abuse disorder in this patient group. The purpose of this study was to review the related evidence to serve as a reference for multidisciplinary teams who treat these patients.MethodsWe searched the PubMed and CENTRAL databases. The odds ratios were extracted from the different articles, comparing the prevalence of the abuse of alcohol or other substances in the postoperative period versus preoperative levels. We also compared the prevalence of alcohol use disorder after different types of bariatric surgery.ResultsA total of 49 121 bariatric patients (80.8% female) were evaluated for alcohol use disorder. In general, bariatric surgery was found to be associated with an increase in the prevalence of alcohol abuse (4.58±5.3 vs. 1.58±10.7% in the preoperative period). We also found that the population of patients who underwent RYGB procedures had a higher prevalence of alcohol use disorder than patients who underwent another type of surgery (OR: 1.83; 95% CI: 1.51-2.21). The prevalence of substance abuse disorder (other than alcohol) after this procedure is less studied, although there appears to be an increased risk of abuse of certain substances.ConclusionsBariatric surgery is the best treatment for obesity and its complications. The evidence reviewed suggests that it correlates with a modest but consistent increase in the prevalence of abuse of alcohol and other substances. Medical teams who treat bariatric patients must be informed about this eventuality for its timely prevention, diagnosis and treatment.     

Alcohol and bariatric surgery: review and suggested recommendations for assessment and management

BackgroundEstablished clinical guidelines identify current alcohol abuse and dependence as contraindications for weight loss surgery. However, guidance on how to best assess alcohol use in bariatric patients has not been elucidated. Furthermore, concerns with postoperative alcohol use/abuse and increased sensitivity warrant the development of recommendations on appropriate interventions for patients pursuing weight loss surgery. Our objective was to review the current data on bariatric surgery and substance abuse/addiction, with an emphasis on alcohol use, offer guidance on how to assess the risk of such problems, and provide preliminary recommendations on treating high-risk patients.MethodsThe relevant published data on alcohol use, abuse, and dependence in pre- and postoperative bariatric patients was reviewed. Also, the putative mechanisms of increased alcohol sensitivity after weight loss surgery were examined.ResultsAlthough current alcohol abuse/dependence is less than that in population-base rates, bariatric surgery candidates have a greater history of alcohol use disorders. Physiologic changes after surgery can also change vulnerability to problematic alcohol use, and many patients continue to consume alcohol after surgery. Assessment techniques and strategies to provide informed consent and education on alcohol were included from the Bariatric and Metabolic Institute at the Cleveland Clinic.ConclusionWeight loss surgery candidates might have a greater lifetime risk of alcohol use disorders and greater sensitivity to the intoxicating effects of alcohol after surgery. Adequate screening, assessment, and preoperative preparation could help mitigate this risk. Future research should examine the efficacy of such risk management strategies.     

Cannabis use and bariatric surgery psychology practice: survey and insights

BackgroundCannabis is second only to alcohol as a substance of abuse and dependence in the United States. While there is extensive research examining alcohol use and bariatric surgery, there is currently little research and there are no published guidelines specific to cannabis use and bariatric surgery.ObjectivesTo identify major themes and general guidelines applied by bariatric surgery psychology clinicians.SettingThis practice survey was disseminated to bariatric surgery psychologists at various U.S. academic medical centers, hospitals, and private practices.MethodsAn electronic, 35-question survey was sent to 47 bariatric surgery psychologists to collect information on current clinical practice guidelines regarding cannabis use before and after bariatric surgery.ResultsThe survey questionnaire was completed by 34 (72.34%) bariatric surgery psychologists. The major identified themes included: (1) the lack of a standardized assessment of cannabis use; (2) a requirement for 3 months of abstinence from cannabis before bariatric surgery; (3) recommended lifetime abstinence from cannabis after bariatric surgery; and (4) discussion of cannabis use risks following bariatric surgery, including appetite stimulation, addiction potential, and possible negative impacts on judgment.ConclusionCannabis use will likely further increase in the United States. This survey highlighted common bariatric surgery psychology practices in the absence of extensive research and published guidelines. These findings suggest a preliminary framework with which to address cannabis use in patients seeking bariatric surgery. It is recommended that professional organizations and societies build on these initial survey findings to develop guidelines for more consistent, evidence-based practice regarding cannabis use and bariatric surgery.     

