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Patient perceptions suggest that several common themes may be related to risk for the development of postsurgical substance use disorders.

Emerging research suggests that rates of food addiction are high among individuals seeking bariatric surgery, but little is known about associated features and the prognostic significance of pre-operative food addiction. Thus, this article provides a systematic review and synthesis of the literature on food addiction and bariatric surgery. Articles were identified through PubMed and SCOPUS databases, resulting in a total of 19 studies which assessed food addiction among pre- and/or post-bariatric surgery patients using the Yale Food Addiction Scale. Most studies were cross-sectional and only two studies prospectively measured food addiction both pre-and post-operatively. The presence of pre-surgical food addiction was not associated with pre-surgical weight or post-surgical weight outcomes, yet pre-surgical food addiction was related to broad levels of psychopathology. The relationship between food addiction and substance misuse among individuals undergoing bariatric surgery is mixed. In addition, very few studies have attempted to validate the construct of food addiction among bariatric surgery patients. Results should be interpreted with caution due to the methodological limitations and small sample sizes reported in most studies. Future rigorous research with larger and more diverse samples should prospectively examine the clinical utility and validity of the food addiction construct following bariatric surgery.

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Overall, findings suggest that post-WLS patients are overrepresented in substance abuse treatment programmes, and the majority of them report no history of SUD before WLS. Relative to non-WLS patients in SUD treatment, post-WLS patients in substance abuse treatment are disproportionally diagnosed with alcohol dependence, including alcohol withdrawal. Post-WLS patients may be at elevated risk for development of New Onset SUD in the absence of a prior SUD history; this group is phenotypically different from those with a history of substance abuse prior to surgery, and such patients may have unique treatment needs. A comprehensive substance abuse treatment facility began observing increased admissions who reported histories of weight loss surgery (WLS). Emerging evidence suggests that roughly half of post-WLS patients in substance abuse treatment developed their substance use disorder (SUD) after surgery. The present study examined differences between SUD patients who developed New Onset SUD after surgery and those with a reported SUD onset before WLS (SUD Hx+ group). Participants completed a questionnaire and participated in a semi-structured interview. Data were also obtained from participants' electronic medical records. Of the total treatment sample (n = 4658), 2.8% reported a history of WLS. Post-WLS patients were significantly more likely to be diagnosed with alcohol use disorders (AUDs). Among post-WLS patients who were interviewed (n = 56), 60% were classified as New Onset SUD, while only 40% were SUD Hx+. SUD Hx+ cases reported using significantly more types of substances than New Onset cases and were more likely to report pre-surgical binge eating disorder (BED). Post-WLS patients are overrepresented in substance abuse treatment and are disproportionally diagnosed AUDs. Post-WLS patients may be at elevated risk for development of New Onset SUD at a time in life (middle age) when SUD onset is relatively uncommon.