Magazine article The Journal of Employee Assistance

Weight Loss Surgery: From Obesity to Alcoholism?

Magazine article The Journal of Employee Assistance

Weight Loss Surgery: From Obesity to Alcoholism?

Article excerpt

Obesity rates in the United States are increasing. It is a substantial enough problem that it's sparking an increasing number of cases of weight loss surgery (WLS). While more employees are undergoing bariatric surgery, few are educated about the increased risk of addiction transfer (developing alcoholism) following surgery. This article is designed to shed some light on this subject.

Regarding the recent trend toward weight loss surgery (WLS), National Center for Health Statistics data from 2007-2008 in the U.S., indicated the following for adults 20 to 79 years of age:

* 19.6% are classified as Obesity Class I (BMI (1) = 30.0 - 34.9) and are not usually candidates for WLS. More recently, reports of WLS success with this group have been reported. (2)

* 8.8% are classified as Obesity Class II (BMI = 35.0 - 39.9) and are candidates for WLS when co-occurring risk factors exist such as diabetes, hypertension, sleep apnea, or gastric reflux disease.

* 6.0% are classified as Obesity Class III (BMI [greater than or equal to] 40.0 and are traditional candidates for WLS.

WLS Benefits

This means that of the estimated 211 million people in the United States aged 20 to 79, (3) 72 million are obese, and 31 million are potential WLS candidates. WLS has numerous medical benefits, including decreases in mortality and morbidity, blood pressure, diabetes, cholesterol, sleep apnea, urinary incontinence, Gastroesophogeal Reflux, and orthopedic problems. WLS in the U.S. is steadily increasing, from 13,365 cases in 1998 to 200,000 in 2007.

Addiction Substitution

Beginning around 1999, anecdotal reports of an increase in alcohol abuse among post-operative WLS patients began to appear, culminating in a 2006 program on the Oprah Winfrey show Suddenly Skinny, where several WLS patients revealed their new addictions. Starting with the position that WLS candidates are food addicts, "experts" explained the sudden appearance of "new" addictions as substitutes for the former addiction to overeating: "If a patient drops a lot of weight without confronting why they were overweight, they risk becoming addicted to something else." (4) Many behavioral health experts attribute psychopathology to WLS patients as an explanation not only to their obesity, but also to their subsequent new addictions such as alcoholism.

We disagree. We believe that such attribution of addiction substitution not only reflects ignorance of the nature of addiction, which is, as we will demonstrate, a neurobiological process, but is also a not-so-subtle means of blaming the victim for problems, which arise from anatomical and physiological changes engendered by WLS rather than psychological defects.

In this article, we will report facts about the neurobiological processes of addiction, metabolic changes impacted by WLS, and how these changes engage addictive mechanisms in the case of alcohol use, abuse, and dependence. Our goal is to provide the EA professional with a better understanding of the issues relevant to their clients who are contemplating WLS or who develop alcohol problems following WLS.

The Neurobiology of Addiction

Addiction is not a psychological issue, but rather a neurobiological process. Specifically, our brains contain structures and circuits commonly called the reward system. This system comprises structures in the limbic system, which is a set of evolutionarily primitive brain structures located on top of the brain stem and buried under the cortex. This system is involved in many of our emotions and motivations, particularly those that are related to survival. These emotions include fear, anger, and feelings related to sexual behavior. The limbic system is also involved in feelings of pleasure that are related to our survival, such as those experienced from eating and sex. Two of these structures, the ventral tegmental area (VTA) and the nucleus accumbens (NA) form the structural foundation for addiction: In response to addictive substances (or, for that matter, events) the VTA activates dopamine (a neurotransmitter) in the NA, giving rise to pleasurable, rewarding psychological states. …

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