History of substance abuse relates to improved postbariatric body mass index outcomes

BackgroundRecent clinical guidelines have identified current alcohol or substance abuse as contraindications for weight loss surgery. Past research has indicated that a lifetime history of any substance use disorder is significantly greater in those seeking weight loss surgery than the population base rate. However, current substance abuse has been reported to be remarkably low (<1%). The objective was to examine whether a history of substance abuse/dependence is associated with differing weight loss outcomes after bariatric surgery.MethodsA total of 413 patients who had undergone weight loss surgery (75.8% women, 77.7% white, mean age 47.72 years, mean body mass index 50.27 kg/m²) at the Cleveland Clinic Bariatric and Metabolic Institute completed a psychological evaluation before surgery, and a history of substance abuse and/or dependence was determined.ResultsA series of analyses of covariance examining group differences in the percentage of excess weight loss (%EWL) at 1, 3, 6 , 9, and 12 months after surgery were conducted comparing a history of substance abuse/dependence (SA+; n = 45) with the absence of a substance abuse/dependence history (SA?; n = 368), controlling for the baseline body mass index. The groups did not differ in the type of surgery or %EWL at 1 and 3 months of follow-up. However, after adjusting for the baseline body mass index, the patients with a substance abuse history had a significantly greater %EWL at 6 and 9 months postoperatively, with a trend toward significance at the 12-month follow-up visit.ConclusionPatients with a substance abuse/dependence history had a greater %EWL from 6 months postoperatively onward. Future research should examine longer term outcomes among SA+ patients and the possible explanations for their short-term improved outcomes compared with SA? patients.     

Psychosocial correlates of pelvic floor disorders in women seeking bariatric surgery

BackgroundWomen who struggle with obesity are at a significant risk for pelvic floor disorders (PFDs), defined as urinary incontinence, pelvic organ prolapse, and/or fecal incontinence. The association between PFDs and reduced quality of life has been demonstrated; however, the psychosocial correlates of PFDs in women undergoing bariatric surgery have yet to be examined. The present study explored the potential psychosocial correlates of PFD. The setting was an academic medical center.MethodsData were analyzed from 421 female patients evaluated for bariatric surgery. Based upon a screening questionnaire, participants were dichotomized as women with PFDs (n = 121) and women without PFDs (n = 300). Patients completed the “Minnesota Multiphasic Personality Inventory, 2nd ed., Restructured Form (MMPI-2-RF),” and medical records were reviewed for demographic data, body mass index, substance abuse/dependence history, history of physical and/or sexual abuse, psychiatric medication usage, and psychiatric diagnoses. MMPI-2-RF scales measuring depression, anxiety, somatic symptoms, and social support were examined.ResultsWomen with PFDs were significantly older (F_1,420 = 3.87, P < .05) and more likely to evidence a history of substance abuse/dependence (chi-square = 4.53, P < .05) and depression (chi-square = 4.31, P < .05) than women without PFDs. There also was a trend for previous inpatient hospitalization (chi-square = 2.93, P < .09), outpatient behavioral health treatment (chi-square = 2.89, P < .09), and psychotropic medication usage (chi-square = 3.32, P < .07). No differences were found in the objective psychological testing.ConclusionWomen with PFDs may be more psychiatrically vulnerable than other bariatric surgery candidates. Additional research on the association among PFDs, substance abuse, and depression is warranted. Future research should consider whether this potential relationship changes postoperative bariatric surgery.     

