A food-addicted woman "drank herself to death" after a gastric bypass made her swap the habit for a drinking problem, her heartbroken family has said.
"Outgoing and funny" Nicole Wilson, 44, had suffered with a binge eating disorder since childhood and used food as a comfort, causing her to become obese.
She had a gastric bypass - where surgical staples are used to create a small pouch at the top of the stomach - and lost 120 pounds.
And despite not drinking much alcohol before the op she began drinking about a year later - and it became "excessive and concerning", her sister Amanda Wilson, 46, said.
Soon she was drinking every day and, after being in and out of rehab for two and a half years, Nicole died from alcohol poisoning in November 2018.
Amanda from Indianapolis, Indiana, US, said she thinks her sister suffered from transfer addiction - when people trade food addiction for another dependence.
The Bariatric Centers of America recently restated a warning up to 30% of people may experience transfer addiction after surgery.
Around one in five people become addicted to alcohol according to Tranquil Shores - a Florida drug and alcohol addiction rehab centre.
Amanda said: "I am angry patients are not being properly screened or properly educated.
"I know she was in a Facebook support group for transfer addiction but I don't know how many times she went but I know she was involved.
"I believe there should have been counselling for Nicole.
"When you are obese your entire life the adjustment to how people treat you is huge.
"You go from being told you are not good enough, to people fancying you and wanting to take you for a drink.
"The mental health aspect and realising how differently you have been treated your whole life - there needs to be support for that."
Nicole, who had a successful career in marketing, underwent a gastric bypass surgery in April 2013.
Before gastric bypass surgeries, patients are screened and receive a psychological assessment, her sister said.
Nicole passed, had surgery, started exercising, and dropped to 14st.
She didn't drink for a year at all - but started in early 2015.
Amanda said: "It wasn't any excessive - probably one or two beers.
"When you have this surgery your stomach is smaller so it changes the way you absorb alcohol.
"Nicole started dating, being social and going out to see friends.
"It started off with a beer here and there, then it moved onto mixed drinks and then she would drink vodka straight from the bottle.
"I do believe in my sister's case that she had a binge eating disorder and it was undiagnosed and untreated - yes I do.
"When you can't go to your usual comfort you replace it with something else, in this case it was alcohol."
Amanda and her father were so concerned with Nicole's behaviour that they staged an intervention.
Amanda wrote down how she felt Nicole needed to get help, and said there would be family consequences if she didn't.
Five years post-surgery and after years of alcohol addiction Nicole died in November 2018.
Amanda said: "She died at night. I live pretty close and I got a call from her boyfriend and I went around.
"My father blames himself. He had been at the house about two hours before she passed away.
"He thinks that if he had stayed that she wouldn't have drank more but if it wasn't that night it would have been a different night."
Reflecting on the life of her sister, she said: "She didn't have a large circle of friends but the ones she was friends with she was very close with.
"She was my best friend. She was quiet, but at the same time she used her words to let you know exactly what she was thinking.
"She was also funny, we loved travelling together - we would go travelling at least twice a year.
"She was outgoing, funny and enjoyed life."
Amanda is calling on more support for people who have life-changing surgery.
She said: "The longest she was sober was 30-35 days and then drank herself to death.
"Her blood alcohol level was 0.46 and the legal limit is 0.08.
"She tried to get sober - she was so happy when she was sober - but the addition just took over."
