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printer-friendly version| Addictions After Bariatric Surgery by Philip R. Schauer, MD and Kathleen Ashton, PhD - January 2007 Obesity is a growing epidemic in the western world and is emerging as the most debilitating disease of modern times, as well as the leading cause of preventable death. For persons affected by morbid obesity, bariatric surgery is the only intervention with proven effectiveness for long term significant weight loss. In addition, results of numerous scientific studies demonstrate that weight loss following bariatric surgery is accompanied by numerous other positive outcomes, including dramatic improvement in quality of life, reduction or even reversal of chronic medical conditions?such as hypertension, sleep apnea and diabetes?and lengthening of life span. However, as the number of patients undergoing bariatric surgery continues to increase rapidly, there has been growing attention focused on reports of patients who develop compulsive behaviors after the procedure, such as compulsive shopping, alcoholism, or drug abuse. While the suggestion has been made that patients adopt a new addictive habit as an exchange for their compulsive eating problem, how commonly this type of phenomenon occurs and whether there is a true cause-and-effect relationship between the surgery and the appearance of these behaviors has not been established. Experience at the Cleveland Clinic Bariatric and Metabolic Institute is that the vast majority of patients recover well after their procedure without developing new addictions. For the few patients who do acquire these behaviors, concrete evidence is lacking to conclude they are linked directly to the surgery. Comprehensive physical and psychological pre-operative assessments combined with continued medical care and counseling post-operatively are critical for assuring the best possible outcome for patients who undergo bariatric surgery. Prospective WLS patients may have a previous or current history of various mental health disorders, including binge eating or addictions to cigarettes, alcohol, drugs or other illegal substances; active substance abuse is generally considered a reason to exclude a patient from surgery. However, the pre-surgical screening program can help identify persons affected by such problems and allow them to receive treatment so that they can overcome the addiction and then be considered for WLS in the future. The physical recovery process after bariatric surgery and the need to adapt to the major life changes that follow from the procedure create stress, and it is conceivable that patients may develop or redevelop compulsive behavior problems as a response to those pressures when overeating is no longer an option. However, there is also research to suggest that persons who have undergone previous psychotherapy or other counseling for addictive behaviors may do especially well after weight loss surgery since they have already learned positive coping techniques. Anyone deciding on a bariatric surgery program should consider the availability of services focused on reinforcing mental health. Psychologists dedicated to bariatric surgery patients are an integral part of the clinical team at the Cleveland Clinic Bariatric and Metabolic Institute. In addition to their role in pre-operative assessment, psychologists maintain close contact with patients after surgery, which allows them to answer questions, provide therapy and support, and identify any worrisome emerging habits and the need for intervention to prevent a more significant problem. In addition, patients have the opportunity to participate in support group activities sponsored by Cleveland Clinic and are provided with information about a large number of other support groups in the local area. Bariatric surgery is a life modifying and potentially lifesaving procedure, but persons considering this surgical intervention for obesity need to become fully educated about the potential risks and ready themselves for the challenges they will face afterward. Continued counseling and participation in support group activities can help bolster emotional health and assist patients in developing positive coping strategies. Individuals who take advantage of these programs to make necessary changes in their lifestyle and dietary habits will be well served?not only reducing any risk for developing new compulsive behavior problems?but increasing their chances of an overall successful outcome after bariatric surgery.  Philip Schauer, MD, is President of the American Society for Bariatric Surgery and is the Director of Advanced Laparoscopic and Bariatric Surgery at Cleveland Clinic. In addition to bariatric surgery, his specialty interests include laparoscopic surgery, gastrointestinal surgery and colon surgery. A frequent national and international lecturer, Dr. Schauer also has published numerous articles on topics relating to laparoscopic surgery, and his first textbook on the subject will be published this year. Kathleen Ashton, PhD, is a health psychologist with Cleveland Clinic?s Department of Psychiatry and Psychology. She received her doctorate from The Ohio State University and completed specialty training in health psychology at the Cleveland VA Medical Center and Cleveland Clinic. Dr. Ashton?s clinical and research interests include bariatric surgery evaluation and treatment, stress management and the relationship of stress to physical illness, women?s health, and sleep disorders. |
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