Background Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) following bariatric surgery is limited. Objective To report SUD-related outcomes following RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. Setting Ten US hospitals. Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to seven years through January 2015. Results Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95%CI, 18.5-23.3), 7.5% (95%CI, 6.1-9.1), and 3.5% (95%CI, 2.6-4.8), respectively, post-RYGB, and 11.3% (95%CI, 8.5-14.9), 4.9% (95%CI, 3.1-7.6), and 0.9% (95%CI, 0.4-2.5) post-LAGB. Undergoing RYGB vs. LAGB was associated with higher risk of incident AUD symptoms (AHR=2.08 [95%CI, 1.51-2.85]), illicit drug use (AHR=1.76 [95%CI, 1.07-2.90]) and SUD treatment (AHR=3.56 [95%CI, 1.26-10.07]). Conclusions Undergoing RYGB vs. LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.

Objective To examine changes in depressive symptoms and treatment in the first three years following bariatric surgery. Design and Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study of adults (n=2,458) who underwent a bariatric surgical procedure at one of ten US hospitals between 2006–9. This study includes 2,148 participants who completed the Beck Depression Inventory (BDI) at baseline and ≥ one follow-up visit in years 1–3. Results At baseline, 40.4% self-reported treatment for depression. At least mild depressive symptoms (BDI score≥10) were reported by 28.3%; moderate (BDI score 19–29) and severe (BDI score ≥30) symptoms were uncommon (4.2% and 0.5%, respectively). Mild-to-severe depressive symptoms independently increased the odds (OR=1.75; p=.03) of a major adverse event within 30 days of surgery. Compared with baseline, symptom severity was significantly lower at all follow-up time points (e.g., mild-to-severe symptomatology was 8.9%, 6 months; 8.4%, 1yr; 12.2%, 2yrs; 15.6%, 3yrs; ps<.001), but increased between 1 and 3 years postoperatively (p<.01). Change in depressive symptoms was significantly related to change in body mass index (r=.42; p<0001). Conclusion Bariatric surgery has a positive impact on depressive features. However, data suggest some deterioration in improvement after the first postoperative year.

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WHAT'S KNOWN ON THIS SUBJECT: Adverse effects of excess weight are likely related to both obesity severity and duration. Little is known about the contribution of adolescent weight status to development of specific comorbid conditions in adults.WHAT THIS STUDY ADDS: Severe obesity at age 18 was independently associated with increased risk of lower extremity venous edema, walking limitation, kidney dysfunction, polycystic ovary syndrome, respiratory conditions, diabetes, and hypertension in adulthood.abstract OBJECTIVE: To test the hypothesis that adolescent obesity would be associated with greater risks of adverse health in severely obese adults. METHODS:Before weight loss surgery, adult participants in the Longitudinal Assessment of Bariatric Surgery-2 underwent detailed anthropometric and comorbidity assessment. Weight status at age 18 was retrospectively determined. Participants who were $80% certain of recalled height and weight at age 18 (1502 of 2308) were included. Log binomial regression was used to evaluate whether weight status at age 18 was independently associated with risk of comorbid conditions at time of surgery controlling for potential confounders.RESULTS: Median age and adult body mass index (BMI) were 47 years and 46, respectively. At age 18, 42% of subjects were healthy weight, 29% overweight, 16% class 1 obese, and 13% class $2 obese. Compared with healthy weight at age 18, class $2 obesity at age 18 independently increased the risk of lower-extremity venous edema with skin manifestations by 435% (P , .0001), severe walking limitation by 321% (P , .0001), abnormal kidney function by 302% (P , .0001), polycystic ovary syndrome by 74% (P = .03), asthma by 48% (P = .01), diabetes by 42% (P , .01), obstructive sleep apnea by 25% (P , .01), and hypertension (by varying degrees based on age and gender). Conversely, the associated risk of hyperlipidemia was reduced by 61% (P , .01). CONCLUSIONS:Severe obesity at age 18 was independently associated with increased risk of several comorbid conditions in adults undergoing bariatric surgery. Dr Inge conceptualized and designed the study, drafted the initial manuscript, and revised the manuscript; Dr King drafted the initial manuscript, carried out the initial analyses and revised the manuscript; Ms Chen carried out the initial analyses and reviewed and revised the manuscript, and approved the final manuscript as submitted; Dr Mitsnefes assisted with analysis and interpretation of metabolic data and critically reviewed and revised the manuscript; Dr Daniels substantially contributed to analysis and interpretation of cardiovascular risk factor data and critically reviewed and revised the manuscript; Drs Zeller and Horlick substantially contributed to the conception and design of the study and critically reviewed and revised the manuscript; Dr Khandelwal substantially contributed acquisition of data and critically reviewed and revised the manuscript; Dr Jenkins substantially contributed to the study design and analysis of data and critically reviewed and r...

