The One Complication of Weight Loss Surgery That No One is Talking About.

For many years, we’ve been telling patients that Bariatric (Weight Loss) Surgery works by preventing people from eating too much and by blocking the absorption of calories in the intestine.  These two mechanisms, labeled “restriction” and “malabsorption” have laid the foundation that has driven much of the advice we’ve given to our postoperative patients as well as the basis for several new treatments.

After fourteen years of practice as a weight loss surgeon, I’m still amazed at the way a single surgery can fix so many problems.  In less than ninety minutes in the operating room (even shorter for a Sleeve Gastrectomy), we can treat diabetes, high blood pressure, immobility, sleep apnea and even heart failure more effectively than any medications.   In the United States, nearly 250,000 weight loss surgeries are performed every year, and as more people become aware of the dramatic health transformations that these procedures can bring about, this number is growing.  As we’ve become more experienced with these procedures, the complication rate has decreased significantly, making weight loss surgery as safe as many other commonly performed operations like gallbladder removal or hysterectomy.

Although weight loss surgery has been performed for nearly fifty years, it is only over the last decade that we’ve begun to understand how these procedures work.  Most people think that weight loss surgery works by blocking you from eating too much and preventing the absorption of the calories that you eat.  However, we now understand that these surgeries work primarily by changing the way important gastrointestinal hormones like insulin, ghrelin and leptin work.  These hormones affect your hunger, food preferences and metabolic rate and work to lower your body’s weight “setpoint” to a new, healthier level.

The alterations in your intestinal anatomy that drive these favorable hormonal changes can also result in a very noticeable change in the way you react to and absorb alcohol.  After weight loss surgery, alcohol is different, and it turns out, more addictive.  One of the most important ways that weight loss surgery works is to speed the delivery of food directly into your small intestine – food spends much less time in your stomach than it does in people who have not had weight loss surgery.  When alcohol is delivered rapidly into your small intestine, it is absorbed faster and more efficiently, causing you to get very drunk from very little alcohol.  I’ve heard many stories over the years of patients becoming very intoxicated from only 1-2 drinks.  Often these stories are told with a humorous bend, but after dozens of difficult conversations with postoperative patients who are coming to terms with their new alcohol dependence, I find them less funny now.

Weight loss surgery is a major life event that changes your relationship with food, your body, your health, and your relationship with alcohol.  Most people have successfully negotiated their relationship with alcohol by the time they choose to undergo weight loss surgery and never worried about whether or not they were drinking too much.  This sense of security often leads to a failure to recognize alcohol’s increasing grip on your life after surgery.  As postoperative patients gradually increase their alcohol use, their friends and family don’t appreciate their growing dependence since they’ve never had a problem with alcohol in the past.

Thankfully, only a small percentage of postoperative patients develop a significant alcohol problem after weight loss surgery.  While it’s difficult to quantify the exact amount, the estimate that I use in my practice is between 3%-4%.  It’s likely a little higher than this after a gastric bypass and a little lower after a sleeve gastrectomy.  Even though this is a relatively small number, it results in 10,000 people a year developing alcoholism in the United as a result of their weight loss surgery.

I think that many cases of alcohol dependency after weight loss surgery can be prevented with appropriate pre-operative education and post-operative surveillance.  It’s time for the weight loss surgery community to recognize that alcoholism is a known complication of weight loss surgery.  Just as we check vitamin levels for years after surgery and perform CT scans to evaluate abdominal pain, we also need to screen patients for alcohol dependency.  Those ten pounds of weight regain a few years after surgery are quickly blamed on dietary non-compliance and referred to the nutritionist, when the actual cause may be the nightly bottle of wine.

With appropriate education, counseling and surveillance, early intervention can become the standard allowing patients to receive the appropriate treatment for their growing dependence on alcohol earlier when it is easier to treat and has not yet resulted in devastating psychosocial damage.  Weight loss surgery can be the most important and powerful medical treatment of someone’s life, however, all of the amazing benefits can be destroyed if they become dependent on alcohol.  If you are considering weight loss surgery, or are a postop patient, make sure you are honest with yourself and your physicians about your alcohol consumption.  A growing dependence on alcohol may actually be a complication of your weight loss surgery.