About three years ago I had a coworker who had gone in for gastric bypass. After her surgery she lost a ton of weight. Well okay maybe not quite a ton, but she did lose over 200 pounds in one year. She used to tell me “I actually miss being able to eat a whole pizza”. I never quite understood that, but a recent article posted on Intelihealth.com, helped shed light on my confusion.

The article titled “Overeating Replaced with Other Compulsive Behaviors” states that for a number of people, giving up overeating leads to adoption of a new compulsion. In the article this adoption of a new compulsion to replace an old one is called “addiction transfer”. Addiction transfer occurs when someone is unable or unwilling to rely on one compulsion and so switches to a new compulsion due to not having dealt with the underlying issue behind the compulsion. For example, one may overeat because he/she is lonely or depressed, or for any number of other reasons. This person has gastric bypass to deal with being overweight, but does not address the depression/loneliness and therefore develops an alternative compulsion strategy such as gambling, alcoholism or excessive shopping. According to the article there are millions of people who have undergone gastric bypass who are now dealing with issues of addiction transfer.

The article discusses the plight of Carnie Wilson, one of the most widely publicized gastric bypass cases to date, who became an alchoholic to soothe the stress after her post-surgery body made it impossible to rely on overeating as a coping mechanism. Another woman mentioned in the article who lost 200 pounds said she started having affairs to distract herself from stress. Apparently, these woman thought being thin was the answer to all their problems, but when they became thin and still had to deal with stress, the pressure became too great. A quote from the article specifically addresses the surprise these woman and others have when they find out that their weight issue was not the fix-all they thought it to be

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.

In addition the article goes on to say that just the act of having lost weight adds stress;

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.”

Lastly, biomedical research suggests that the causes of compulsive behavior no matter what compulsion it may be (alcoholism, overeating, etc) are very similar. Experts also agree that gastric bypass does not cause addiction, rather if someone has an addiction prior to the surgery that it is likely they will have one after, although a different one. The best thing to do is seek professional counseling for the compulsion itself before trying to treat the symptoms; otherwise you may just end up transferring to a new problem to replace the old. It has to do with treating the cause of something and not the symptoms, after all, if your house is infested with ants you shouldn’t just keep treating ant bites, you would hire an exterminator to get rid of the problem.

Perhaps that’s what my coworker was talking about when she talked about how she missed eating a whole pizza. It’s possible she was still trying to fill a void with something, just not food anymore.