Objective To evaluate change in sedentary behavior (SB) and physical activity (PA) over three years following bariatric surgery. Methods A subset of participants in an observational study (n=473 of 2458; 79% female, median body mass index 45kg/m2) wore an activity monitor pre-surgery and at 1–3 annual post-surgery assessments. Results Over the first year, on average, sedentary time decreased from 573 (95%CI 563–582) to 545 (95%CI 534–555) min/d and moderate-to-vigorous intensity PA (MVPA) increased from 77 (95%CI: 71–84) to 106 (95%CI: 98–116) min/wk, or 7 (95%CI: 5–10) to 24 (95%CI: 18–29) min/wk in MVPA bouts ≥10 minutes. There were no changes in these parameters from years 1 to 3 (P for all>.05). The percentage of participants achieving ≥150 min/wk of bout-related MVPA was not different at year 3 [6.5% (95%CI: 3.1–12.7)] vs. pre-surgery [3.4% (95%CI: 1.8–5.0); p=.45]. Most participants followed SB and PA trajectories that paralleled mean change and were consistent with their pre-surgery position in relation to the group. Conclusions On average, bariatric surgical patients make small reductions in SB and increases in PA during the first post-surgery year, which are maintained through 3 years. Still, post-surgery PA levels fall short of PA guidelines for general health or weight control.

IMPORTANCE Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking.OBJECTIVES To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery. DESIGN, SETTING, AND PARTICIPANTSThe Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).INTERVENTION Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter. MAIN OUTCOMES AND MEASURESThe frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up. RESULTSOf 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m 2 (range, 34-94 kg/m 2 ), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation.CONCLUSIONS AND RELEVANCE Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.

Background Limited evidence suggests bariatric surgery may not reduce opioid analgesic use, despite improvements in pain. Objective To determine if use of prescribed opioid analgesics changes in the short- and long-term following bariatric surgery and to identify factors associated with continued and post-surgery initiated use. Setting Ten US hospitals. Methods The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Assessments were conducted pre-surgery, 6 months post-surgery and annually post-surgery for up to 7 years until January 2015. Opioid use was defined as self-reported daily, weekly or “as needed” use of a prescribed medication classified as an opioid analgesic. Results Of 2258 participants with baseline data, 2218 completed follow-up assessment(s) (78.7% were female, median body mass index 46; 70.6% underwent Roux-en-Y gastric bypass). Prevalence of opioid use decreased following surgery from 14.7% (95% CI, 13.3–16.2) at baseline to 12.9% (95% CI, 11.5–14.4) at month-6, but then increased to higher than baseline levels as time progressed to 20.3% (95% CI, 18.2–22.5) at year-7. Among participants without baseline opioid use (N=1892), opioid use prevalence increased from 5.8% (95% CI, 4.7–6.9) at month-6 to 14.2% (95%CI, 12.2–16.3) at year-7. Public versus private health insurance, more pain pre-surgery, undergoing subsequent surgeries, worsening/less improvement in pain, and starting or continuing non-opioid analgesics post-surgery were significantly associated with higher risk of post-surgery initiated opioid use. Conclusion Following bariatric surgery, prevalence of prescribed opioid analgesic use initially decreased, but then increased, surpassing baseline prevalence, suggesting the need for alternative methods of pain management in this population.

Background Recent literature suggests that some patients may develop addictive disorders after bariatric surgery, in particular following Roux-en-Y gastric bypass (RYGB). These may include traditional addictions and so called “behavioral addictions”, although prevalence data on the latter have not been published. Objectives To establish prevalence of addictive behaviors in adults following RYGB. Setting 2 university hospitals and 1 not-for-profit research institute in the U.S. Methods Participants from a large observational study of bariatric surgery who had undergone RYGB were recruited to complete additional measures. Of 241 consented participants, 201 provided data (i.e., Structured Clinical Interview for DSM-IV Axis I [SCID], additional Impulsive Control Disorder Modules, and various self-report measures, including the Alcohol Use Disorder Identification Test [AUDIT]) to assess status prior to surgery and in the first three post-operative years.). Results Based on the SCID, 16 (8.0%) developed alcohol use disorder [AUD] within three years post-RYGB, 7 (43.8%) of whom had no history of AUD. When both the SCID and AUDIT were used to identify AUD, the corresponding numbers/percentages were 32 (18.4%) and 13 (40.6%). Data on other behavioral addictive disorders indicated 19 (9.5%) had a post-surgery disorder, 6 (31.6%) of whom had no history. Conclusions These data add to a growing literature suggesting there is a substantial risk for the development of AUD after bariatric surgery. Understanding the risk for non-drug related addictive disorders requires more data from larger studies before clear conclusions can be drawn.