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Kenkre JS, Gesell S, Keller A, Milani RM, Scholtz S, Barley EA. Alcohol Misuse post Metabolic and Bariatric Surgery: A Systematic Review of Longer-term Studies with Focus on new Onset Alcohol use Disorder and Differences Between Surgery Types. Curr Obes Rep 2024:10.1007/s13679-024-00577-w. [PMID: 38850501 DOI: 10.1007/s13679-024-00577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Evidence suggests an increased risk of alcohol problems post-surgery where no problematic alcohol use was present prior to surgery which may be different across types of surgery. OBJECTIVE To characterise the risk of new onset alcohol misuse post bariatric surgery, differences between surgeries and the impact over time. METHODS All published studies on new and relapsing alcohol use were reviewed. Data were classed as 'subjective' (clinical interview, self-report questionnaires) and 'objective' (hospital admissions, substance misuse programmes) and further categorised by follow up time - 'shorter-term' (one year), 'medium-term' (one year to two years) and 'long-term' (> two years). RESULTS Twenty-three of the forty-two studies included in the review reported new onset data. Nine studies reported on differences between surgery types. In those reporting objective measures, all of which were long term, RYGB carried a higher risk than SG, followed by LAGB. All but one study using subjective measures reported a small but significant number of new onset concerning alcohol use, and comparisons between surgery types had more varied results than the objective measures. Studies of substance abuse programmes found high rates of new onset cases (17-60%). CONCLUSION This systematic review provides support for the consensus guidance suggesting patients should be informed of a small but significant risk of new onset alcohol use following bariatric surgery, with the strongest evidence in the medium- to long-term and in those who have had RYGB followed by SG.
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Affiliation(s)
- Julia S Kenkre
- Section of Endocrinology and Investigative Medicine, Imperial College, London, UK
| | - Sutapa Gesell
- Central and North West London NHS Foundation Trust, London, UK
| | - Annalise Keller
- School of Human and Social Sciences, University of West London, London, UK
| | - Raffaella M Milani
- School of Human and Social Sciences, University of West London, London, UK
| | - Samantha Scholtz
- Section of Endocrinology and Investigative Medicine, Imperial College, London, UK.
- West London NHS Trust, London, UK.
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2
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White GE, Boles RE, Courcoulas AP, Yanovski SZ, Zeller MH, Jenkins TM, Inge TH. A Prospective Cohort of Alcohol Use and Alcohol-related Problems Before and After Metabolic and Bariatric Surgery in Adolescents. Ann Surg 2023; 278:e519-e525. [PMID: 36538630 PMCID: PMC10188659 DOI: 10.1097/sla.0000000000005759] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe alcohol use, alcohol-related harm, and alcohol-related problems preoperatively and up to 8 years following metabolic and bariatric surgery (MBS) in adolescents. BACKGROUND Risk for alcohol use and alcohol use disorders (AUD) increases post-Roux-en-Y gastric bypass and vertical sleeve gastrectomy in adults. However, data are lacking in adolescents who undergo MBS. METHODS This study includes 217 adolescents (aged 13-19 y) enrolled in a 5-center prospective cohort study who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy (2007-2011) and reported alcohol use preoperatively and annually postoperatively for up to 8 years. Time to elevated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score, alcohol-related harm, and alcohol-related problems were analyzed with Kaplan-Meier estimates of cumulative incidence. RESULTS Preoperatively, the median age was 17 years; the median body mass index was 51 kg/m 2 . Alcohol use frequency and average quantity of drinks per drinking day increased postoperatively (2% consumed alcohol 2-4 times/month 6 months versus 24% 8 years postoperatively, P <0.001; 2% consumed≥3 drinks per drinking day 6 months versus 35% 8 years postoperatively, P <0.001). Cumulative incidence of postoperative onset elevated AUDIT-C score, alcohol-related harm, and alcohol-related problems at year 8 were 45% (95% CI:37-53), 43% (95% CI:36-51), and 47% (95% CI:40-55), respectively. CONCLUSIONS Nearly half of those who underwent MBS as adolescents screened positively for AUD, symptoms of alcohol-related harm, or alcohol-related problems 8 years post-MBS, highlighting the risk for alcohol use and AUD after MBS in adolescents. AUD evaluation and treatment should be integrated into routine long-term care for adolescents undergoing MBS.
