Is bariatric surgery making the patients prone to develop substance abuse? The data suggest that the patients, after losing a considerable amount of weight through bariatric surgery, are in a state of euphoria and elation. However, some patients go into a state of depression as they are not able to consume a large portion of food, as they used to earlier. This is where good post-bariatric surgery counselling plays a vital role. These situations may make a person prone to substance abuse. At the same time, there are individuals who are consuming alcohol, smoking cigarettes, or chewing tobacco in huge quantities before surgery. What do these patients do after their bariatric surgery? These are two crucial questions that I wish to address today.

The first issue, whereupon the person was initially not chewing tobacco or consuming restricted substances or drugs and alcohol but has started substance abuse after bariatric surgery. We have to take good care of the patient, good counselling, regular follow-up and love, tender and care with good support will prevent them from substance abuse. Similarly, those patients who consumed alcohol or were smoking or chewing tobacco should stop it after bariatric surgery. Chewing tobacco or smoking a cigarette is much more dangerous than consuming alcohol after bariatric surgery. Chewing tobacco results in the rise of several forms of malignancies, starting from oral cancer to cancers of the GI tract to lung cancer and other malignancies. Both chewing tobacco and smoking cause lung cancer and cancers related to the gastrointestinal tract, while some may also cause cancer related to the brain and other parts of the body. Smoking has been linked to 55 different types of cancers.

If we leave aside the risk of cancer, smoking is still dangerous as it induces marginal ulcers in the pouch of the stomach and the anastomosis at the gastrointestinal site. These marginal ulcers cause epigastric pain to the patients, vomiting, and severe discomfort, and if they tend to perforate, it may lead to an abdominal catastrophe and a surgical emergency. Thus, I request all of you to guide and advise on refraining from any kind of substance abuse, consumption of alcohol and strictly smoking cigarettes post-bariatric surgery. Smoking after bariatric surgery has led to numerous complications and therefore my advice would be to strictly refrain from it. Alcohol consumption is not advisable either for it may increase the weight after bariatric surgery. When we consume alcohol, the amount of food that we consume is 4-to-5 times greater because most patients would not realise the amount of food they are consuming after they have consumed alcohol and the pouch dilatation, the enlargement of the pouch after bariatric surgery may take place.  On the other hand, if after consumption of alcohol the patient is dehydrated, it may cause permanent liver damage. Hence, the right advice would be to completely cease smoking and alcohol consumption or reduce the quantity.

It is always said that bariatric surgery is a life-transforming, life-changing, and life-saving procedure; it is a new lease of life that any patient would get after bariatric surgery. The patient would not only lose weight but also get rid of all the complications of obesity, and diseases associated with obesity like type 2 diabetes, hypertension, sleep apnoea, and many others. Let us not spoil the life which you have regained after undergoing such a crucial surgery. Stop smoking and consumption of alcohol for a healthy and better life after your bariatric surgery.

Author: Mohit Bhandari

Mohit Bhandari is a renowned Indian bariatric surgeon and globally recognized for his contribution in Laparoscopic and Robotic surgeries.

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