Alcohol abuse and dependence before and after bariatric surgery: a review of the literature and report of a new data set

BackgroundTo review the published data on alcohol abuse and alcohol dependence after bariatric surgery and to assess the prevalence of alcohol abuse and alcohol dependence in a sample of bariatric surgery patients, both before and after surgery. All participant data were collected from patients who had undergone gastric bypass at a Midwestern hospital.MethodsThe participants were contacted by mail 6–10 years after surgery and asked to complete the Post-Bariatric Surgery Appearance Questionnaire.ResultsThe results of the analysis indicated that a small percentage of the sample appeared to spontaneously develop alcohol abuse or dependence after bariatric surgery.ConclusionThe results of the present study will be useful in understanding the likelihood of bariatric surgery patients developing alcohol abuse and dependence after surgery. However, additional research is needed to fully understand the risk of this outcome.     

Prevalence and psychosocial correlates of self-reported past suicide attempts among bariatric surgery candidates

BackgroundAlthough research has been limited, suicidal behavior has commonly been identified as a contraindication for bariatric surgery. The present study aimed to determine the prevalence and correlates of past suicide attempts in a bariatric surgery population at an academic medical center.MethodsA retrospective chart review, including the demographic and psychosocial variables, was conducted of 1020 consecutive bariatric surgery candidates presenting during a 32-month period.ResultsOf the 1020 patients, 115 (11.2%) self-reported ≥1 previous suicide attempt. The patients with a positive suicide history were significantly younger (mean 42.9 ± 11.0 years), less educated (mean 13.4 ± 2.4 years), had a greater body mass index (mean 52.3 ± 11.6 kg/m²), and were more predominantly single (32.2% versus 20.9%), female (90.4% versus 74.8%), and receiving disability (45.2% versus 21.8%) compared with patients without a suicide history. A positive suicide history was also significantly associated with a history of psychiatric hospitalization, outpatient psychotherapy and/or psychotropic medication, sexual abuse, and substance abuse.ConclusionAssessing suicide history is an important aspect of the bariatric preoperative assessment. Additional research is needed to evaluate the effects of suicide history on the postoperative outcomes and adherence.     

Pilot evaluation of a substance abuse prevention group intervention for at-risk bariatric surgery candidates

BackgroundConcerns have been raised about an increased incidence of substance abuse after bariatric surgery. Alcohol use after surgery may be particularly problematic because of changes in pharmacokinetics leading to greater intoxication. The present study evaluated a substance abuse prevention group pilot intervention for at-risk bariatric surgery candidates.MethodsPatients with a history of substance abuse/dependence or at-risk substance use applying for weight loss surgery (WLS; N = 86) were referred to a single-session 90-minute intervention (67.4% female; 65.1% Caucasian; mean age 46.2 years; mean body mass index 48.77 kg/m²). The session included education about the health effects of alcohol/substances on WLS outcomes, developing alternative coping strategies, identifying warning signs of misuse, and providing treatment resources. Patients completed a preintervention and postintervention questionnaire measuring knowledge of substance use health effects, the Alcohol Use Disorders Identification Test-Consumption Items, and items on motivation for abstinence.ResultsPatients reported a significant increase in knowledge regarding the negative effects of substance abuse after surgery (t = 42.34; P<.001). Patients also reported more healthy alternative coping strategies after the intervention (t = 18.96; P<.001). In addition, a significant number of patients reported a lower intention of consuming alcohol after surgery (χ² = 16.18; P<.001) and were more likely to report health reasons as motivation to abstain (χ² = 102.89; P< .001).ConclusionsAt-risk patients applying for weight loss surgery may benefit from a substance abuse prevention intervention. More research will be needed to see if such benefits can be sustained over time and if interventions affect postsurgical behaviors.     

