Talk about swapping out one problem for another: Research suggests that people who undergo a particular type of weight-loss surgery may raise their risk of abusing alcohol. The study, published in Surgery for Obesity and Related Diseases—the journal of the American Society for Metabolic and Bariatric Surgery (ASMBS)—suggests there may be repercussions from bariatric surgery that have not been anticipated.
It can take years, even decades, for all outcomes to appear after a medical procedure. The ASMBS study took place over seven years, following more than 2,000 patients from 10 hospital-based weight-loss surgery centers nationwide. These patients were already participating in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2). Roux-en-Y gastric bypass (RYGB) was the most common procedure in the group, accounting for 1,481 patients. Most of the remaining patients (522) had less-invasive laparoscopic adjustable gastric banding. (Gastric band weight-loss surgery has fallen out of favor in recent years because it tends to be less effective.)
The study found that all patients appeared to increase alcohol consumption over the years. The RYGB patients, however, were noted to have significantly more “alcohol-use disorder symptoms.” In fact, among patients with no alcohol problems preceding surgery, RYGB patients had more than double the risk of developing problems with alcohol following surgery, compared to patients who had gastric band weight-loss surgery. Almost 21 percent of RYGB patients developed symptoms of alcohol disorder, compared to 11 percent of gastric-band patients.
Another finding from the study was that four times as many RYGB patients as gastric-band patients received substance-abuse therapy post-surgery. Yet few of these patients reported the therapy or the substance abuse to the surgical team or support team.
Currently, the ASMBS recommends that all candidates for weight-loss surgery be screened for alcohol-use disorder. Given this study, it also seems prudent to screen patients for a family history of alcohol or drug abuse. Family history alone might be a risk factor.
It is glaringly obvious from these findings that all patients who undergo weight-loss surgery, especially those opting for RYGB, be made aware of the potential for alcohol abuse post-surgery. These patients require education and close follow-up.
Though the LABS-2 study was not designated to look at alcohol issues specifically, the data showed that patients who underwent RYGB had higher and quicker blood-alcohol elevations compared to patients who chose gastric banding. Separate animal studies suggest that the alcohol “reward” sensitivity may be heightened in RYGB patients. LABS-2 findings also indicate that certain kinds of patients are at higher risk of developing alcohol issues: They tend to be male, young, and with less social support. Red flags include: getting a divorce after surgery, a worsening in mental health post-surgery, and simply starting to drink twice a week post-surgery.
The lead researcher, Wendy C. King, Ph.D., said that when she and her team launched this study in 2000, they were aware that patients experienced problems with alcohol in the two years after surgery. What surprised the team was the persistence of this problem over the next five years.
It appears that when people “give up” food—whether through a lifestyle choice, surgical intervention, or both—those with addictive inclinations typically seek out a replacement behavior. They might become obsessive exercisers or begin to spend money recklessly in an effort to recapture that missing food “high.” It’s worth considering that RYGB, which is the more aggressive weight-loss surgery, may instigate an almost primal need to engage in another unhealthy behavior to achieve the same dopamine mood-booster payoff. So for someone who was eating large amounts of food frequently, it’s not unreasonable to assume they would seek a replacement in alcohol.
The big takeaway from this research is the need for patients to ask for up-to-date findings about possible negative outcomes of any surgical procedure or therapy. It’s also clear that after weight-loss surgery, patients may need support for years and even decades.