If you’ve been struggling with your weight, have you thought about bariatric surgery? You may have seen billboards or heard radio ads promoting surgery or heard celebrities like Roseanne Barr, Star Jones, and Al Roker talk about their weight loss surgeries. Well over 200 thousand of these procedures were performed last year.
A review of 22 studies tracking more than 4,200 patients found that they lost an average of 66 percent of their excess weight and kept it off over time. In addition to weight loss there were significant improvements in weight-related conditions like diabetes and hypertension although a 15-year follow-up study found that 13 percent had postoperative complications. While many people have good outcomes, two recent studies suggest that there may be an unanticipated complication following surgery: an increase in alcohol abuse.
A Swedish study of over 2000 bariatric surgery patients found that, for patients who had the gastric bypass procedure, alcohol consumption decreased in the first six months after surgery but then increased markedly. In contrast, the lap band procedure didn’t result in increased alcohol abuse.
Similar results were found in a smaller study from Massachusetts General Hospital. Of the 340 patients who had bypass surgery seven percent who never had a drinking problem before surgery developed alcohol problems after surgery. This finding was noteworthy since most of the patients were middle aged and, in the general population, alcohol problems usually develop before age 35.
One possible cause of the increased alcohol abuse is that the surgery causes faster delivery of alcohol to the small intestine where it is absorbed quickly. Perhaps the more immediate effect of drinking increased problems with alcohol. An alternative explanation is that alcohol addiction became a substitute for food addiction.
The bypass procedure results in a golf ball sized stomach so patients can’t eat very much after surgery. If they were emotional eaters before surgery they would have used food to cope with anxiety, depression, anger or other unpleasant emotions. After surgery emotional eating would be difficult or impossible since the smaller stomach couldn’t handle binges or even frequent snacks. It would be necessary to find a different method for dealing with unpleasant emotions. Drinking may provide an alternative means of coping.
These studies demonstrate that weight loss after surgery doesn’t address the underlying issues that contribute to obesity for some people. This was illustrated by a women I met several years ago when I was giving a talk to a group of patients who had bariatric surgery. After the talk was over one woman told me that she had regained much of the weight she had lost. I thought she would be unhappy or perhaps frustrated after regaining weight. Instead, as she described her recent history, it became apparent that she wasn’t upset.
She didn’t start drinking but she worked at gradually expanding her stomach so that she could continue to use eating to cope with unpleasant emotions. Rather than addressing the situations in her life that were the source of distress she resumed emotional eating even though it defeated the surgery.
By itself, surgery and weight loss doesn’t deal with the emotional issues that may contribute to overeating and weight gain. To address this problem one surgery center in an Iowa hospital offers my ”Overcoming Emotional Eating” CD to patients following surgery. It’s hardly a complete solution to the problem but at least it’s a recognition that psychological issues may emerge following surgery. A more comprehensive solution would include post-surgical support groups along with reading materials such as Emotional Eating: What You Need to Know Before Starting Another Diet, (http://amzn.to/LE8WmY) to help patients resolve the emotional issues that trigger unnecessary eating.
There are many reasons why people gain weight and become obese. When emotional eating is part of the problem, surgery by itself is unlikely to yield a satisfactory outcome.