To the Editor: Drs. Banerjee and colleagues provided a comprehensive review of metabolic surgery for adult obesity.¹ Although the authors included current alcohol use in the exclusion criteria, readers might benefit from knowing about the increased risk of alcohol use disorder following metabolic surgery. A formal mental health preoperative evaluation is recommended in patients with a known or suspected psychiatric illness or substance use disorder; however, individuals may develop new unhealthy alcohol use or alcohol use disorder following metabolic surgery.² Among individuals without preoperative unhealthy alcohol use within two years of the procedure, metabolic surgery was significantly associated with the development of unhealthy alcohol use several years after metabolic surgery regardless of whether patients had laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass.³

Although the mechanism of increased alcohol use after metabolic surgery is not fully understood, Roux-en-Y gastric bypass may affect obesity-induced regulation of dopamine reward processing, increasing sensitivity to alternative rewards such as alcohol instead of food.⁴ Risk factors for alcohol use disorder following metabolic surgery include preoperative regular alcohol use, male sex, younger age, tobacco use, attention-deficit/hyperactivity disorder, and mental health disorders.^5,6 These factors can help family physicians identify patients at high risk and provide counseling and close follow-up after metabolic surgery.

Editor's Note: This letter was sent to the authors of “Metabolic Surgery for Adult Obesity: Common Questions and Answers,” who declined to reply.