Cohort studycited by the Tayebat archivefull text checked★ key study A-BAR-13 in-depth review
Alcohol problems after weight-loss surgery
Prevalence of alcohol use disorders before and after bariatric surgery.
Overview
King WC et al.. JAMA 2012 · PMID 22710289 · DOI 10.1001/jama.2012.6147
Alcohol use disorder symptoms rose from 7.6% before surgery to 9.6% in the second year, mostly after gastric bypass.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
AUD risk
- How was the study done?
Prospective cohort
- How many people, animals or samples were studied?
1945
- What was actually found?
Increase in year 2
- How large was the observed effect?
7.6% -> 9.6%; RYGB AOR 2.07
- What do the results mean in everyday life?
A real but moderate increase; screening is advised
- What are the study's limitations?
Self-report screening (not diagnosis); no non-surgical control; 2 years only
- What does it say about Elawady's specific claim?
Supports claim; Arabic 'doubled' wrong
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Long-term course
Scientific in-depth review
1. Full reference
- Authors
- King WC, Chen JY, Mitchell JE, Kalarchian MA, Steffen KJ, Engel SG, Courcoulas AP, Pories WJ, Yanovski SZ
- Journal
- JAMA
- Year
- 2012
- Identifier
- PMID 22710289 DOI 10.1001/jama.2012.6147 · PMC3682834
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- full text
- Conflicts of interest and funding
NIDDK cooperative agreement (U01 grants; NIDDK scientists co-designed and a co-author contributed); Courcoulas: research grants from Allergan, Pfizer, Covidien, EndoGastric Solutions and Ethicon J&J advisory board; Pories: grants from J&J Ethicon Endosurgery and GSK.
2. Research question
Prevalence and predictors of alcohol use disorder before and after bariatric surgery
3. Study design and population
- Study design
- Cohort study – Prospective multicentre cohort (LABS-2, 10 US hospitals; NCT00465829), within-person comparison of past-year AUD symptoms before vs 1 and 2 years after surgery; no non-surgical control
- Population
Adults (78.8% female, 87.0% white, median age 47, median BMI 45.8) undergoing a first bariatric procedure (69.9% RYGB, 25.2% LAGB, 2.6% sleeve, 1.5% banded bypass, 0.8% BPD-DS)
- Country
USA
- Period
Recruitment February 2006 - February 2009; assessments 2006-2011
- Sample size
2458 enrolled and operated; 2265 completed preoperative AUDIT; 1945 analysed (completed AUDIT at 1 and/or 2 years); 1400 with data at all three time points (descriptive tables)
- Inclusion and exclusion criteria
Adults >=18 years seeking first bariatric procedure by participating surgeons; analysis excluded participants without pre- and at least one post-operative AUDIT (n=513 excluded: younger, fewer white, more smokers)
4. Methods and endpoints
- Exposure / intervention
Bariatric surgery (RYGB vs LAGB)
- Comparator
Pre-surgery year; LAGB
- Endpoints
Past-year AUD symptoms by AUDIT (score >=8, or alcohol-dependence symptoms, or alcohol-related harm) - a screening definition broader than DSM-IV AUD
- Statistical methods
Generalized linear mixed models with site random effect, data assumed missing at random; backward elimination confirmed by forward selection; interaction testing
5. Actual results
- Results
AUD prevalence (n=1400 with all time points): 7.6% pre-op, 7.3% at 1 year (P=.98), 9.6% at 2 years (P<.01 vs pre-op). Adjusted odds of AUD in year 2 vs year 1: 1.57 (95% CI 1.26-1.96). RYGB: 7.0% -> 7.9% -> 10.7% (P<.01); LAGB: 9.3% -> 5.6% -> 7.0% (P=.24). Preoperative predictors: male sex OR 2.14 (1.51-3.01), younger age per 10 years OR 1.95 (1.65-2.30) without pre-op AUD, smoking 2.58 (1.19-5.58), regular drinking 6.37 (4.17-9.72), pre-op AUD at age 45 OR 11.14 (7.71-16.10), recreational drug use 2.38 (1.37-4.14), lower belonging support 1.09 (1.04-1.15) per point, RYGB vs LAGB 2.07 (1.40-3.08); sleeve OR 0.80 (0.24-2.75; underpowered). 62.3% (66/106) of those with pre-op AUD had AUD after surgery vs 7.9% (101/1283) without; 60.5% (101/167) of post-op AUD occurred in people without pre-op AUD. Hazardous consumption was lower post-op (19.6% pre, 13.3% year 1, 16.5% year 2).