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Affiliation(s)
| | | | | | - Susan Z Yanovski
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD
| | - Meg H Zeller
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas H Inge
- Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL
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3
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Miller-Matero LR, Hecht LM, Barnett NP, Moore RS, Jackson KM, McCarthy D, Martens KM, Hamann A, Felton JW, Carlin AM, Braciszewski JM. Patient perceptions regarding alcohol use after bariatric surgery. Surg Endosc 2023; 37:3669-3675. [PMID: 36639579 PMCID: PMC10251245 DOI: 10.1007/s00464-023-09868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Patients who have undergone bariatric surgery are at increased risk of an alcohol use disorder. Though patients understand this risk, the majority engage in post-surgical alcohol use. This suggests that education alone is not sufficient to reduce post-surgical drinking. To prevent development of post-surgical alcohol use disorders, we need better understanding of the reasons patients use alcohol following surgery. The purpose of this study was to identify factors associated with post-surgical alcohol use. METHOD Patients (N = 20) who were 1-3 years post-bariatric surgery and were consuming alcohol at least twice monthly participated in a 60-min interview. Participants responded about their knowledge regarding risk of post-surgical alcohol use and reasons why patients may start drinking. Deductive and inductive coding were completed by two independent raters. RESULTS Although nearly all participants were aware of the risks associated with post-surgical alcohol use, most believed that lifelong abstinence from alcohol was unrealistic. Common reasons identified for using alcohol after bariatric surgery included social gatherings, resuming pre-surgical use, and addiction transfer. Inductive coding identified three themes: participants consumed alcohol in different ways compared to prior to surgery; the effect of alcohol was substantially stronger than pre-surgery; and beliefs about why patients develop problematic alcohol use following surgery. CONCLUSION Patients consume alcohol after bariatric surgery for a variety of reasons and they do not believe recommending abstinence is useful. Understanding patient perceptions can inform interventions to minimize alcohol use after bariatric surgery. Modifications to traditional alcohol relapse prevention strategies may provide a more robust solution to decreasing negative outcomes experienced by individuals undergoing bariatric surgery.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA.
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA.
| | - Leah M Hecht
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Roland S Moore
- Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Kristina M Jackson
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | | | - Kellie M Martens
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
| | - Julia W Felton
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
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4
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Miller-Matero LR, Adkins E, Zohr SJ, Martens KM, Hamann A, Snodgrass M, Maye M, Braciszewski JM, Szymanski W, Green S, Genaw J, Carlin AM. Utility of phosphatidylethanol testing as an objective measure of alcohol use during the preoperative evaluation for bariatric surgery. Surg Obes Relat Dis 2023; 19:158-164. [PMID: 36443213 DOI: 10.1016/j.soard.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The risk of alcohol use disorder increases after bariatric surgery. Preoperative alcohol use is a risk factor, and this is evaluated during the routine preoperative psychosocial evaluation. However, it is not clear whether patients accurately report their alcohol use. OBJECTIVE To determine whether an objective measure of alcohol use, phosphatidylethanol (PEth) testing, offers utility beyond self-reported alcohol use during the preoperative evaluation for bariatric surgery. SETTING Single healthcare system. METHODS PEth testing was included as part of the routine laboratory work for 139 patients undergoing evaluation for bariatric surgery. PEth testing results were compared with self-reported alcohol use and scores on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) questionnaire obtained during the preoperative psychosocial evaluation. PEth testing results were categorized into abstinent, light use, moderate use, or heavy use. There were 85 patients who completed both PEth testing and a preoperative psychosocial evaluation. RESULTS There were 25 participants (29.4%) who had a positive PEth test; about half had moderate or heavy use values (15.3% of the total sample). The majority of participants with a positive PEth test (82.6%) denied recent alcohol use. Of those with PEth values indicating moderate or heavy use, 61.5% did not have an elevated AUDIT-C score. CONCLUSIONS Patients appeared to underreport their alcohol use during the preoperative psychosocial evaluation. There appears to be utility for routine PEth testing as part of the evaluation process to identify those with risky drinking patterns. Patients with preoperative risky drinking could be educated about their risk and/or referred to programs to mitigate the development of preoperative alcohol misuse.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Elise Adkins
