For an emerging number of weight-loss surgery patients, giving up comfort food means guzzling Southern Comfort. Or hitting the mall instead of McDonald’s, even though creditors are calling. Researchers call this behavioral shift "addiction transfer," which means swapping one compulsive act, such as overeating, with another in an attempt to numb emotions or fill an inner void.
Mental-health experts say that because bariatric procedures have become more common — and patients more candid — they’re seeing increased cases of alcoholism, obsessive shopping, gambling and promiscuity.
After the euphoria of rapid weight loss fades, a harsh reality appears: Life is still tough even if you can fit in an airplane seat.
"The problem is that many people who have surgery haven’t been in therapy to address the issues behind their eating disorder," says Kathryn Friedman Sloan, a licensed mental-health counselor in Palm Beach Gardens. "Most of them are emotional eaters, and when you take that away, they’re left with ‘what do I do with my emotions?’ "
An upcoming Bariatric Times article focuses on addiction transfer.
"It’s probably been about the last year and a half to two years that it’s been coming out in the research," says coauthor Cynthia Alexander, a psychologist at Cleveland Clinic Florida in Weston. "We’ve started warning people that they have to be on the lookout. I’ve stepped up what I do in support groups and through education so that this doesn’t happen to our patients.
"There are millions of people who’ve had surgery who are dealing with this and want to bring it to light."
Gastric-bypass poster child Carnie Wilson, for example, appeared on Oprah
last month to say she’d become an alcoholic two years after her highly publicized operation in 1999. With binge eating gone as a coping mechanism, the singer started drinking up to 10 martinis a day to soothe stress. Although she’d lost 150 pounds, the negative feelings that fueled her obesity still lurked.
"I’m here to get the message out that after you’ve had surgery, you need to focus on what’s in your head," she said, adding that it’s not always possible to "solve it all" before going under the knife because many morbidly obese people face life-threatening illnesses that mandate weight loss now, therapy later.
Another woman on the show, who lost 200 pounds, revealed that she started having affairs as a way to distract herself from an unhappy marriage. "Being thin was supposed to be the answer to all my problems," she said. "But then you finally achieve that goal, and everything is not all better. It came as such a shock."
That light-bulb moment, counselors say, can trigger depression that some post-operative patients try to medicate with liquor, shopping or cigarettes. And for many, depression is what brought them to a bariatric surgeon’s office in the first place.
There’s another paradox: The positive step of dropping pounds can be stressful in itself.
"Dynamics change after you start reducing weight and putting the next foot forward," says psychologist Melodie Moorehead, the other author of the upcoming Bariatric Times article. "Relationships can shift as you put more balance in your life. You may have to retrain your boss that you’re not working 65 hours a week or retrain family members that you’re taking better care of yourself.
"Perhaps, for the first time, you’re going out on dates or playing soccer or doing a number of things to round out your lifestyle," says Moorehead, who works with patients at JFK Medical Center in Atlantis. "All of this requires adjustment."
In other words, weight-loss surgery alters more than a person’s pant size.
John Hoffmann, a construction project manager who lives in Boynton Beach, has lost nearly 200 pounds since his operation in April.
"I started dealing with some anxiety issues about two months ago," he says. "But with therapy and medication, I’m doing better. I don’t care how prepared you are for this, when I talk to people about it, I compare it to drug addicts and alcoholics. The things you were eating over are going to get to you eventually."
Experts emphasize that bariatric surgery doesn’t cause addiction, which Alexander and Moorehead state in their article.
"It seems to make sense," they write, "that if a person has a high addiction factor before surgery and is turning to food for reasons other than nutrition, (then) after surgery… the disease of addiction can show up in another form."
Wilson echoed their point on Oprah.
"The weight-loss surgery didn’t cause me to be an alcoholic," said the singer, who quit drinking two years ago. "I’m a born addict."
This is why Dr. Philip Schauer, president of the American Society for Bariatric Surgery, takes issue with linking addiction to the operating room.
"This has just come up out of nowhere," says Schauer, who works at the Cleveland Clinic in Ohio. "Bariatric surgery has been around for 30 years. It is true that some people before surgery have a predilection toward addiction. But transfer addiction has been sort of made up. There’s no real psychological evidence that that’s what’s happening."
Mental-health workers say that all you have to do is attend a support group or click on an anonymous chat room to discover otherwise. However, the stigma of addiction, like that of obesity, keeps many patients from admitting they’re in trouble.
New research suggests that the biochemical causes of compulsive behavior — be it overeating, alcoholism or drug addiction — are remarkably similar. The Wall Street Journal reported in July that scores of clinical trials on addiction are under way at the National Institutes of Health, and many of the drugs being studied target multiple behaviors.
For now, experts say, the addiction-transfer issue is awareness.
"If you’re having a drink now and then, it might not be a problem," Alexander says. "But if you find it’s steadily escalating, take notice of that and get help early.
"Call any psychologist. Call the number on the back of your insurance card for a referral. Call the mental-health hot line at 211. There’s help out there for developing other ways to deal with stress and emotions."