Deficits in cognitive control during alcohol consumption after bariatric surgery

BackgroundWhile bariatric surgery results in substantial weight loss, one negative side effect of surgery is that patients often experience more rapid and intense intoxication effects after consuming alcohol.ObjectivesGiven that alcohol use has been associated with impaired cognitive functioning in the general population, this study examined whether acute alcohol consumption after bariatric surgery immediately led to impaired cognitive control, and whether this effect was impacted by baseline levels of cognitive control.SettingNonprofit teaching hospital, United States.MethodsParticipants were 34 adults who attended a laboratory visit before and 1 year after Roux-en-Y gastric bypass surgery, wherein they consumed a weight-based dose of alcohol and completed cognitive testing over the course of 3 hours.ResultsA series of generalized mixed-effect models demonstrated that performance on the cognitive task generally improved over time, likely due to practice effects. However, following bariatric surgery, individuals with impaired cognitive control before consuming alcohol experienced greater commission errors immediately afterward.ConclusionsThese findings suggest that alcohol use after bariatric surgery may produce immediate deficits in inhibitory control among individuals who are already vulnerable to impaired cognitive control. Clinicians should seek to educate bariatric surgery candidates on this possible effect, as deficits in inhibitory control may ultimately lead to risky behaviors and poor adherence with postsurgical medical recommendations.     

Sexual Abuse Survivors and Psychiatric Hospitalization after Bariatric Surgery

Background Some investigators have postulated that a history of being the victim of childhood sexual abuse may impact outcome of bariatric surgery. Methods In this retrospective chart review, we examined the electronic medical records of 152 adults with morbid obesity who underwent Roux-en-Y gastric bypass and who had a weight recorded in their medical record or reported in a follow-up surgery at 2 years after the RYGBP. The purpose of this retrospective chart review was to examine the relationship between psychosocial factors assessed preoperatively and the percent of excess weight lost (%EWL) at 2 years after bariatric surgery. Results We found a high prevalence of being the victim of childhood sexual abuse (27%), adult sexual trauma (9%), and/or physical abuse (19%) at the initial evaluation. There was no association between these factors and %EWL at 2 years. However, when we examined participants’ medical records for post-operative psychiatric hospitalizations at our medical center, 8 of 11 hospitalized patients reported a history of childhood sexual abuse (73%). Conclusions History of being the victim of childhood sexual abuse is reported frequently by patients seeking bariatric surgery. Our finding that having been the victim of childhood sexual abuse may be associated with increased risk of psychiatric hospitalization after RYGBP has several clinical implications. First, we recommend that clinicians assess carefully for a history of sexual or physical abuse, and secondly, abuse survivors may need to be told that there is an increased risk of psychiatric morbidity after bariatric surgery. Finally, perhaps close monitoring of these patients may prevent psychiatric difficulties after surgery. Further research to verify these preliminary findings is clearly needed.     

Psychological risk may influence drop-out prior to bariatric surgery

BackgroundFactors necessitating a delay before psychological clearance for bariatric surgery have been previously identified; however, research has not examined why patients who begin the preoperative evaluation fail to complete surgery or drop-out of bariatric programs. This study sought to explore the potential psychosocial reasons for a failure to reach bariatric surgery. The setting was an academic medical center.MethodsData were analyzed from 129 patients psychologically evaluated for bariatric surgery who had failed to reach surgery after 15 months. Medical records were reviewed for demographics, body mass index, and psychiatric variables.ResultsThe most common reasons for not reaching surgery included withdrawal from the program, outstanding program requirements, self-canceled surgery, moving out of the area, insurance denial, switching to non-surgical weight management, or death. Patients with outstanding program requirements were psychosocially different from patients who had not achieved surgery for other reasons. They were significantly more likely to be involved in outpatient behavioral health treatment (chi-square = 12.90, P < .05), to be taking psychotropic medications (chi-square = 15.17, P < .05), and to have met the criteria for current or past alcohol abuse/dependence (chi-square = 23.70, P < .01), and there was a trend for previous inpatient hospitalizations (chi-square = 11.59, P < .07).ConclusionPatients who failed to complete outstanding program requirements often had significant psychiatric and/or substance abuse/dependence issues that required additional treatment. It is possible that these patients drop-out of the program due to unwillingness to complete psychiatric treatment recommendations. Continued screening of high-risk patients and the education of patients on the importance of managing these risks is indicated. However, patients may choose to leave programs once education has been provided or treatment mandated.     