- Behavioral Health, Henry Ford Health, Detroit, Michigan
| | | | - Kellie M Martens
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Maunda Snodgrass
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Sally Green
- Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Jeffrey Genaw
- Department of Surgery, Henry Ford Health, Detroit, Michigan
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5
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The Factor Structure and Stability of the Beck Depression Inventory-II (BDI-II) in a Population Undergoing Bariatric Surgery. Obes Surg 2022; 32:3732-3739. [PMID: 36169910 DOI: 10.1007/s11695-022-06277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Depression is a multifaceted psychiatric condition that has been associated with suboptimal weight loss following bariatric surgery. Previous variations of Beck Depression Inventory-Second Edition (BDI-II) subscales been proposed, including those identified within bariatric populations; however, it is unclear whether the BDI-II items contained within these subscales would remain consistent after the procedure considering the physical and lifestyle changes that occur following bariatric surgery. MATERIALS AND METHODS A two-step analytic approach that comprised of exploratory (EFA) and confirmatory factor analyses (CFA) that aimed to identify a stable factor structure using pre- and 6-month post-surgical BDI-II responses. Baseline BDI-II responses of 149 patients (Group 1) were used to identify an initial EFA model. Five BDI-II models underwent CFA using BDI-II responses of a comparable pre-surgical group (Group 2; n = 142), and 6-month post-surgical data from Group 1. RESULTS EFA generated a two-factor solution. Of the five CFA models performed, the three-factor model that was initially identified by Hayes (2015) among patients undergoing bariatric surgery demonstrated superior fit across time and between groups. CONCLUSIONS Although the EFA initially identified a two-factor model, CFA determined that a previously defined three-factor model reliably fit both pre- and post-surgical BDI-II responses. This study supports using the Hayes (2015) subscales when monitoring pre- and post-bariatric surgery facets of depression specific to this population. Being able to accurately and reliably monitor depressive symptoms of patients that are undergoing bariatric surgery will allow for the provision and monitoring of targeted interventions aimed at improving their mental and physical health outcomes.
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Tolvanen L, Christenson A, Surkan PJ, Lagerros YT. Patients’ Experiences of Weight Regain After Bariatric Surgery. Obes Surg 2022; 32:1498-1507. [PMID: 35061154 PMCID: PMC8986695 DOI: 10.1007/s11695-022-05908-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/11/2022]
Abstract
Purpose Bariatric surgery is a successful obesity treatment; however, an estimated 1/5 of patients have regained more than 15% of their body weight 5 years post-surgery. To increase the understanding of patients who experienced weight regain after bariatric surgery, we conducted a qualitative study. Materials and Methods We recruited 16 adult participants (4 men, 12 women) at an obesity clinic in Stockholm, Sweden, 2018 to 2019, and performed semi-structured individual interviews. The transcribed recorded interview data was analyzed with thematic analysis. Results Participants had undergone gastric bypass surgery on average 10 years prior to study and regained 36% (range 12 to 71%) of their weight from their nadir. Participants experienced challenges such as eating in social settings, loneliness, family difficulties, increases in appetite, and physical and mental health problems, which distracted them from weight management. Participants responded to weight regain with emotional distress, particularly with hopelessness, discouragement, shame, and frustration (theme: loss of control and focus). Nonetheless, participants experienced remaining benefits from the surgery, despite weight regain. Social support, self-care, and behavioral strategies were perceived as facilitators for weight management (theme: reducing the burden of weight management). Conclusions Weight regain after bariatric surgery was perceived to be an unexpected and difficult experience that induced hopelessness, discouragement, shame, and frustration. Results indicate that internal and external circumstances such as psychosocial factors, changes in appetite, and physical and mental health problems may contribute to loss of control over weight. Social support, self-care, and behavioral strategies might facilitate long-term post-surgical weight management. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-05908-1.
