Substance use and excess body weight loss following bariatric surgery

Abstract:

Background: Bariatric surgery is the most effective treatment for obesity by decreasing caloric intake while simultaneously reducing hunger and increasing satiation through multiple cognitive, psychological, and metabolic factors.

Objective: To assess the relationship of various psychological and substance-use factors in surgical weight loss outcomes at 1-year postoperative.

Methods: Our Metabolic Surgery and Bariatric Care (MSBC) clinic utilizes a Psychology Postoperative Questionnaire at the routine initial postoperative visit to assess sleep, mood, alcohol, marijuana, and nicotine use, and surgical satisfaction. We conducted a retrospective chart review to collect responses to the questionnaire with patients’ excess body weight loss at 1-year postoperatively. Statistical analysis was completed using Wilcoxon rank sum test and Kruskal-Wallis rank-sum test to compare excess body weight loss at one year between patients who did and did not self-report substance use.

Results: A total of 110 patients who underwent vertical sleeve gastrectomy or Roux-en-Y gastric bypass between January 2021 and December 2022 and attended their initial routine Psychology follow-up visit were included in this study. No significant differences were observed in excess body weight loss in patients who used alcohol, marijuana, or nicotine compared to those who did not use substances (p > 0.05).  Patients who did not self-report substance use, on average, lost 50.11% of excess body weight (36.85, 84.45). Patients who did report substance use lost, on average, 54.06% (33.08, 83.87) (p > 0.05). 

Conclusion: Patients who utilized substances in the postoperative period did not have any significant differences in weight loss compared to those who did not. Results are limited in that the survey data is self-reported and patients may feel apprehensive following bariatric surgery to share substance use behaviors with psychologists – this may also contribute to the low number of patients reporting substance use.  

Audience take away:

• Effect of substance use on bariatric surgical weight loss
• Current literature surrounding bariatric surgery and substance usage
• Future studies/directions to consider substance use in bariatric surgery

Biography:

I currently am the senior Medical Psychologist at Loyola University Medical Center's (LUMC) Metabolic and Bariatric Surgery program.  I have been with this clinic since it's inception in 2011 and assisted in creating Psychology's role on this multidisciplinary team. In addition, I established the Behavioral Cardiology Program in partnership with the Loyola Medicine Preventative Cardiology and Lipid Program.  My clinical practice also includes management of the Behavioral Medicine Consult Liaison Service which provides assessment and treatment in the inpatient hospital setting across a wide range of hospital services including General Medicine, Hospital Medicine, Trauma, Neurology, Minimally Invasive Surgery, Colorectal Surgery, Orthopedic Surgery, OB-GYN, and Gastroenterology.  I have been Director of Clinical Training (DCT) in Psychology at LUMC since 2015.  In this role, I oversee the psychology training experiences in the Department of Psychiatry and Behavioral Neurosciences at Loyola including six different advanced therapy externships, research externships, and a health psychology fellowship.  This year, I was chosen to become Chief of the Psychology Department and oversee the department of 15 Psychologists.  I also engage in on-going education efforts in the Medical school and conduct clinical research.  My research experience thus far in my career has focused on aspects of health psychology that converge with my clinical activities.