History of sexual abuse among bariatric surgery candidates.

BACKGROUND: A history of sexual abuse is associated with a range of psychosocial difficulties and health risk behaviors in the general population. Sexual abuse also appears to be a risk factor for the development of obesity. Little is known, however, about the prevalence and psychosocial correlates of sexual abuse among persons with extreme obesity who seek bariatric surgery. METHODS: Questionnaire data were collected from 567 individuals with extreme obesity who presented for bariatric surgery. Those with and without a self-reported history of sexual abuse were compared on several psychosocial variables. RESULTS: Sixteen percent of the surgery candidates (17.0% of women and 11.5% of men) reported a history of sexual abuse. Those who reported a history of sexual abuse were more likely to report previous emotional difficulties, as well as a personal and family history of substance abuse. They also were significantly more likely to meet the criteria for binge eating disorder, as determined from self-report responses to the Questionnaire on Eating and Weight Patterns, compared with those without a self-reported history of sexual abuse. In addition, those who reported a history of sexual abuse were more likely to report both current and previous psychiatric treatment than were those who denied a history of abuse. CONCLUSION: A significant minority of bariatric surgery candidates reported a history of sexual abuse. Among these individuals, a history of sexual abuse was associated with both current and past psychiatric problems and treatment. The relationship of these variables to postoperative outcomes, however, is unknown.     

Emergency department encounters,hospital admissions,course of treatment,and follow-up care for behavioral health concerns in patients after Roux-en-Y gastric bypass surgery

BackgroundThe benefits of bariatric surgery are well-established, however, concerns surrounding postoperative psychiatric destabilization and alcohol misuse remain. Research has initiated the process of identifying risks associated with bariatric surgery, although less is known regarding when or why psychiatric hospitalizations occur postoperatively.ObjectivesThe goal of the current study was to examine the incidence of, and contributing factors to, behavioral health-related emergency room (ER) encounters and hospitalization after bariatric surgery.SettingIntegrated multispecialty health system with an accredited bariatric surgery program.MethodsRetrospective review of patients who underwent Roux-en-Y gastric bypass (RYGB) surgery and had been readmitted to the hospital or presented to the ER after bariatric surgery at least once for a behavioral-health related reason.ResultsOf 1449 patients, 93 had at least 1 psychiatric or substance use–related ER visit/hospitalization post-surgery and were included in the study; 53% had 1 ER/hospital encounter after bariatric surgery; 24% had 2 encounters, 11% had 3–4 encounters, and 10% of patients had ≥5 encounters. Across 267 postbariatric surgery encounters, 42.4% were due to alcohol-related problems. The index presentation for alcohol-related reasons occurred at a mean of 1942 days (approximately 5.3 yr; SD = 1217 d). Patients’ index presentation for a psychiatric concern (41.3%) occurred at a mean of 1278 days (3.5 yr; SD = 1056 d) post-surgery.ConclusionA significant percentage of patients who present to the ER or hospital for behavioral health reasons after RYGB surgery had alcohol-related problems, long after their surgery. Psychologists working with bariatric surgery teams should prioritize ongoing assessment of and education on alcohol misuse in those seeking RYGB and in the long-term postoperative period.     

Does bariatric surgery change the risk of acute ischemic stroke in patients with a history of transient ischemic attack? A nationwide analysis

BackgroundStroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults.ObjectiveWe aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery.SettingAcademic hospital, United States.MethodsUsing the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment).ResultsA total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group.ConclusionsAfter analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.     