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Affiliation(s)
- Liisa Tolvanen
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 30A, 171 64 Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm, Sweden
| | - Anne Christenson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 30A, 171 64 Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm, Sweden
| | - Pamela J. Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 30A, 171 64 Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm, Sweden
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7
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Carter J, Chang J, Birriel TJ, Moustarah F, Sogg S, Goodpaster K, Benson-Davies S, Chapmon K, Eisenberg D. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1956-1976. [PMID: 34629296 DOI: 10.1016/j.soard.2021.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan Carter
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California.
| | - Julietta Chang
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - T Javier Birriel
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Fady Moustarah
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Stephanie Sogg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Kasey Goodpaster
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Sue Benson-Davies
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Katie Chapmon
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Dan Eisenberg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
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8
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Fipps DC, Goetze RE, Clark MM, Mara K, Watt KD, Jowsey-Gregoire SG, Heimbach JK, Grothe K. Liver Transplantation After Bariatric Surgery: a Clinical Cohort Study. Obes Surg 2021; 31:3700-3706. [PMID: 34021883 DOI: 10.1007/s11695-021-05483-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Individuals that undergo bariatric surgery are at higher risk for problematic alcohol use via pharmacokinetic changes in alcohol metabolism and cross addictions. Little data exists regarding post-bariatric surgery patients with alcohol-related liver disease (ALD) who ultimately require liver transplantation. The aim of this project was to better understand demographic, medical, and psychological characteristics of post-bariatric surgery patients who undergo liver transplantation due to ALD. METHODS This retrospective clinical cohort identified 1416 patients who underwent ALD liver transplantation over a 10-year timespan at three academic medical centers. Electronic medical records were reviewed for patient characteristics, including sex, age, body mass index, surgery dates, Model for End Stage Liver Disease (MELD) scores, medical history, psychiatric history, and mortality rates. RESULTS Within the sample of liver transplantation patients, 1.3% had undergone bariatric surgery prior to transplantation. Fifty percent of the post-bariatric surgery sample was female. The MELD score was higher and the median age at transplantation was younger in the post-bariatric surgery subgroup in comparison to that in the non-bariatric surgery patients. Mood and anxiety disorders were more common among those with a history of having bariatric surgery, with major depressive disorder having the largest difference between subgroups. CONCLUSIONS Among patients who require a liver transplantation due to ALD, those with a history of bariatric surgery are more likely to be female, younger, and diagnosed with mood disorders. Further studies with larger and more diverse samples are necessary to better understand how to prevent development of alcohol use disorder in the bariatric surgery population.
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Affiliation(s)
- David C Fipps
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Rachel E Goetze
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Mental Health Services, VA Maine Healthcare System, 1 VA Center, Augusta, ME, 04330, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Internal Medicine (Division of Endocrinology), Mayo Clinic, Rochester, MN, 55905, USA
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kymberly D Watt
- Department of Medicine (Division of Gastroenterology and Hepatology), Mayo Clinic, Rochester, MN, 55905, USA
| | - Sheila G Jowsey-Gregoire
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Karen Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Internal Medicine (Division of Endocrinology), Mayo Clinic, Rochester, MN, 55905, USA
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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. Surg Obes Relat Dis 2021; 17:1611-1615. [PMID: 34103252 DOI: 10.1016/j.soard.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The 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. OBJECTIVES The 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. SETTING Integrated multispecialty health system with an accredited bariatric surgery program. METHODS Retrospective 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. RESULTS Of 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. CONCLUSION A 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.
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10
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Converging vulnerability factors for compulsive food and drug use. Neuropharmacology 2021; 196:108556. [PMID: 33862029 DOI: 10.1016/j.neuropharm.2021.108556] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 12/12/2022]
Abstract
Highly palatable foods and substance of abuse have intersecting neurobiological, metabolic and behavioral effects relevant for understanding vulnerability to conditions related to food (e.g., obesity, binge eating disorder) and drug (e.g., substance use disorder) misuse. Here, we review data from animal models, clinical populations and epidemiological evidence in behavioral, genetic, pathophysiologic and therapeutic domains. Results suggest that consumption of highly palatable food and drugs of abuse both impact and conversely are regulated by metabolic hormones and metabolic status. Palatable foods high in fat and/or sugar can elicit adaptation in brain reward and withdrawal circuitry akin to substances of abuse. Intake of or withdrawal from palatable food can impact behavioral sensitivity to drugs of abuse and vice versa. A robust literature suggests common substrates and roles for negative reinforcement, negative affect, negative urgency, and impulse control deficits, with both highly palatable foods and substances of abuse. Candidate genetic risk loci shared by obesity and alcohol use disorders have been identified in molecules classically associated with both metabolic and motivational functions. Finally, certain drugs may have overlapping therapeutic potential to treat obesity, diabetes, binge-related eating disorders and substance use disorders. Taken together, data are consistent with the hypotheses that compulsive food and substance use share overlapping, interacting substrates at neurobiological and metabolic levels and that motivated behavior associated with feeding or substance use might constitute vulnerability factors for one another. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.
