# Factors Associated With Alcohol Use After Metabolic and Bariatric Surgery: Protocol for an Ecological Momentary Assessment

## TL;DR

This study aims to understand factors linked to alcohol use after weight-loss surgery, using real-time data to improve monitoring and intervention strategies.

## Contribution

The study introduces a protocol using ecological momentary assessment to explore both distal and proximal factors influencing alcohol use after metabolic and bariatric surgery.

## Key findings

- The study will identify distal factors like depressive symptoms and proximal factors like negative affect associated with alcohol use.
- It will examine how alcohol use may substitute for disordered eating behaviors post-surgery.
- The protocol is expected to achieve high participant retention and response rates.

## Abstract

Individuals who undergo metabolic and bariatric surgery (MBS) are at increased risk for postoperative alcohol use disorder. Reducing postoperative alcohol use could prevent the development of alcohol use disorder; however, the factors leading to episodic alcohol use are not known.

The purpose of this paper is to describe the protocol for a study that will examine distal and proximal factors associated with episodic alcohol use and hazardous alcohol use among individuals who undergo MBS.

We will enroll 100 participants who undergo MBS at a single health care system. Participants will complete measures of substance use, psychiatric symptoms, and disordered eating behaviors at baseline and at 6- and 12-week follow-ups. Participants will also complete a 3-week ecological momentary assessment protocol in which they will complete brief surveys each morning and evening, reporting on their mood, disordered eating, and substance use.

This study received funding from the National Institute on Alcohol Abuse and Alcoholism (R21 AA029423) in May 2023. This part of the grant was approved by the institutional review board in March 2024, and data collection occurred between November 2024 and December 2025. We anticipate that our study protocol will be feasible and that we will observe at least 80% participant retention at the follow-up assessments and their response to at least 75% of ecological momentary assessment signals. We hypothesize that depressive symptoms (distal factor) and negative affect (proximal factor) will be associated with increased alcohol use, and alcohol use will occur in lieu of disordered eating behaviors.

Findings will help us understand distal and proximal factors leading to episodic alcohol use after undergoing MBS. This knowledge will allow us to construct better monitoring strategies for postoperative alcohol use within MBS programs and identify targets for intervention to reduce alcohol use after undergoing MBS.

DERR1-10.2196/87209