The effect of marijuana use on short-term outcomes with bariatric surgery

BackgroundDespite increasing marijuana use nationwide, there are limited data on implications of marijuana use on bariatric surgery outcomes.ObjectiveWe investigated associations between marijuana use and bariatric surgery outcomes.SettingMulticenter statewide study utilizing data from the Michigan Bariatric Surgery Collaborative, a payor-funded consortium including over 40 hospitals and 80 surgeons performing bariatric surgery statewide.MethodsWe analyzed data from the Michigan Bariatric Surgery Collaborative clinical registry on patients who underwent a laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between June 2019 and June 2020. Patients were surveyed at baseline and annually on medication use, depression symptoms, and substance use. Regression analysis was performed to compare 30-day and 1-year outcomes between marijuana users and nonusers.ResultsOf 6879 patients, 574 reported baseline marijuana use and 139 reported use at baseline and 1 year. Marijuana users were more likely to be current smokers (14% versus 8%, P < .0001), screen positive for alcohol use disorder (20.0% versus 8.4%, P < .0001), and score higher on the Patient Health Questionnaire–8 (6.1 versus 3.0, P < .0001). There were no statistically significant differences in 30-day outcomes or co-morbidity remission at 1 year. Marijuana users had higher adjusted total mean weight loss (47.6 versus 38.1 kg, P < .0001) and body mass index reduction (17 versus 14 kg/m², P < .0001).ConclusionsMarijuana use is not associated with worse 30-day outcomes or 1-year weight loss outcomes and should not be a barrier to bariatric surgery. However, marijuana use is associated with higher rates of smoking, substance use, and depression. These patients may benefit from additional mental health and substance abuse counseling.     

Development of cancer after bariatric surgery

BackgroundAlthough bariatric surgery has been associated with a reduction in risk of obesity-related cancer, data on the effect of bariatric interventions on other cancers are limited.ObjectivesThis study aimed to examine the relationship between bariatric interventions and the incidence of various cancers after bariatric surgery.SettingAdministrative statewide database.MethodsThe New York Statewide Planning and Research Cooperative System database was used to identify all adult patients diagnosed with obesity between 2006 and 2012 and patients who underwent bariatric procedures without preexisting cancer diagnosis and alcohol or tobacco use. Subsequent cancer diagnoses were captured up to 2016. Multivariable proportional subdistribution hazard regression analysis was performed to compare the risk of having cancer among obese patients with and without bariatric interventions.ResultsWe identified 71,000 patients who underwent bariatric surgery and 323,197 patients without a bariatric intervention. Patients undergoing bariatric surgery were less likely to develop both obesity-related cancer (hazard ratio.91; 95% confidence interval, .85–.98; P = .013) and other cancers (hazard ratio .81; 95% confidence interval, .74–.89; P < .0001). Patients undergoing Roux-en-Y gastric bypass had a lower risk of developing cancers that are considered nonobesity related (hazard ratio .59; 95% confidence interval, .42–.83; P = .0029) compared with laparoscopic sleeve gastrectomy.ConclusionsBariatric surgery is associated with a decreased risk of obesity-related cancers. More significantly, we demonstrated the relationship between bariatric surgery and the reduction of the risk of some previously designated nonobesity-related cancers, as well. Reclassification of nonobesity-related cancers and expansion of bariatric indications for reducing the risk of cancer may be warranted.     

Acute delirium and poor compliance in total hip arthroplasty patients with substance abuse disorders

From the joint registry of 2831 primary total hip arthroplasties (2351 patients) performed between 1998 and 2003, we identified 15 patients (16 hips) who had a documented history of substance abuse disorders at the time of the index surgery. The patients included 13 men (14 hips) and 2 women (2 hips), with the mean age of 49 years (range, 29-65 years). On the basis of the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 13 patients had alcohol abuse disorders, 1 had amphetamine abuse disorder, and 1 had heroin abuse disorder. We found high rates of postoperative substance withdrawal delirium and psychosis (46%), late complication (25%), and lost to follow-up (27%) in these patients. Because patients with substance abuse disorders have unexpected perioperative psychotic episodes, poor compliance, and a tendency to not follow medical advice after surgery and show early discontinuation of follow-up, we suggest that surgeons should work with other medical professionals and carefully perform total hip arthroplasty in such patients.     

