Obesity Surgery

, Volume 28, Issue 6, pp 1492–1497 | Cite as

A Qualitative Examination of Increased Alcohol Use after Bariatric Surgery among Racially/Ethnically Diverse Young Adults

  • Christine E. Spadola
  • Eric F. Wagner
  • Leah M. Varga
  • Jennifer L. Syvertsen
  • Nestor F. De La Cruz Munoz
  • Sarah E. Messiah
Original Contributions



Mounting evidence suggests that bariatric surgery, or weight loss surgery (WLS), patients might be vulnerable to developing post-operative alcohol use problems. While the majority of published research offers information concerning the prevalence of problematic alcohol use post-WLS, the literature lacks comprehensive, qualitative explorations examining why alcohol misuse might emerge after WLS. Such data-driven hypotheses are needed to effectively target this emerging concern. Additionally, young adults and racial/ethnic minorities are both increasingly undergoing WLS and are at heightened risk for problems related to alcohol use. To date, these groups have been under-represented in study samples.


To address these important gaps in the literature, racially/ethnically diverse, young adult WLS patients who indicated a post-WLS increase in alcohol use (n = 12) participated in an individual, semi-structured qualitative interview. Data were analyzed through two coding cycles; an external audit of the emerging themes was also conducted to further ensure the trustworthiness of the data.


Interviews revealed four major themes prompting an increase in alcohol use after WLS: (1) increased sensitivity to alcohol intoxication, (2) utilizing alcohol as a replacement self-soothing mechanism for food, (3) increase in socialization, and (4) utilizing alcohol as a coping mechanism.


By understanding the drivers of increases in alcohol use after WLS, precision-targeted pre- and post-surgical counseling interventions can be developed to address this emerging concern.


Bariatric surgery Young adult Alcohol RYGB Substance use Weight loss surgery Qualitative 



The authors wish to thank Geoffrey Hunt PhD, Suzanne Bertisch MD MPH, Rebecca Rottapel MS MPH, and Susan Redline MD MPH for their feedback on this manuscript. The authors also are grateful for the participants who generously shared their post-WLS experiences, without whom this article would not be possible.