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Abstract
Childhood obesity can lead to comorbidities that cause significant decrease in health-related quality of life and early mortality. Recognition of obesity as a disease of polygenic etiology can help deter implicit bias. Current guidelines for treating severe obesity in children recommend referral to a multidisciplinary treatment center that offers metabolic and bariatric surgery at any age when a child develops a body mass index that is greater than 120% of the 95th percentile. Obesity medications and lifestyle counseling about diet and exercise are not adequate treatment for severe childhood obesity. Early referral can significantly improve quality and quantity of life.
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Affiliation(s)
- Adi Steinhart
- Department of Pediatrics, Stanford University School of Medicine, 1017 Paradise Way, Palo Alto, CA 94306, USA
| | - Deborah Tsao
- Stanford University School of Medicine, 227 Ayrshire Farm Ln (Apt 203), Stanford, CA 94305, USA
| | - Janey S A Pratt
- Division of Pediatric Surgery, Stanford University School of Medicine, Lucille Packard Children's Hospital, M166 Alway Building, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Strømmen M, Klöckner CA, Bjerkan KK, Græslie H, Hoff DAL, Johnsen G, Kulseng B, Mårvik R, Nymo S, Sandvik J. Characteristics of Patients Reporting Presumed Problematic Drinking Behavior After Gastric Bypass: Exploring Long-Term Data From the BAROBS Study. Front Endocrinol (Lausanne) 2021; 12:679006. [PMID: 34226824 PMCID: PMC8253806 DOI: 10.3389/fendo.2021.679006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To explore patients' long-term experiences with drinking alcohol after Roux-n-Y gastric bypass (RYGB) for conceptualizing what may indicate problematic drinking behavior after bariatric surgery. STUDY DESIGN Three-center, observational study. PATIENTS 546 adult patients undergoing RYGB in the period 2003-2009 in Norway. MAIN OUTCOME MEASURES Self-reported data on drinking behavior and experiences related to alcohol collected 10-15 years after surgery. RESULTS Out of the 959 patients undergoing RYGB in the period, 29 were diseased and 546 participated in this follow-up study (58.7%). Focusing on suspicious changes in drinking behavior, 8.8% reported drinking more, 11.5% consumed alcohol at least twice a week, and 10.6% consumed at a minimum of 6 units of alcohol at a frequency of at least once monthly. The nature of hangovers had changed for about a third of the patients, with 21.6% reporting these to feel weaker or absent. Repeated alcoholic blackouts were reported by 11.9%. A subgroup of the patients were categorized as displaying presumed problematic drinking behavior(PPDB). Among the PPDB-men there was a significant association to having had a fall last year (6 (100.0%) PPDB-patients vs. 30 (29.7%) non-PPDB, p<.001). Among the PPDB-women, there was a significant association to having had alcohol problems prior to surgery (7 (70.0%) PPDB-patients vs. 67 (17.7%) non-PPDB, p<.001). Less significant associations to PPDB reported for explorative purposes were lack of patient education (men) (16 (26.2%) PPDB-patients vs. 8 (61.5%) non-PPDB, p=.014); more than 3 months persistent musculoskeletal pain (women) (45 (15.3%) PPDB-patients vs. 29 (24.6%) non-PPDB, p=.026); subjective problems with memory (women) (58 (20.7%) PPDB-patients vs. 10 (9.1%) non-PPDB, p=.006); and, receiving professional help for mental problems last 12 months (women) (29 (22.7%) PPDB-patients vs. 45 (14.7%) non-PPDB, p=.043). CONCLUSION A subset of patients display drinking behaviors that may be consistent with postsurgical alcohol problems. Screening instruments like AUDIT may not be sufficiently specific to capture several risk behaviors occurring after bariatric surgery.
