Leslie M. Schuh

Substance misuse following roux-en-y gastric bypass surgery

Post-bariatric surgery patients are overrepresented in substance abuse treatment, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The severity of the substance use disorder (SUD; i.e., warranting inpatient treatment) and related consequences necessitate a better understanding of the variables associated with post-RYGB SUDs. This investigation assessed factors associated with post-RYGB substance misuse. Post-RYGB patients (N = 141; at least 24 months postsurgery) completed an online survey assessing variables hypothesized to contribute to post-RYGB SUDs. Fourteen percent of participants met criteria for postoperative substance misuse. Those with a lower percent total weight loss (%TWL) were more likely to endorse substance misuse. Family history of substance misuse was strongly associated with postoperative substance misuse. Eating-related variables including presurgical food addiction and postsurgical nocturnal eating, subjective hunger, and environmental responsiveness to food cues were also associated with a probable postoperative SUD. These findings have clinical utility in that family history of substance misuse can be easily assessed, and at-risk patients can be advised accordingly. In addition, those who endorse post-RYGB substance misuse appear to have stronger cognitive and behavioral responses to food, providing some support for the theory of behavioral substitution (or “addiction transfer”).

Predictors of Lowest Weight and Long-Term Weight Regain Among Roux-en-Y Gastric Bypass Patients.

BackgroundWeight loss surgery (WLS) outcomes are poorly understood. This study aimed to evaluate the relationship of well-documented (e.g., health, diet, physical activity) and theoretically relevant variables (e.g., substance use and “food addiction”) with both weight nadir and weight regain (WR) following WLS.MethodsA sample of 97 Roux-en-Y gastric bypass patients (Mtime since surgeryu2009=u20098.86xa0years) were surveyed about pre- and post-WLS weight, health, self-management behaviors, alcohol problems, and clinical symptoms.ResultsPatients lost a mean of 42xa0% (SDu2009=u200910.71xa0%) of total weight at weight nadir, but 26xa0% (SDu2009=u200919.66xa0%) of the lost weight was regained by the time of the survey. Correlates of lower weight nadir and WR differed considerably, with minor overlap. Weight nadir was associated with pre-WLS drug use and post-WLS medical comorbidities. WR, on the other hand, was associated with post-WLS adherence to dietary and physical activity modification. Post-WLS nocturnal eating, depression, and problematic alcohol use were also associated with WR. With all associated variables in regression models, number of post-WLS medical comorbidities (βu2009=u2009−.313, pu2009<u20090.01) and post-WLS depression (βu2009=u20090.325, pu2009<u20090.01) accounted for the most variance and remained as significant predictors of weight nadir and WR, respectively.ConclusionsWhile weight nadir was associated with relatively few and largely nonmodifiable variables, WR was significantly associated with adherence-related behaviors, mood symptoms, and pathological patterns of food and alcohol use, all of which are potentially modifiable. These findings underscore the importance of long-term behavioral and psychosocial monitoring after surgery.

New-Onset Substance Use Disorder After Gastric Bypass Surgery: Rates and Associated Characteristics

BackgroundSubstance use disorder (SUD) may develop de novo for a subgroup of weight loss surgery patients, particularly those who have had the Roux-en-Y gastric bypass (RYGB) procedure. The present study examined the rate of SUD in a broad sample of RYGB patients and identified associated behavioral and psychological factors.MethodsParticipants included 143 RYGB patients; the majority were women (nu2009=u2009120; 83.9xa0%) and white (nu2009=u2009135; 94.4xa0%). Participants completed a web-based survey assessing retrospective accounts of presurgical substance use, eating pathology, family history, and traumatic history, postsurgical substance use, life stressors, and global trait-like measures (emotion dysregulation, impulsivity, sensation-seeking, and coping skills).ResultsA subgroup (nu2009=u200928, 19.6xa0%) of post-RYGB patients met criteria for probable SUD; however, the majority of those who met SUD criteria postsurgery (nu2009=u200919, 68xa0%) did not report a pre-RYGB SUD history. Family history of substance abuse, poor coping skills, and potential life stressors were related to post-RYGB SUD, particularly for the new-onset group. Additionally, the majority of those who met criteria for pre-RYGB SUD (nu2009=u200921, 70xa0%) did not continue to meet SUD criteria following RYGB.ConclusionsFindings highlight a subgroup of post-RYGB patients reporting new-onset SUD, which is unexpected among middle-aged women. Importantly, findings also indicate that many patients with presurgical SUD did not relapse postsurgery. Assessing for family history of SUD and coping skills at the presurgical evaluation is recommended. Future research should identify psychological and physiological risk factors for SUD postsurgery and examine protective factors of those who discontinue substance use postsurgery.