Funding Support

This study was funded by the Micah Batchelor Foundation.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Conason A, Teixeira J, Hsu CH, et al. Substance use following bariatric weight loss surgery. JAMA Surg. 2013;148(2):145–50.
  2. 2.
    King WC, Chen JY, Mitchell JE, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307(23):2516–25.
  3. 3.
    Spadola CE, Wagner EF, Dillon FR, et al. Alcohol and drug use among postoperative bariatric patients: a systematic review of the emerging research and its implications. Alcohol Clin Exp Res. 2015;39(9):1582–601.
  4. 4.
    Svensson PA, Anveden Å, Romeo S, et al. Alcohol consumption and alcohol problems after bariatric surgery in the Swedish obese subjects study. Obesity. 2013;21(12):2444–51.
  5. 5.
    King WC, Chen JY, Courcoulas AP, et al. Alcohol and other substance use after bariatric surgery: prospective evidence from a US multicenter cohort study. Surg Obes Relat Dis. 2017.Google Scholar
  6. 6.
    Spadola CE, Wagner EF, Accornero VH, et al. Alcohol use patterns and alcohol use disorders among young adult, ethnically diverse bariatric surgery patients. Subst Abus. 2017;38(1):82–7.
  7. 7.
    Pepino MY, Okunade AL, Eagon JC, et al. Effect of Roux-en-Y gastric bypass surgery: converting 2 alcoholic drinks to 4. JAMA Surg. 2015;150(11):1096–8.
  8. 8.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(S1).Google Scholar
  9. 9.
    Orellana ER, Jamis C, Horvath N, et al. Effect of vertical sleeve gastrectomy on alcohol consumption and preferences in dietary obese rats and mice: a plausible role for altered ghrelin signaling. Brain Res Bull. 2017.
  10. 10.
    Gallo AS, Berducci MA, Nijhawan S, et al. Alcohol metabolism is not affected by sleeve gastrectomy. Surg Endosc. 2015;29(5):1088–93.
  11. 11.
    Maluenda F, Csendes A, De Aretxabala X, et al. Alcohol absorption modification after a laparoscopic sleeve gastrectomy due to obesity. Obes Surg. 2010;20(6):744–8.
  12. 12.
    Brown SA, McGue M, Maggs J, et al. A developmental perspective on alcohol and youths 16 to 20 years of age. Pediatrics. 2008;121(Supplement 4):S290–310.
  13. 13.
    Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Vital signs: Bing drinking among women and high school girls-united states, 2011. Morb Mortal Wkly Rep. 2013;62:1.Google Scholar
  14. 14.
    Messiah SE, Lopez-Mitnik G, Winegar D, et al. Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2013;9(4):503–13.
  15. 15.
    Contreras JE, Santander C, Bravo J. Correlation between age and weight loss after bariatric surgery. Obes Surg. 2013;23(8):1286–9. Scholar
  16. 16.
    Chen K, Kandel D. The natural history of drug use from adolescence to the mid-thirties in a general population sample. Am J Public Health. 1995;85(1):41–7. Scholar
  17. 17.
    Mulia N, Ye Y, Greenfield TK, et al. Disparities in alcohol-related problems among white, black, and Hispanic Americans. Alcohol Clin Exp Res. 2009;33(4):654–62.
  18. 18.
    Yoon YH, Yi HY, Grant BF, et al. Surveillance report# 57: liver cirrhosis mortality in the United States, 1970–98. NIAAA, Division of Biometry and Epidemiology, Alcohol Epidemiologic Data System, Bethesda; 2001.Google Scholar
  19. 19.
    Ivezaj V, Saules KK, Wiedemann AA. “I didn’t see this coming.”: why are postbariatric patients in substance abuse treatment? Patients’ perceptions of etiology and future recommendations. Obes Surg. 2012;22(8):1308–14. Scholar
  20. 20.
    Patton MQ. Qualitative research and evaluation methods. 3rd ed. London: Sage; 2002.Google Scholar
  21. 21.
    Strauss A, Corbin J. Basics of qualitative research: techniques for developing grounded theory. 2nd Ed. Thousand Oaks: Sage; 1998.Google Scholar
  22. 22.
    Saldano J. The coding manual for qualitative researchers. London: Sage Publications; 2009.Google Scholar
  23. 23.
    Charmaz K. Constructing grounded theory: a practical guide through qualitative research. London: Sage Publications Ltd.; 2006.Google Scholar
  24. 24.
    Auerbach CE, Silverstein LB. Qualitative data: an introduction to coding and analysis. New York: New York University Press; 2003.Google Scholar
  25. 25.
    Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? Br Med J. 2001;322(7294):1115–7. Scholar
  26. 26.
    Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. Sage publications; 2013.Google Scholar
  27. 27.
    Creswell JW, Miller DL. Determining validity in qualitative inquiry. Theory Pract. 2000;39(3):124–30. Scholar
  28. 28.
    Conceição E, Vaz A, Bastos AP, et al. The development of eating disorders after bariatric surgery. Eat Disord. 2013;21(3):275–82.
  29. 29.
    Engström M, Forsberg A. Wishing for deburdening through a sustainable control after bariatric surgery. Int J Qual Stud Health Well-being. 2011;6(1):5901.CrossRefGoogle Scholar
  30. 30.
    Rusch MD, Andris D. Maladaptive eating patterns after weight-loss surgery. Nutr Clin Pract. 2007;22(1):41–9. Scholar
  31. 31.
    Ivezaj V, Stoeckel LE, Avena NM, et al. Obesity and addiction: can a complication of surgery help us understand the connection? Obes Rev. 2017;18:765–75Google Scholar
  32. 32.
    Jackson KM, Sher KJ, Schulenberg JE. Conjoint developmental trajectories of young adult alcohol and tobacco use. J Abnorm Psychol. 2005;114(4):612.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Collins RL, Parks GA, Marlatt GA. Social determinants of alcohol consumption: the effects of social interaction and model status on the self-administration of alcohol. J Consult Clin Psychol. 1985;53(2):189.CrossRefPubMedGoogle Scholar
  34. 34.
    O'Hare T. Stress and drinking context in college first offenders. J Alcohol Drug Educ. 2001;47(1):4.Google Scholar
  35. 35.
    Wood KV, Ogden J. Patients’ long-term experiences following obesity surgery with a focus on eating behaviour: a qualitative study. J Health Psychol. 2016;21(11):2447–56. Scholar
  36. 36.
    Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Division of Sleep MedicineHarvard Medical School and Brigham and Women’s HospitalBostonUSA
  2. 2.Banyan Research Institute for Dissemination, Grants and EvaluationFlorida International UniversityMiamiUSA
  3. 3.District of Columbia Department of HealthWashingtonUSA
  4. 4.Department of AnthropologyUniversity of California RiversideRiversideUSA
  5. 5.Department of SurgeryUniversity of Miami Miller School of MedicineMiamiUSA
  6. 6.Department of PediatricsUniversity of Miami Miller School of MedicineMiamiUSA

Personalised recommendations