Deficits in cognitive control during alcohol consumption after bariatric surgery

Published:October 27, 2022DOI:


      • Bariatric surgery patients completed cognitive tasks following alcohol consumption
      • Most cognitive task performance improved over time, likely due to practice effects
      • Number of commission errors post-surgery was impacted by baseline cognitive control



      While bariatric surgery results in substantial weight loss, one negative side effect of surgery is that patients often experience more rapid and intense intoxication effects after consuming alcohol.


      Given that alcohol use has been associated with impaired cognitive functioning in the general population, this study examined whether acute alcohol consumption after bariatric surgery immediately led to impaired cognitive control, and whether this effect was impacted by baseline levels of cognitive control.


      Nonprofit teaching hospital, United States.


      Participants were 34 adults who attended a laboratory visit before and 1 year after Roux-en-Y gastric bypass surgery, wherein they consumed a weight-based dose of alcohol and completed cognitive testing over the course of 3 hours.


      A series of generalized mixed-effect models demonstrated that performance on the cognitive task generally improved over time, likely due to practice effects. However, following bariatric surgery, individuals with impaired cognitive control before consuming alcohol experienced greater commission errors immediately afterward.


      These findings suggest that alcohol use after bariatric surgery may produce immediate deficits in inhibitory control among individuals who are already vulnerable to impaired cognitive control. Clinicians should seek to educate bariatric surgery candidates on this possible effect, as deficits in inhibitory control may ultimately lead to risky behaviors and poor adherence with postsurgical medical recommendations.


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      1. American Society for Metabolic and Bariatric Surgery (ASMBS) [Internet]. Newberry, FL: The Society; [updated 2022 Jun; cited 2022 Aug 4]. Estimate of Bariatric Surgery Numbers, 2011–2019; [about 1 screen]. Available from:

        • Rosenthal R.J.
        • Morton J.
        • Brethauer S.
        • et al.
        Obesity in America.
        Surg Obes Relat Dis. 2017; 13: 1643-1650
        • Chang S.H.
        • Stoll C.R.T.
        • Song J.
        • Varela J.E.
        • Eagon C.J.
        • Colditz G.A.
        The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012.
        JAMA Surg. 2014; 149: 275-287
        • Klockhoff H.
        • Näslund I.
        • Jones A.W.
        Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery.
        Br J Clin Pharmacol. 2002; 54: 587-591
        • Steffen K.J.
        • Engel S.G.
        • Wonderlich J.A.
        • Pollert G.A.
        • Sondag C.
        Alcohol and other addictive disorders following bariatric surgery: prevalence, risk factors and possible etiologies.
        Eur Eat Disord Rev. 2015; 23: 442-450
        • Jellinek E.M.
        • McFarland R.A.
        Analysis of psychological experiments on the effects of alcohol.
        Q J of Stud Alcohol. 1940; 1: 272-371
        • Peterson J.B.
        • Rothfleisch J.
        • Zelazo P.D.
        • Pihl R.O.
        Acute alcohol intoxication and cognitive functioning.
        J Stud Alcohol. 1990; 51: 114-122
        • Day A.M.
        • Kahler C.W.
        • Ahern D.C.
        • Clark U.S.
        Executive functioning in alcohol use studies: a brief review of findings and challenges in assessment.
        Curr Drug Abuse Rev. 2015; 8: 26-40
        • Harvey A.J.
        • Seedhouse M.
        Influence of alcohol and cognitive capacity on visual number judgements.
        Perception. 2021; 50: 39-51
        • Purdie M.P.
        • Norris J.
        • Davis K.C.
        • et al.
        The effects of acute alcohol intoxication, partner risk level, and general intention to have unprotected sex on women’s sexual decision making with a new partner.
        Exp Clin Psychopharmacol. 2011; 19: 378-388
        • Brown T.G.
        • Ouimet M.C.
        • Nadeau L.
        • et al.
        From the brain to bad behaviour and back again: neurocognitive and psychobiological mechanisms of driving while impaired by alcohol.
        Drug Alcohol Rev. 2009; 28: 406-418
        • Choudhary P.
        • Amiel S.A.
        Hypoglycaemia: current management and controversies.
        Postgrad Med J. 2011; 87: 298-306
        • Engel S.G.
        • Schaefer L.M.
        • Kerver G.A.
        • et al.
        The rewarding effects of alcohol after bariatric surgery: Do they change and are they associated with pharmacokinetic changes?.
        Surg Obes Relat Dis. 2022; 18: 190-195
        • Casbon T.S.
        • Curtin J.J.
        • Lang A.R.
        • Patrick C.J.
        Deleterious effects of alcohol intoxication: diminished cognitive control and its behavioral consequences.
        J Abnorm Psychol. 2003; 112: 476-487
        • Jaeggi S.M.
        • Studer-Luethi B.
        • Buschkuehl M.
        • Su Y.F.
        • Jonides J.
        • Perrig W.J.
        The relationship between n-back performance and matrix reasoning — implications for training and transfer.
        Intelligence. 2010; 38: 625-635
        • Gregg A.P.
        • Sedikides C.
        Narcissistic fragility: rethinking its links to explicit and implicit self-esteem.
        Self Identity. 2010; 9: 142-161
        • Adam K.C.S.
        • Vogel E.K.
        Improvements to visual working memory performance with practice and feedback.
        PLoS One. 2018; 13e0203279
        • Emch M.
        • Ripp I.
        • Wu Q.
        • Yakushev I.
        • Koch K.
        Neural and behavioral effects of an adaptive online verbal working memory training in healthy middle-aged adults.
        Front Aging Neurosci. 2019; 11: 300
        • Handley J.D.
        • Williams D.M.
        • Caplin S.
        • Stephens J.W.
        • Barry J.
        Changes in cognitive function following bariatric surgery: a systematic review.
        Obes Surg. 2016; 26: 2530-2537
        • Bartholdy S.
        • Dalton B.
        • O’Daly O.
        • Campbell I.
        • Schmidt U.
        A systematic review of the relationship between eating, weight and inhibitory control using the stop signal task.
        Neurosci Biobehav Rev. 2016; 64: 35-62
        • Majid S.F.
        • Davis M.J.
        • Ajmal S.
        • et al.
        Current state of the definition and terminology related to weight recurrence after metabolic surgery: review by the POWER Task Force of the American Society for Metabolic and Bariatric Surgery.
        Surg Obes Relat Dis. 2022; 18: 957-963
        • Ibrahim N.
        • Alameddine M.
        • Brennan J.
        • Sessine M.
        • Holliday C.
        • Ghaferi A.A.
        New onset alcohol use disorder following bariatric surgery.
        Surg Endosc. 2019; 33: 2521-2530