Changes in Alcohol Use after Metabolic and Bariatric Surgery: Predictors and Mechanisms


Purpose of Review

This review synthesized the literature on predictors and mechanisms of post-bariatric alcohol problems, in order to guide future research on prevention and treatment targets.

Recent Findings

Consistent evidence suggests an elevated risk of developing problems with alcohol following bariatric surgery. While there is a paucity of empirical data on predictors of problematic alcohol use after bariatric surgery, being male, a younger age, smoking, regular alcohol consumption, pre-surgical alcohol use disorder, and a lower sense of belonging have predicted alcohol misuse post-operatively. This review synthesizes potential mechanisms including specific bariatric surgical procedures, peptides and reinforcement/reward pathways, pharmacokinetics, and genetic influences. Finally, potential misperceptions regarding mechanisms are explored.


Certain bariatric procedures elevate the risk of alcohol misuse post-operatively. Future research should serve to elucidate the complexities of reward signaling, genetically mediated mechanisms, and pharmacokinetics in relation to alcohol use across gender and developmental period by surgery type.

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Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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The authors would like to acknowledge the Radcliffe Institute for Advanced Study at Harvard University for funding the meeting, which contributed to this review. All authors received travel reimbursement to attend the Radcliffe meeting, from which this manuscript resulted. Outside the submitted work, Dr. Pepino and Dr. Mitchell report grants from the NIH and Dr. Steffen reports grants from Sanford Profile/NDSU, NIH, and Shire Pharmaceuticals.

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Correspondence to Valentina Ivezaj.

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Conflict of Interest

Valentina Ivezaj, Stephen C. Benoit, Jon Davis, Celia Lloret-Linares, Ann M. Rogers, and Stephanie Sogg each declare no potential conflicts of interest.

Scott Engel is a section editor for Current Obesity Reports and he was not involved in the peer-review process.

Dr. Pepino reports a grant from the University of Illinois at Urbana-Champaign (NIH AA024103) and Dr. Mitchell reports funding from NIH.

Kristine Steffen reports grants from Sanford Profile/NDSU Grants, NIH, and Shire Pharmaceuticals and travel reimbursements from Radcliffe Institute.

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This article does contain studies performed by the authors (among other studies) which did use appropriate procedures for IRB and IACUC.

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Ivezaj, V., Benoit, S.C., Davis, J. et al. Changes in Alcohol Use after Metabolic and Bariatric Surgery: Predictors and Mechanisms. Curr Psychiatry Rep 21, 85 (2019).

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  • Obesity
  • Bariatric surgery
  • Alcohol
  • Alcohol use disorder
  • Roux-en-Y gastric bypass
  • Sleeve gastrectomy