By Jenni Deming
If you’re considered medically obese — or have been at some point in your life — you know firsthand how cruel such a small word can be. At times, it feels like you’re no longer a person at all. You’re a health condition.
But obesity isn’t a medical classification to you. It’s a personal label you’ve had to contend with for years.
You know what it’s like to go to the doctor for a sinus infection and suffer through a condescending lecture on diet and exercise. You’ve felt the stabbing pain of airplane armrests digging into your sides for hours. And you’ve endured the rude stares of waiters at restaurants and cart-snoopers at the grocery store.
If you’ve thought to yourself that you just don’t fit in, it’s understandable.
But the truth is actually much different. You are not an outsider. More than one-third of all Americans have a body mass index of 30 or higher (the medical definition for obesity according to the CDC).1 And by 2030, some estimates put that number closer to 50 percent of the population.2
Most people have legitimate reasons for gaining 50, 100 or 200 extra pounds — like thyroid conditions, autoimmune disorders, pregnancies, mental illnesses, car accidents or back pain. It happens gradually, over the course of years. And then, as a person’s metabolism slows down, it becomes harder and harder to shed the weight.
That usually leads to a laundry list of extremely unhealthy starvation diets and workout routines in an effort to be healthy. Doesn’t make much sense, right?
For many, a safer and more effective alternative is weight-loss surgery. It’s far from an easy choice (as some critics believe) since candidates must usually drop 20 or 30 pounds before the surgery, adhere to a strict diet and maintain a recommended exercise regime.
While weight-loss surgery is a strong option for those who qualify, scientists are still learning about some of the potential side effects of bariatric surgery — like whether or not it can lead to an increased risk of alcohol use disorder.
What Is Roux-en-Y Gastric Bypass Surgery?
Roux-en-Y gastric bypass (RYGB) is the most popular form of bariatric surgery. It’s a laparoscopic procedure (which means doctors make small incisions and use a camera) that reduces the size of the stomach significantly.
Surgeons staple off a small stomach pouch and “bypass” a section of the large intestine, reconnecting it lower down in the intestinal tract. This drastically shrinks the amount of food the new stomach can hold — from about four cups to about a tablespoon (the size of a walnut).3
The rest of the stomach stays in the patient’s body, producing important enzymes needed for digestion, though food no longer passes through it.
Typically, patients can expect to lose up to two-thirds of their body weight within the first two years after surgery.4 But a growing number of RYGB patients began reporting more than weight loss at the two-year mark. They were reporting an increase in alcohol consumption as well.
Studies Show Increased Alcohol Use After Gastric Bypass
Researchers from the University of Pittsburgh found that patients with alcohol use disorders (AUD) jumped from 7.6 percent to 9.6 percent around 24 months post-bypass. That may sound minor, but it’s scientifically significant.
According to the study, “that 2 percent increase potentially represents more than 2,000 additional people with AUD in the United States each year, with accompanying personal, financial and societal costs.”
Although safe levels of alcohol consumption for bariatric surgery patients have yet to be established, researchers say it’s troubling that “1 in 6 participants reported consumption at a hazardous level in the second postoperative year.”5
Another study by Swedish scientists followed participants for up to 20 years post- surgery. They found the same trend of increased alcohol use beginning in the second year:
“The long-term follow-up in our study allows us to show that increased alcohol problems after bariatric surgery persist beyond two years and result in increased alcohol abuse diagnosis … Our study, as well as three previous reports, shows that alcohol consumption is reduced during the first year after surgery, emphasizing the importance of long-term follow-up.”6
Interestingly, these studies determined that increased alcohol use was not associated with other common gastric bypass procedures, such as adjustable banding or sleeve gastrectomy.
So what gives? Why are RYGB patients “suddenly” developing AUD? And what can be done about it?
Why Scientists Believe This Is Happening
One relatively agreed-upon theory revolves around alcohol absorption. People with smaller stomachs appear to feel the affects of alcohol more quickly and for longer periods of time.