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Affiliation(s)
- Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- *Correspondence: Magnus Strømmen,
| | - Christian Andreas Klöckner
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kirsti Kverndokk Bjerkan
- Faculty of Social Science and History, Volda University College, Volda, Norway
- Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Hallvard Græslie
- Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Dag Arne Lihaug Hoff
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Gjermund Johnsen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Obesity Research Group, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bård Kulseng
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ronald Mårvik
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Obesity Research Group, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siren Nymo
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
- Obesity Research Group, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jorunn Sandvik
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund, Norway
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Maciejewski ML, Smith VA, Berkowitz TSZ, Arterburn DE, Mitchell JE, Olsen MK, Liu CF, Livingston EH, Funk LM, Adeyemo A, Bradley KA. Association of Bariatric Surgical Procedures With Changes in Unhealthy Alcohol Use Among US Veterans. JAMA Netw Open 2020; 3:e2028117. [PMID: 33346846 PMCID: PMC7753905 DOI: 10.1001/jamanetworkopen.2020.28117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Bariatric surgical procedures have been associated with increased risk of unhealthy alcohol use, but no previous research has evaluated the long-term alcohol-related risks after laparoscopic sleeve gastrectomy (LSG), currently the most used bariatric procedure. No US-based study has compared long-term alcohol-related outcomes between patients who have undergone Roux-en-Y gastric bypass (RYGB) and those who have not. OBJECTIVE To evaluate the changes over time in alcohol use and unhealthy alcohol use from 2 years before to 8 years after a bariatric surgical procedure among individuals with or without preoperative unhealthy alcohol use. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed electronic health record (EHR) data on military veterans who underwent a bariatric surgical procedure at any of the bariatric centers in the US Department of Veterans Affairs (VA) health system between October 1, 2008, and September 30, 2016. Surgical patients without unhealthy alcohol use at baseline were matched using sequential stratification to nonsurgical control patients without unhealthy alcohol use at baseline, and surgical patients with unhealthy alcohol use at baseline were matched to nonsurgical patients with unhealthy alcohol use at baseline. Data were analyzed in February 2020. INTERVENTIONS LSG (n = 1684) and RYGB (n = 924). MAIN OUTCOMES AND MEASURES Mean alcohol use, unhealthy alcohol use, and no alcohol use were estimated using scores from the validated 3-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), which had been documented in the VA EHR. Alcohol outcomes were estimated with mixed-effects models. RESULTS A total of 2608 surgical patients were included in the final cohort (1964 male [75.3%] and 644 female [24.7%] veterans. Mean (SD) age of surgical patients was 53.0 (9.9) years and 53.6 (9.9) years for the matched nonsurgical patients. Among patients without baseline unhealthy alcohol use, 1539 patients who underwent an LSG were matched to 14 555 nonsurgical control patients and 854 patients who underwent an RYGB were matched to 8038 nonsurgical control patients. In patients without baseline unhealthy alcohol use, the mean AUDIT-C scores and the probability of unhealthy alcohol use both increased significantly 3 to 8 years after an LSG or an RYGB, compared with control patients. Eight years after an LSG, the probability of unhealthy alcohol use was higher in surgical vs control patients (7.9% [95% CI, 6.4-9.5] vs 4.5% [95% CI, 4.1-4.9]; difference, 3.4% [95% CI, 1.8-5.0])). Similarly, 8 years after an RYGB, the probability of unhealthy alcohol use was higher in surgical vs control patients (9.2% [95% CI, 8.0-10.3] vs 4.4% [95% CI, 4.1-4.6]; difference, 4.8% [95% CI, 3.6-5.9]). The probability of no alcohol use also decreased significantly 5 to 8 years after both procedures for surgical vs control patients. Among patients with unhealthy alcohol use at baseline, prevalence of unhealthy alcohol use was higher for patients who underwent an RYGB than matched controls. CONCLUSIONS AND RELEVANCE In this multi-site cohort study of predominantly male patients, among those 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 during follow-up.
