Weight loss surgery (WLS) has been an effective treatment for many patients with clinically severe obesity and comorbid medical con­ditions. Despite its merits, WLS requires major lifestyle changes for potential candidates, and many patients may not be adequately prepared to make such changes. Studies have suggested that substance and alcohol abuse is more common among patients undergoing WLS, but this research has been limited by the lack of preoperative baseline data as well as longitudinal data.

The symptom substitution theory states that eliminating a particular symptom without treating the underlying cause will lead to the development of a substitute symptom. Under this theory, it’s possible that the risk of substance use may rise after WLS; while the surgery helps eliminate excessive eating, it doesn’t address any potential underlying psychopathology. Since drugs, alcohol, and other substances trigger responses in the brain similar to that of food, it’s possible that they can serve as a food substitute in the WLS population.

A Closer Look At Substance Use After Weight Loss Surgery

My colleagues and I had a study published in JAMA Surgery that examined the likelihood of WLS patients to develop substance use—specifically alcohol, cigarettes, and recreational drugs—after their operation. We analyzed 155 patients undergoing WLS—100 who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery and 55 who received laparoscopic adjustable gastric band (AGB) surgery.


Participants undergoing either RYGB or AGB surgery reported significant increases in the frequency of substance use—using a composite of drug use, alcohol use, and cigarette smoking—when assessed 2 years after surgery. Notably, patients in the RYGB group reported a significantly higher frequency of alcohol use at 2 years after surgery. Participants did not experience any significant increases from baseline to 1, 3, or 6 months, but they did experience increases in substance use from 1, 3, and 6 months after surgery to 24 months postoperatively.

Managing Candidates for Weight Loss Surgery

Our analysis demonstrates the importance of being mindful of several factors when managing candidates for WLS and WLS recipients. Preoperative prevention interventions are critical; clini­cians should be vigilant about identifying patients who may be at higher risk of developing substance use problems after WLS. For example, patients may have postoperative issues with alcohol use if they have a personal or family history of alcohol abuse or dependence. These risks and benefits should be weighed when recommending RYGB or AGB surgery. Alternatives should be readily available for such patients, proven fat burners can and should be supplied.

In addition, patients should be screened at follow-up visits with surgeons and other medical professionals to determine whether they have developed substance use problems. Several simple, easy-to-use screening measures are available, and these evaluations should be conducted throughout the postoperative period, including long-term follow-up, since most problems with substance use occur 2 years and more after WLS.