Weight loss therapy and addiction: Increased risk after bariatric surgery but reduced risk with GLP-1 receptor agonists.
Level 5 - mechanism / opinion, no new human data
Narrative review of observational cohort studies and mechanisms without systematic meta-analysis
PubMed 39818408 · doi:10.1016/j.diabet.2025.101612
What was done
The authors conducted a literature review of clinical studies assessing the prevalence of addictive disorders (food addiction, alcohol abuse, smoking, cannabis, cocaine, and opioid use) following bariatric surgery or GLP-1 receptor agonist (GLP-1RA) therapy in patients with obesity.
What was found
In observational cohort studies, the prevalence of alcohol use disorder was twofold higher more than 2 years after bariatric surgery (11 studies, primarily gastric bypass). Conversely, alcohol use disorder prevalence was reduced by roughly half with GLP-1RA therapy (5 studies, primarily semaglutide). Similar directions of effect were reported for other addictive disorders. No exact overall participant numbers, confidence intervals, or pooled effect estimates were reported in the abstract.
Why it matters
These findings highlight opposing associations between surgical and pharmacological obesity interventions and substance misuse, supporting vigilance for addiction transfer after bariatric surgery and motivating dedicated randomized trials for GLP-1RAs.
Limits
Findings are based on observational cohort studies subject to confounding and reporting bias rather than randomized controlled trials. The abstract provides no precise effect sizes, confidence intervals, meta-analytic pooling, or total participant sample sizes.
Cited by
- supports GLP-1 receptor agonists reduce desire in reward pathways, with emerging evidence showing decreased cravings for addictive behaviors such as gambling, shopping, alcohol, and smoking.