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Affiliation(s)
- Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Theodore S. Z. Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - David E. Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - James E. Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo
| | - Maren K. Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Chuan-Fen Liu
- Department of Health Services, University of Washington, Seattle
| | - Edward H. Livingston
- Department of Surgery, University of California, Los Angeles, Los Angeles
- Deputy Editor, JAMA, Chicago, Illinois
| | - Luke M. Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin–Madison, Madison
- William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin
| | - Adenike Adeyemo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
- Department of Health Services, University of Washington, Seattle
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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Coluzzi I, Iossa A, Spinetti E, Silecchia G. Alcohol consumption after laparoscopic sleeve gastrectomy: 1-year results. Eat Weight Disord 2019; 24:1131-1136. [PMID: 29411323 DOI: 10.1007/s40519-018-0486-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (SG) represents, at present, the most performed bariatric procedure worldwide with excellent long-term results on weight loss and comorbidities control. After the gastrectomy procedure, together with hormonal modification, several changes in taste and habits occur, including the potential modification in alcohol consumption. The aim of this prospective study was to determine the frequency and the amount of alcohol use before and after SG using a modified version of the Alcohol Use Disorder Identification Test (AUDIT) at 1-year follow-up and eventually to evaluate relationships between different ages and sexes. MATERIALS AND METHODS A total of 142 patients were prospectively enrolled and evaluated before and 1 year after SG with a modified AUDIT. The exclusion criteria were as follows: history of alcohol abuse, presence of psychopathology or cognitive impairments, diabetes mellitus type II decompensated, or previous gastrointestinal, liver, and pancreatic resective surgery. Subgroup analyses were performed between male and female and between under and over 40 years old. RESULTS The median AUDIT score decreased from 2.70 (range 1-18) before surgery to 1.38 (range 1-7) after 1 year of SG, indicating a marked reduction in alcohol use. The most consumed alcoholic drink was beer (36.6%/n = 52) while after surgery the consumption of beer decreased considerably (21.1%/n = 30). The frequency of alcohol consumption also decreased: at baseline 45% of patients consumed alcoholic drinks "from 2 to 4 times per month", whereas 26 and 39.4% consumed alcohol "never" and "less than once a month," respectively. After surgery, nobody consumed more then six alcoholic drinks. No differences were found between the subgroups in terms of alcohol consumption and social behavior. CONCLUSIONS The alcohol preference is modified and decreased 1 year after SG and this could be related to the strict nutritional follow-up and to the hormonal changes. Studies with large samples and long-term follow-up are needed to confirm our data. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ilenia Coluzzi
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy
| | - Angelo Iossa
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy
| | - Elena Spinetti
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy
| | - Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "La Sapienza", Rome, Italy.
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Exploring pre-surgery and post-surgery substance use disorder and alcohol use disorder in bariatric surgery: a qualitative scoping review. Int J Obes (Lond) 2019; 43:1659-1674. [PMID: 31213657 DOI: 10.1038/s41366-019-0397-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 04/15/2019] [Accepted: 05/12/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Bariatric surgery (BS) produces superior weight loss compared to non-surgical interventions. However, studies suggest bariatric patients who have undergone gastric-bypass surgery have an increased risk of developing new onset substance use disorder (SUD) or suffer negative outcomes after surgery. As such, many bariatric programs consider alcohol/ illicit drug misuse a contraindication to BS. The purpose of this systematic review was to investigate weight loss outcomes, post-surgery substance use patterns and other morbidity/mortality in BS patients with a history of substance use/SUD. METHODS Studies were identified by searching Ovid Medline(R), Embase, and PsychInfo. We included all study types investigating humans of any age/sex who had undergone any BS procedure with data regarding substance use before and/or after surgery. Outcome measures included metabolic outcomes and psychiatric outcomes after bariatric surgery in patients reporting substance use prior to bariatric surgery and substance use patterns after bariatric surgery. RESULTS Fifty-eight studies were included in the review. Studies reporting weight loss after BS did not demonstrate an association between substance use and negative weight loss outcomes. Several studies reported a significant portion of participants having new onset or increased substance use after BS. Factors associated with new onset or increased substance use/SUD after BS included the type of surgery, a history of SUD, a family history of SUD, coping skills/life stressors, age, male sex and alcohol sensitization after surgery. CONCLUSION Substance use history does not appear to influence weight loss after BS, however it may contribute to increased substance use after BS. Clinicians should ensure valid screening tools when assessing BS candidates for substance use history and ensure long term follow-up care post-operatively.
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Miller-Matero LR, Coleman JP, LaLonde L, Martens KM, Hamann A, Carlin AM. Patient Recall of Education about the Risks of Alcohol Use Following Bariatric Surgery. Obes Surg 2019; 29:2707-2710. [DOI: 10.1007/s11695-019-03940-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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