Associations between relationship stability, relationship quality, and weight loss outcomes among bariatric surgery patients.

After weight loss surgery (WLS), psychosocial functioning, including the quality of social relationships, generally improves, but for a minority, relationships worsen. We examined how changes in relationship stability and quality from pre- to post-WLS relate to long-term weight loss outcomes. Postoperative patients (N=361) completed surveys which queried relationship changes and weight loss. The sample was 95.9% Caucasian, 80.1% female, averaged 7.7years post-WLS, with a mean age at surgery of 47.7years (range 21-72); 87.3% had a Roux-en-Y gastric bypass. Four relationship status groups were created: Not in a relationship at surgery or follow-up (No-Rel, n=66; 18.2%); Post-WLS relationship only (New-Rel, n=23; 6%); Pre-WLS relationship only (Lost-Rel, n=17; 5%); and Pre-Post Relationship (Maintainer, n=255; 70.6%). Current BMI was 34.5 for No-Rel; 40.5 for New-Rel; 37.4 for Lost-Rel; 33.3 for Maintainers (p<.05 for Maintainers and No-Rel vs. New-Rel). These same group differences were significant for weight loss, which was not associated with gender, time since surgery, or age at time of surgery, but was associated with pre-WLS BMI (lower pre-WLS BMI was associated with greater %EWL). Analyses were repeated with pre-WLS BMI as a covariate; group differences remained significant [F (3, 355)=3.09, p=.03], as did pre-WLS BMI, [F (1, 355)=9.12, p=.003]. Among Maintainers, relationship quality was associated with weight loss outcomes: those with improved relationships post-WLS had significantly greater %EWL [F (2, 234)=15.82, p<0.000; p<.05 for Improved>(Stayed Same=Got Worse)]. Findings support the importance of assessing relationship stability and quality in pre-WLS candidates, as healthy and stable relationships may support improved long-term outcomes. Interventions to improve relationships pre-and post-WLS may increase both quality of life and weight loss outcomes.

A randomized trial comparing two interventions to increase physical activity among patients undergoing bariatric surgery

To test the effectiveness of two levels of physical activity interventions before and up to 6½ months after bariatric surgery.

Exercise Testing Reveals Everyday Physical Challenges of Bariatric Surgery Candidates

BACKGROUNDnFew studies have quantified cardiorespiratory fitness among individuals seeking bariatric surgery. Treadmill testing allows researchers to determine exercise capacity through metabolic equivalents. These findings can assist clinicians in understanding patients capabilities to carry out various activities of daily living. The purpose of this study was to determine exercise tolerance and the variables associated with fitness, among individuals seeking bariatric surgery.nnnMETHODSnBariatric surgery candidates completed submaximal treadmill testing and provided ratings of perceived exertion. Each participant also completed questionnaires related to history of exercise, mood, and perceived barriers/benefits of exercise.nnnRESULTSnOver half of participants reported that exercise was hard to very hard before reaching 70% of heart rate reserve, and one-third of participantsxa0reported that exercise was moderately hard at less than 3 metabolic equivalents (light activity). Body mass index and age accounted for the majority of the variance in exercise tolerance, but athletic history, employment status, and perceived health benefits also contributed. Perceived benefit scores were higher than barrier scores.nnnCONCLUSIONnCategories commonly used to describe moderate-intensity exercise (3-6 metabolic equivalents) do not coincide with perceptions of intensity among many bariatric surgery candidates, especially those with a body mass index of 50 or more.