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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

March 2016

Self-Harm and Alcohol Abuse Risks After Bariatric Surgery

Bariatric surgeries produce positive physical results in the overwhelming majority of severely obese patients who undergo them. A high number of these patients experience significant weight loss, improvement in blood glucose levels, stabilization of blood pressure, and resolution of many obesity-related conditions, like type 2 diabetes, heart disease, and orthopedic problems.

Despite these well-documented favorable effects, recent research indicates that weight loss surgeries like gastric bypass often lead to substantially increased rates of self-harm behaviors and alcohol abuse. Patients who undergo the surgeries are subjected to rigorous pre-operative behavioral health evaluations and are followed by their surgery center for about a year after the operation. Yet, this may not be enough; it is imperative that the behavioral health needs of bariatric surgery patients be continually monitored and evaluated on a long-term basis after these patients have been transferred from the surgical team back to the primary care setting.

Behavioral health conditions after bariatric surgery

A recent study in the Journal of the American Medical Association (JAMA) indicates that the number of self-harm emergencies — categorized as medication overdose, alcohol-related incidents, poisoning by toxic chemicals, or physical trauma — increases by 50% after bariatric surgery. It should be noted that prior to their surgeries, morbidly obese patients are already more likely to have diagnosed mental health problems than the general population, particularly depression and binge eating disorder.

Roux-en-Y gastric bypass (RYGB) has especially strong ties to alcohol problems, with up to 17% of patients who undergo RYGB developing alcohol use disorder in the three years following the surgery — a rate approximately 10% higher than in the general population. There are numerous potential explanations for this connection between RYGB and alcohol use disorder. One possible explanation deals with addiction transfer from food addiction before the surgery to alcohol addiction after it. RYGB can also change the sensitivity to or the pharmacodynamics of alcohol after weight loss surgery. It changes the gastric environment so that there are differences in how alcohol is digested, and patients may also feel intoxicated after fewer drinks than when they were heavier.

Assessing risks in the primary care setting

After a patient is transferred from the surgery center back to primary care, the patient’s PCP plays an instrumental role in determining the presence of behavioral health issues like alcohol abuse. Such risks should be continually assessed on a long-term basis in post-bariatric surgery patients through measures like probing questions about alcohol use and mood. If you suspect any type of mental health condition or self-harm behavior in a patient who has undergone a weight loss surgery, Optum/UBH can help facilitate a referral for necessary behavioral health services.

How Optum/UBH can help your patients — For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at 800-292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum/UBH at 888-777-4742.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator