Cross addiction in patients who underwent bariatric surgery: a systematic review

Introduction: Bariatric surgery is the most effective intervention for severe obesity. The transfer of addiction after bariatric surgery involves the potential development of new addictive behaviors in individuals who have undergone the procedure. This phenomenon, also referred to as cross addiction, has gained attention in scientific literature. Understanding these occurrences is crucial for informing clinical practices and health policies concerning bariatric surgery and post-operative care. Objective: To analyze the relationship between remission of food dependence and the emergence of addictions after bariatric surgery through the produced scientific evidence. Method: Systematic review conducted in Biblioteca Virtual em Saúde (BVS), PubMed and Scopus, using the keywords “Cross Addiction”, “Bariatric Surgery” and similar terms collected from the Medical Subject Headings (MeSH). The inclusion criteria were experimental and observational studies published between 2012 and 2022 in English, Portuguese or Spanish that discuss about cross addiction in patients that have undergone bariatric surgery. Studies that did not fulfill the inclusion criteria and duplicate articles were excluded. Two independent researchers selected the articles. Results: Most studies evidenced a positive relationship between cross-addiction and bariatric surgery. Patients reported significant increment in substance use and cross addiction. Still, some studies observed no relationship between previous food addiction and postoperatively substance abuse or other disorders. Limitations of the reviewed studies include variability of samples, diversity in the measurement of cross-dependence, focus on alcohol, and limited consensus on psychological and psychiatric criteria for the surgery. Conclusion: The theory of addiction transfer has not been fully validated and remains a point of discussion. Further research, methodological standardization, and defined protocols are imperative to improve our understanding of this phenomenon.