Marijuana Use after Bariatric Surgery
Post Weight Loss Surgery
Marijuana Use after Bariatric Surgery

With the rise in the legalization and decriminalization of marijuana across the country, the popularity and medical usage of this drug has increased significantly. And there is almost some degree of denial that marijuana is still a drug and has adverse outcomes. In this blog, we will discuss the implications of marijuana use after bariatric surgery, including the long-term effects on both physical health and mental health.

Pre-Surgery Considerations

In one study,  it was discovered that patients who regularly used marijuana were more likely to be current smokers and screen positive for alcohol use disorder. Interestingly, these patients also scored higher on the Patient Health Questionnaire–8, indicating a greater prevalence of depressive symptoms. Despite these associations, marijuana use was not linked to worse 30-day outcomes or reduced comorbidity remission at one year. In fact, marijuana users showed higher adjusted total mean weight loss and body mass index reduction.

From this data, it's evident that marijuana use before bariatric surgery is not directly associated with poorer surgical outcomes. However, the correlation with higher rates of smoking, substance use, and depression cannot be ignored.

Marijuana Use after Bariatric Surgery

Post-surgery, the landscape changes somewhat. The effects of cannabis on the gastrointestinal system are particularly relevant here. Given the changes in the digestive tract post-bariatric surgery, cannabis can cause unpredictable reactions, potentially worsening nausea or leading to discomfort. Appetite stimulation is another critical aspect to consider. Cannabis is known for increasing appetite, which could be counterproductive to the strict dietary guidelines and weight loss objectives set for post-bariatric surgery patients.

Mental health is another area where cannabis use post-surgery demands careful consideration. While some individuals find relief from anxiety or depression through cannabis, it's imperative to be mindful of its potential impact on mental well-being, especially during the sensitive post-operative period. There is also the risk of developing a dependency on cannabis, particularly if it's used as a coping mechanism during this challenging phase.

A study published in Surgery for Obesity and Related Diseases, reveals that marijuana use after bariatric surgery is linked to increased symptoms of anxiety and a higher likelihood of engaging in maladaptive eating behaviors. Frequent marijuana use, defined as once per week or more, is associated with loss of control when eating, binge eating, and nighttime snacking behaviors. However, this study found no correlation between marijuana use after bariatric surgery and depression in patients.

This research highlights a significant concern regarding marijuana use after bariatric surgery. Although there was not an effect on depression, the increased likelihood of anxiety and problematic eating behaviors can potentially hinder the long-term success of the surgery and negatively impact the patient's psychological well-being.

Clinical Implications and Recommendations for Cannabis use Post Bariatric Surgery

Given these findings, what should patients and clinicians consider regarding marijuana use in the context of bariatric surgery? Firstly, it's crucial to acknowledge that marijuana is still a drug, despite the widespread use and increase in legalizations. In regards to bariatric patients, the lack of association with poorer surgical outcomes or reduced weight loss effectiveness is a positive indication. However, the associated risks, especially post-surgery, warrant a careful and individualized approach.

For patients considering bariatric surgery who currently use marijuana, it's advisable to have an open discussion with their healthcare provider. Addressing potential mental health issues and substance use is vital for a holistic approach to your weight loss journey. Counseling and support for these issues should be an integral part of pre-surgical preparation.

Post-surgery, the focus shifts to ensuring the long-term success and well-being of the patient. Here, the emphasis should be on understanding the risks associated with marijuana use, particularly in relation to anxiety and maladaptive eating behaviors. Frequent marijuana users may require additional support and monitoring to mitigate these risks. Healthcare providers should counsel patients on the potential impact of marijuana use on their recovery and long-term weight management goals.

In conclusion, while marijuana use is not a barrier to bariatric surgery, it is associated with factors that necessitate a comprehensive approach to patient care, both before and after surgery.

Mitch Roslin, MD
Dr. Mitch Roslin is a board-certified bariatric surgeon with nearly 30 years of experience in the field of weight loss surgery. He was among the first to pioneer bariatric surgery and was a part of the Lap-Band® System clinical trials in the early 2000s. Dr. Roslin sees patients in New York City, in affiliation with Lenox Hill Hospital, a Northwell Health facility.
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