History of substance abuse relates to improved postbariatric body mass index outcomes

Background: Recent clinical guidelines have identified current alcohol or substance abuse as contraindications for weight loss surgery. Past research has indicated that a lifetime history of any substance use disorder is significantly greater in those seeking weight loss surgery than the population base rate. However, current substance abuse has been reported to be remarkably low (<1%). The objective was to examine whether a history of substance abuse/dependence is associated with differing weight loss outcomes after bariatric surgery. Methods: A total of 413 patients who had undergone weight loss surgery (75.8% women, 77.7% white, mean age 47.72 years, mean body mass index 50.27 kg/m(2)) at the Cleveland Clinic Bariatric and Metabolic Institute completed a psychological evaluation before surgery, and a history of substance abuse and/or dependence was determined. Results: A series of analyses of covariance examining group differences in the percentage of excess weight loss (%EWL) at I, 3, 6, 9, and 12 months after surgery were conducted comparing a history of substance abuse/dependence (SA+; n = 45) with the absence of a substance abuse/dependence history (SA-; n = 368), controlling for the baseline body mass index. The groups did not differ in the type of surgery or %EWL at I and 3 months of follow-up. However, after adjusting for the baseline body mass index, the patients with a substance abuse history had a significantly greater %EWL at 6 and 9 months postoperatively, with a trend toward significance at the 12-month follow-up visit. Conclusion: Patients with a substance abuse/dependence history had a greater %EWL from 6 months postoperatively onward. Future research should examine longer term outcomes among SA+ patients and the possible explanations for their short-term improved outcomes compared with SA- patients. (Surg Obes Relat Dis 2010;6:417-422.) (C) 2010 American Society for Metabolic and Bariatric Surgery. All rights reserved.