Another Study Suggests Patients are at Risk of Developing Transfer of Addiction after Bariatric Surgery Reminding Us, Yet Again, of the Importance of Follow Up

| June 7, 2011

Dear Bariatric Times fans:

The detrimental health implications of the obesity disease as well as the dramatic benefits and unusual side effects of bariatric surgery inducing weight loss and remission of comorbidities have made the headlines again in the past month. A new study, based on data that were extracted from a Swedish health database, was presented at Digestive Disease Week (DDW), May 7–10, 2011, Chicago, Illionois. The study examined the records of 12,277 patients who had undergone obesity surgery between 1980 and 2006. The patient records were compared to 122,270 people in the general population, matched for age and gender. The researchers, led by Dr. Magdalena Plecka Ostlund of the Karolinska Institute in Stockholm, Sweden, reviewed interventions for psychiatric disorders in pre- and postoperative settings. They concluded that patients with obesity were at greater risk for hospitalization for depression and other mood disorders, both before and after surgery, compared with patients in the general population. The study found that patients were at risk of alcoholism, but more so in a group of patients who underwent gastric bypass. Those who underwent gastric bypass were 2.3 times more likely to become alcoholics than those who underwent laparoscopic adjustable gastric banding. These findings add to previous research that suggested alcohol and food are substitute addictions for some individuals (i.e., individuals with obesity may use eating to self medicate their emotional distress the same way many alcoholics use alcohol). In my opinion, the study by Ostlund et al is important because it gives us an estimated low prevalence of this unusual side effect after bariatric surgery and it emphasizes, once again, how important it is to maintain close follow up of patients after bariatric procedures. On a more critical note, the comparison of bypass versus banding is incorrect and I am sure that industry will use this for marketing purposes in the coming months. However, the flaw in this study is, as it has been well documented in the literature, that in bariatric and metabolic surgery, it is not about the two percent of patients that might develop alcoholism, the one percent of leaks, or the six percent strictures that should guide patients and surgeons in making a decision which procedure to choose, but the efficacy in achieving significant and sustainable weight loss with remission of comorbidities. I wonder what the weight loss was in the LAGB and RYGBP groups that were analyzed.

During the DDW, I attended a presentation by Dr. Jeffrey Peters from the University of Rochester, who emphasized, once again, how important it is to prevent and treat obesity in order to control cancer-related mortality in this patient population. You may be familiar with an article by Adams et al published in The New England Journal of Medicine published in 2007. This study showed an increased mortality due to heart attacks, strokes, and cancer in patients with morbid obesity who did not undergo surgical treatment compared to matched control patients who underwent bariatric surgery and resolved their obesity and associated comorbidities. In this issue of Bariatric Times, Bouras and Tucker present a review on the molecular mechanisms that appear to be involved in the epidemiological association between obesity and increased risk of cancer.

I recently read another great article about the discovery of a so-called “obesity master switch gene.” The article, published in the journal Nature Genetics, detailed a study conducted by researchers from King’s College, London, and the University of Oxford . The researchers discovered a “master regulator gene,” that causes obesity and is linked to diabetes and cholesterol. This gene, called KLF14, controls the behavior of distant genes that exist inside fat cells. The KLF14 gene is inherited from the mother and father, but researchers found that only the mother’s gene has a real effect on fat metabolism.

In this month’s edition of “The Hole in the Wall,” Phillips, Director of the Weight Loss Center at Cedars Sinai Medical Center, Los Angeles, California, and colleagues present an excellent review on closure of working trocar sites after laparoscopic surgery and the potential implications if these sites are not properly closed. I teach my fellows that large abdominal wall defects can and should be left untreated during a primary bariatric procedure and closure should be deferred after significant weight loss. On the other hand, I am adamant that small defects, including trocar sites and umbilical hernias, must be carefully closed at the time of a bariatric intervention. Trocar-site hernias have been responsible, in my practice at least, for serious complications, such as bowel obstructions and “blow up” of jejunojejunal anastomosis. Nausea has been a common denominator in patients with trocar-site hernias despite patients not being completely obstructed.

This issue also features a two-part article on the nutritional needs of patients after sleeve gastrectomy. I congratulate authors Jacques and Goldenberg on an excellent contribution to our journal’s nutrition coverage.

I am pleased to introduce to you two new columns debuting in Bariatric Times this month. In “Surgical Pearls: Techniques in Bariatric Surgery,” master surgeons and pioneers describe their techniques in some key aspects of bariatric procedures. Under the guidance of Dr. Dan Jones and myself, we will make sure this column becomes a favorite and is one our readers store in their hard drives. I would like to thank Dr. Higa for inaugurating this column describing his technique of how to perform a hand-sewn gastrojejunostomy.

I am also excited to introduce another new column, “Total Bariatric Care,” authored by Dr. Eric DeMaria, a bariatric surgical leader and a dear personal friend of mine. In his debut column, DeMaria presents a nice prospective on aftercare, which is a must read.

Finally, we feature two segments—The (ASMBS) News and Update and The ASMBS Foundation News and Update, which feature the latest happenings of both organizations and highlights the events of the upcoming ASMBS meeting in Orlando, Florida.

I hope you enjoy reading this month’s issue of Bariatric Times, and I look forward to seeing you all in Orlando, Florida, at the annual meeting of the ASMBS.

Sincerely,

Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

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