- Absolute risks
AUD prevalence 7.6% -> 9.6% (about 2 percentage points) overall; 7.0% -> 10.7% after RYGB; no significant change after LAGB. New post-op AUD in 7.9% of those without pre-op AUD. Alcohol/drug treatment 0.5-0.8%.
- Authors' conclusion
AUD prevalence greater in second postoperative year; associated with male sex, younger age, preoperative risk factors and RYGB.
6. Strengths
- Prospective, large multicentre sample
- Validated AUDIT administered for research, independently of clinical approval
- Pre-specified analysis plan approved by steering committee and DSMB
- Comparison across procedures (RYGB vs LAGB) supports a procedure-specific effect
7. Weaknesses
- No non-surgical control group (authors)
- Self-report; possible under-reporting before surgery and after a safety-referral trigger (authors)
- AUD defined by screening symptoms, not DSM-IV diagnosis; lifetime AUD not assessed so new-onset vs recurrent cannot be separated (authors)
- Only 2 years of follow-up
- Exclusion of 513 participants without complete AUDIT (selection)
- Stepwise model selection
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- structured assessment based on the full text by a single reviewer (no formal double review)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Structured single-reviewer judgement from full text; a formal assessment would require two independent reviewers and a protocol.
| Domain | Judgement | Rationale |
|---|---|---|
| Confounding | some concerns | Pre-post design without control: secular/age trends cannot be excluded; RYGB vs LAGB comparison adjusted for measured predictors but procedure choice not random. |
| Exposure measurement | low | Procedure documented. |
| Selection of participants | some concerns | 1945 of 2265 with pre-op AUDIT analysed; excluded participants differed (younger, more smokers). |
| Post-exposure interventions | low | Revisions/reversals censored. |
| Missing data | some concerns | Only 1400 with all three time points; MAR assumption. |
| Outcome measurement | some concerns | Self-reported screening instrument; social desirability and safety-protocol trigger may bias reporting. |
| Selection of reported result | low | Analysis according to pre-specified plan; registered study. |
Full-text review (25 October 2026): Added sample flow, procedure-specific prevalences (RYGB 7.0%->10.7%; LAGB no change), all predictor ORs with 95% CIs, year-2 vs year-1 OR 1.57, pre-op AUD persistence (62.3%) and new AUD (7.9%), broad AUDIT-based AUD definition, funding/COI; bias domains added, overall unchanged (some_concerns).
9. Assessment of the statistical interpretation
Modest absolute increase (about 2 percentage points overall, about 3.7 points after RYGB) appearing only in year 2; the relative comparison RYGB vs LAGB (OR about 2) is the strongest signal. The Arabic 'doubled' matches the RYGB-vs-LAGB odds ratio, not the change in prevalence.
10. Relevance to the specific claim
Supports C-BAR-07.
11. Independent contrary findings
12. Transferability to Germany and Europe
Applicable.
13. Overall methodological judgement
Correctly cited in English; Arabic narrative overstates ('doubled').
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | correctly reported |
14. Open questions
Longer-term trajectory (addressed in later LABS-2 report A-BAR-14); DSM-based diagnoses; risk after sleeve gastrectomy (n=50, underpowered).
15. Linked fact checks
- Bariatric surgery is followed by documented rises in self-harm, suicide-related deaths and alcohol use disorder. – Studies supporting the claim
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
AUD symptoms rose significantly in the second postoperative year (9.6% vs 7.6% baseline), particularly after Roux-en-Y.
- A. What was actually studied?
AUD before/after surgery
- B. What did the authors find?
7.6% -> 9.6% in year 2
- C. What conclusions do the authors themselves draw?
AUD greater in year 2; RYGB associated
- D. What does the archive derive from it?
Used to document alcohol risk after surgery.
- E. Is this derivation scientifically justified?
Correctly reported. The Arabic wording 'doubled' is not supported for prevalence (7.6% -> 9.6%); only the odds of post-operative AUD after RYGB vs banding were about doubled (OR 2.07). The English 'climbed' is correct.
- Adequacy of the interpretation (by the archive)
- correctly reported