From food to alcohol: exploring psychosocial drivers of post-bariatric alcohol use

Bariatric surgery is an effective intervention for severe obesity; yet emerging evidence indicates a clinically significant risk of problematic alcohol use post-operatively, particularly among women and those undergoing Roux-en-Y gastric bypass. While physiological mechanisms are well documented, , limited qualitative research explores the psychosocial drivers behind this shift.

Using reflexive thematic analysis, we examined semi-structured interviews with 11 UK-based women (aged 33-63) who underwent bariatric surgery (2012-2021) and subsequently developed problematic alcohol use, despite no formal diagnosis of alcohol use disorder. Interviews were co-designed with individuals with lived experience and thematically coded in NVivo.

Five themes emerged, each comprising related sub-themes: (1) altered alcohol metabolism and heightened intoxication; (2) alcohol as a substitute for food and tool for weight control; (3) shifting identity and social confidence; (4) alcohol use as emotional regulation post-weight loss; and (5) insufficient pre- and post-operative psychosocial care. Participants described using alcohol deliberately for appetite suppression, social ease, or emotional escape, reflecting unmet psychological needs.

Post-surgical problematic alcohol use appears not simply physiological but a coping response shaped by trauma, identity change, and unmet emotional needs. Trauma-informed screening and longitudinal psychosocial follow-up are needed to improve long-term outcomes.What is already knownBariatric surgery has been associated with an increased risk of problematic alcohol use, particularly following Roux-en-Y gastric bypass, with emerging evidence also suggesting elevated risk following sleeve gastrectomy, albeit to a lesser extent.Addiction transfer from food to alcohol has been reported but remains poorly understood in psychosocial terms among bariatric surgery patients.Current care pathways still focus mainly on physical outcomes, with less attention to psychosocial risks.What this study addsShows how alcohol is used for appetite suppression, social confidence, and emotional coping after surgery.Demonstrates how post-operative challenges and social dynamics can escalate alcohol use.Underscores the need for improved assessment, patient education, and tailored psychosocial support in bariatric care.