Bariatric surgery is an effective treatment for severe obesity, but accumulating evidence indicates that it may increase vulnerability to AUD and other addictive behaviors, a phenomenon often described as “addiction transfer.” Changes in alcohol metabolism, gut hormones, and reward pathways after surgery are thought to contribute to this risk. Against this backdrop, researchers led by Butros Fakhoury from the Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, sought to determine whether the choice of post-surgical weight-loss medication influences AUD risk.
The study analyzed data from a multi-institutional U.S. electronic health record network, including 15,382 adults who underwent bariatric surgery and subsequently received anti-obesity medications between 2020 and 2024. Participants were followed for up to two years after initiating medication. Incretin-based therapies included semaglutide, liraglutide, and tirzepatide, while comparator drugs comprised non-incretin agents such as orlistat, phentermine, and low-dose naltrexone. To minimize baseline differences, the investigators used 1:1 propensity score matching, resulting in two balanced groups of 3,990 patients each.
The study revealed the following findings:
- Use of incretin-based therapies was clearly associated with a lower risk of alcohol use disorder after bariatric surgery.
- The incidence of new-onset AUD was 2.4 per 1,000 person-years in patients receiving incretin therapy, compared with 5.2 per 1,000 person-years among those on non-incretin medications.
- Incretin therapy was linked to a 55% reduction in the risk of developing AUD.
- Patients treated with incretin-based drugs had a 41% lower likelihood of initiating medications for AUD.
- The protective association remained consistent across multiple sensitivity analyses.
- Similar results were observed with stricter definitions of medication exposure.
- Findings were also consistent when analyses were limited to shorter intervals between bariatric surgery and treatment initiation.
- Beyond weight loss, incretin-based therapies may modulate central reward and addiction pathways.
- GLP-1 signaling is thought to influence craving and compulsive behaviors.
- These neurobehavioral effects may be particularly important for post-bariatric surgery patients, who are at higher risk of developing AUD.
The study’s limitations include its retrospective design using billing codes, potential misclassification, lack of detailed data on alcohol intake and psychotherapy, and a follow-up limited to two years. Generalizability may also be restricted, as the cohort included only patients requiring medication for weight regain or insufficient weight loss after surgery.
Despite these limitations, the findings suggest that choosing incretin-based therapies after bariatric surgery may aid weight control while lowering alcohol-related risk. The authors emphasize the need for prospective studies to confirm these findings and assess long-term outcomes, including liver health.
Reference:
Fakhoury B, Sierra L, Rama K, Jahagirdar V, Díaz LA, Arab JP. Incretin-Based Therapies and Post–Bariatric Surgery Alcohol Use Disorder. JAMA Netw Open. 2025;8(12):e2549086. doi:10.1001/jamanetworkopen.2025.49086
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