The potential for cross‐addiction in post‐bariatric surgery patients

Abstract

Background and purpose Possible mental health issues for post‐bariatric surgery patients include the development of cross‐addictions after the rapid weight loss period. No validated screening tool to assess for possible cross‐addictions exists. The main purpose of this study was to develop recommendations for modifying an existing addiction screening tool (the Shorter PROMIS Questionnaire) for use by primary care providers. Methods A qualitative descriptive design was used with triangulation of input from the scholarly literature, content experts (CEs), and post‐bariatric surgery patients. Three focus groups were conducted with post‐bariatric surgery patients (n = 12) with the same questions asked of the CEs (n = 3). Content analysis was used to analyze the transcripts. Conclusions The following themes regarding addictions after bariatric surgery were identified through consensus: alcohol, gambling, shopping, exercise, food starving/bingeing, and sexuality/relationships. Dissonant themes included caffeine and tobacco by the post‐bariatric surgery patients and prescription/illicit medications by the CEs. Implications for practice Targeted screening for early identification of problem behaviors by primary care providers may result in appropriate referral to and management by mental health providers, assisting ongoing success of bariatric surgery.

Food addiction and other addictive behaviours in bariatric surgery candidates

“…Linking the substance-use disorder framework to the FA concept, the possibility of postoperative behavioural replacement of FA with other addictive behaviours should be taken into consideration (Blum et al, 2011;Lindgren et al, 2018), which bears several clinical implications. It has been argued that certain postoperative patients may seek alternative rewarding behaviours when they are unable to overeat, resulting in "cross-addiction" or "addiction transfer" (Bak, Seibold-Simpson, & Darling, 2016;Blum et al, 2011;Fowler, Ivezaj, & Saules, 2014;Koball et al, 2016;Mc Fadden, 2010;Mitchell et al, 2015;Yoder, MacNeela, Conway, & Heary, 2018). Fowler et al (2014) found an association between preoperative eating of food with addictive qualities (e.g., high-sugar/ low-fat) and new onset of substance use disorder after surgery.…”

British Obesity Metabolic Surgery Society endorsed guidelines for psychological support pre‐ and post‐bariatric surgery

“…Further, many patients show positive psychological outcomes after surgery such as improved self‐identified health status, increased self‐esteem, a decrease in the preoccupation with food and a decrease in depressive symptoms . Some patients, however, may have poorer psychological outcomes post‐surgery such as recurrence of binge eating, substance misuse and suicidality . Further, these patients may also show suboptimal weight loss or weight regain .…”

“…7-10Some patients, however, may have poorer psychological outcomes post-surgery such as recurrence of binge eating, substance misuse and suicidality. [11][12][13][14] Further, these patients may also show suboptimal weight loss or weight regain. 2,[14][15][16] In particular, differences in weight loss trajectories seem to appear between 6 and 12 months alongside the re-emergence of loss of control over eating at 6 months which has led to the suggestion that post-operative interventions are often too late.…”

From bingeing to cutting: the substitution of a mal-adaptive coping strategy after bariatric surgery

“…The focus in this area has mainly been on addictions related to diagnostic categories, such as alcoholism, drug-abuse or gambling [ 18 , 20 ]. Behaviours on the margins of diagnoses, such as excessive shopping or sex addiction, have been briefly examined [ 20 , 21 ], whereas non-suicidal self-harm behaviours, to our knowledge, have not been investigated.…”