Depression and infertility in women seeking bariatric surgery

BackgroundObesity has been associated with abnormalities in reproductive functioning and fertility in women. A number of potential mechanisms have been identified, including neuroendocrine functioning and polycystic ovarian syndrome. Associations between infertility, depression, and anxiety have been found in nonobese populations; however, the relationship between depression and infertility in women pursuing bariatric surgery has not been examined. This study sought to explore potential psychosocial correlates of infertility in a female bariatric population.MethodsData were analyzed from female patients of childbearing age (n = 88; 70.5% Caucasian; mean age 36.2; mean education 14.3 years; mean body mass index [BMI] 47.9 kg/m²) psychologically evaluated for bariatric surgery. Participants were dichotomized as Infertility+(n = 43) or Infertility−(n = 45) based on a medical history self-report questionnaire. Medical records were reviewed for demographic characteristics, BMI, physical and/or sexual abuse history, psychiatric medication usage, outpatient behavioral health treatment, and psychiatric diagnoses.ResultsWomen identified as Infertility+were more likely to have been diagnosed with a depressive disorder not otherwise specified or a major depressive disorder (χ² = 3.71, P<.05, χ² = 4.33, P< .05) than Infertility−women. However, Infertility+women were less likely to be involved in outpatient behavioral health treatment (χ² = 5.65, P< .05) or to have a history of psychotropic medication usage (χ² = 4.61, P<.05).ConclusionWomen struggling with infertility may be more psychiatrically vulnerable than other bariatric surgery candidates and less likely to have received mental health treatment. Additional research on the association between fertility, depression, behavioral health treatment, and obesity is warranted. Future research should consider whether this potential relationship changes after bariatric surgery.     

Diagnoses related to abuse of alcohol and addictive substances after gastric bypass and sleeve gastrectomy: a nation-wide registry study from Norway

BackgroundAfter Roux-en-Y gastric bypass (RYGB) patients are at higher risk of alcohol problems. In recent years, sleeve gastrectomy (SG) has become a common procedure, but the incidence rates (IRs) of alcohol abuse after SG are unexplored.ObjectivesTo compare IRs of diagnoses indicating problems with alcohol or other substances between patients having undergone SG or RYGB with a minimum of 6-month follow-up.SettingAll government funded hospitals in Norway providing bariatric surgery.MethodsA retrospective population-based cohort study based on data from the Norwegian Patient Registry. The outcomes were ICD-10 of Diseases and Related Health Problems diagnoses relating to alcohol (F10) and other substances (F11–F19).ResultsThe registry provided data on 10,208 patients who underwent either RYGB or SG during the years 2008 to 2014 with a total postoperative observation time of 33,352 person-years. This corresponds to 8196 patients with RYGB (27,846 person-yr, average 3.4 yr) and 2012 patients with SG (5506 person-yr; average 2.7 yr). The IR for the diagnoses related to alcohol problems after RYGB was 6.36 (95% confidence interval: 5.45–7.36) per 1000 person-years and 4.54 (2.94–6.70) after SG. When controlling for age and sex, adjusted hazard ratio was .75 (.49–1.14) for SG compared with RYGB. When combining both bariatric procedures, women <26 years were more likely to have alcohol-related diagnoses (3.2%, 2.1–4.4) than women of 26 to 40 years (1.6%, 1.1–2.1) or women >40 (1.3%, .9–1.7). The IR after RYGB for the diagnoses related to problems with substances other than alcohol was 3.48 (95% confidence interval: 2.82–4.25) compared with 3.27 (1.94–5.17) per 1000 person-years after SG. Controlling for age and sex, the hazard ratio was .99 (.60–1.64) for SG compared with RYGB.ConclusionsIn our study, procedure-specific differences were not found in the risks (RYGB versus SG) for postoperative diagnoses related to problems with alcohol and other substances within the available observation time. A longer observation period seems required to explore these findings further.