Obesity is a complex phenomenon that continues to defy one unifying scientific explanation. Behavioral, psychological, environmental, physiologic, metabolic, and genetic explanations are just some of the possibilities identified as contributing to or causing obesity; yet, each explanation encounters controversy and no one explanation has gained unanimous consensus. Ideally, once a patient has had weight loss surgery (WLS), he or she loses excess weight in a controlled, healthy manner and complies with all the components of the recommended bariatric treatment program; sometimes, however, patients “modify” their post-surgical instructions. The ability to identify program modifications may be initially camouflaged if patients continue to lose weight and their laboratory values and other medical tests indicate that their weight loss status is smoothly progressing. On the surface it may seem that all is well, but appearances may be deceiving. A dysfunctional relationship with food and other substances of abuse, such as alcohol, may be lurking underneath the surface of what passes as treatment success, and this condition, left untreated, may persist or evolve to a cross-addiction, also known as an addiction transfer or a substitute addiction. A cross-addiction occurs when an individual exchanges one compulsive behavior for another compulsive behavior, such as when a weight loss surgery patient is no longer overeating or bingeing, but instead is abusing alcohol. An incisive and comprehensive nursing assessment that includes how, why, and in what manner the WLS patient is losing weight needs to be conducted to uncover established or developing cross-addictive behaviors. Clearly, assuming that any weight loss is better than no weight loss is a dangerous proposition when the mechanisms of how this weight loss occurred are not identified.
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