Cohort studyindependent cross-checkfull text checked★ key study I-BAR-127 in-depth review

Swedish 25-year study: alcohol problems after obesity surgery

Alcohol use disorder and alcohol-related mortality after metabolic bariatric surgery: prospective controlled cohort study.

Overview

Sjöholm et al.. Br J Surg 2025 · PMID 41066138 · DOI 10.1093/bjs/znaf211

Alcohol use disorder and alcohol-related deaths were several times more frequent after surgery, especially after gastric bypass.

Does the study support the specific claim? Yes · Methodological quality: high

Study explained simply

What did the researchers want to find out?: AUD and alcohol deaths after MBS
How was the study done?: Prospective controlled study
How many people, animals or samples were studied?: 4,047
What was actually found?: GBP AUD aHR 5.07; alcohol death sub-HR 6.18
How large was the observed effect?: Absolute 1.5 vs 0.3/1000 PY
What do the results mean in everyday life?: Alcohol risk needs monitoring
What are the study's limitations?: No sleeve patients
What does it say about Elawady's specific claim?: Supports the claim
Do the results apply to Germany and Europe?: Directly European
What can explicitly not be concluded from this study?: Sleeve-specific risk

Authors: Sjöholm et al.
Journal: Br J Surg
Year: 2025
Identifier: PMID 41066138 DOI 10.1093/bjs/znaf211
Verification: verified – PubMed efetch 2026-10-26 + Crossref API
Retracted: no
Corrections: none
Extent checked: full text
Conflicts of interest and funding: Swedish Research Council and other public foundations; funders had no role. Some authors report industry honoraria/consultancy (full text).

Is metabolic bariatric surgery associated with alcohol use disorder and alcohol-related mortality?

Study design: Cohort study – Prospective controlled intervention study (Swedish Obese Subjects), up to 35 y follow-up
Population: SOS participants with severe obesity (surgery vs matched usual care)
Country: Sweden
Period: 1987-2001 inclusion; median follow-up 25.2 y
Sample size: 2,007 surgery (266 GBP, 376 banding, 1,365 VBG), 2,040 controls
Inclusion and exclusion criteria: SOS cohort; prior AUD excluded in main analysis

Exposure / intervention: GBP, VBG, gastric banding
Comparator: Usual obesity care
Endpoints: AUD diagnoses (patient register), alcohol-related mortality (cause of death register)
Statistical methods: Cox and Fine-Gray competing-risk models

Results: AUD: GBP aHR 5.07 (3.11-8.25); VBG 2.28 (1.56-3.34); banding 2.34 (1.37-4.01) vs usual care. Alcohol-related mortality: GBP sub-HR 6.18 (2.48-15.40); VBG 3.56 (1.79-7.08); banding 2.52 (0.89-7.15). 45 vs 13 alcohol-related deaths; rates 1.5 (GBP) vs 0.3 (controls) per 1000 person-years.
Absolute risks: Alcohol-related deaths 1.5 vs 0.3 per 1000 person-years (GBP vs usual care).
Authors' conclusion: Managing alcohol-related complications requires preoperative risk assessment, postoperative monitoring and access to AUD treatment.

CI log-symmetric (stats/I-BAR-127_sos_alcohol_2025.py); absolute excess ~1.2 deaths/1000 PY after GBP.

Strong long-term evidence that alcohol problems and alcohol deaths increase after bariatric surgery (not sleeve-specific).

Sleeve not studied.

Swedish.

High-quality evidence supporting C-BAR-07.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	high
Risk of bias	some concerns
Precision of results	moderate
Directness	indirect
Reproducibility	replicated
Consistency with the overall evidence	consistent
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Sleeve-specific AUD risk.