In a Bariatric Times survey, 84 percent of respondents said they were far more sensitive to alcohol than before their procedure:
“Many patients (44 percent) could ‘feel’ (had a physical response to) the effects of alcohol after having only a few sips of one drink. Another 45 percent of the population reported ‘feeling’ the effects of alcohol after having only one alcoholic beverage. Such enhanced alcohol sensitivity following gastric bypass is likely due, in part, to a more rapid increase in the rate of alcohol absorption … Research has shown that gastric bypass patients — even those that are three or more years post-operative — have a more rapid absorption of alcohol and a peak in blood alcohol content that is considerably higher than that of someone with normal gastrointestinal anatomy.”7
Scientists in another study (which was done with lab rats at Pennsylvania State University College of Medicine) also theorize that the hormonal rewards of alcohol intensify after RGYB.
“Although the literature shows that RYGB reduces the rewarding effect of certain foods, the opposite may be true for other rewarding substances such as alcohol … it is likely that RYGB alters the sensitivity to alcohol reward, presumably through effects in the mesolimbic dopamine system [aka ‘the reward pathway’]. One possibility is that RYGB may improve the sensitivity of the dopamine system, which might be blunted in obesity think that dopamine sensitivity is part of the reason for the possible increase in alcohol use.”8
Still another theory points to addiction transfer, which means that one addiction (such as food addiction) is replaced with another (alcohol addiction).9 But views vary on this, as alcohol seems to be the main culprit, rather than say, gambling or harder drugs. One simple explanation might be the cultural ease and acceptability of alcohol over most other addictive behaviors.
How to Mitigate Your Risk for Alcohol Addiction
Despite the correlation between AUD and RYGB, scientists are quick to remind people of the overall benefits of weight-loss surgery. As with all medical procedures, it’s wise to be informed of the risks, but to also weigh them against the potential health benefits. Whether you’ve undergone bariatric surgery in the past or are considering it now, here are some things to keep in mind:
- Tell your doctor about your family history of alcohol use disorder. Talk openly and honestly about past addictions in your family, and be vigilant if symptoms begin to develop. Seek treatment if you become reliant on alcohol.
- Continue regular checkups and screenings. Studies show that AUD develops most frequently around the two-year mark, so maintain regular follow-up visits with your doctor. And if something feels “off” don’t be afraid to schedule an appointment.
- If you suffer from binge eating disorder, treat the underlying causes. Therapy is a good way to ensure you’ve dealt with dormant stressors and triggers that can lead to addiction transfer.
- Find a support group. Whether it’s online or in-person, talk to others who are experiencing the same ups and downs of weight-loss surgery that you are. Allow friends to strengthen and encourage you along the way.
- Consider alternative types of weight-loss surgery. If your doctor determines you have an increased risk for AUD, you may want to explore alternatives to RYGB, such as gastric banding or sleeve gastrectomy. No matter what you choose, do your research, and ask lots of questions.
Bariatric surgery is a big step. But it’s the right step for many people who are ready to shed the weight they’ve been trying to lose for years. With a few safety parameters in place, you can be confident you’re doing the right thing for yourself — for years to come.
1 “Adult Obesity Facts.” Centers for Disease Control and Prevention, August 29, 2017.
2 Sjöström, L. “Review of the Key Results From the Swedish Obese Subjects (SOS) Trial – A Prospective Controlled Intervention Study of Bariatric Surgery.” Journal of Internal Medicine, February 8, 2013.
3 “Your Diet After Gastric Bypass Surgery.” MedlinePlus, June 27, 2016.
4 “Roux-en-Y Gastric Bypass.” Cleveland Clinic, Accessed October 2017.
5 King, Wendy C., Jia-Yuh Chen, et al. “Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery.” JAMA, June 20, 2012.
6 Svensson, Per-Arne, Asa Anveden, et al. “Alcohol Consumption and Alcohol Problems After Bariatric Surgery in the Swedish Obese Subjects.” Obesity: A Research Journal, May 31 2013.
7 Buffington, Cynthia K. “Alcohol Use and Health Risks Survey Results.” Bariatric Times, March 25, 2007.
8 Polston, James E., Carolyn E. Pritchett, et al. “Roux-en-Y Gastric Bypass Increases Intravenous Ethanol Self-Administration in Dietary Obese Rats.” PLoS ONE, December 31, 2013.
9 Broadwater, Kelly. “Transfer Addiction Following Bariatric Surgery.” Obesity Action Coalition, April 19, 2016.