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Food is essential for life, so how can you have food addiction?. NZ Food Addiction Symposium Christchurch, 6 September 2013 Prof Doug Sellman National Addiction Centre University of Otago, Christchurch. Acknowledgements. Ria Schroder Daryle Deering Jane Elmslie Frances Carter Jim Mann

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Food is essential for life so how can you have food addiction
Food is essential for life, so how can you have food addiction?

NZ Food Addiction Symposium

Christchurch, 6 September 2013

Prof Doug Sellman

National Addiction Centre

University of Otago, Christchurch


Acknowledgements
Acknowledgements addiction?

Ria Schroder

Daryle Deering

Jane Elmslie

Frances Carter

Jim Mann

David Schroeder

25 fellow travellers


Journey out of skepticism addiction?

  • My own experience of weight loss

  • The stories of 25 fellow travellers

  • Growing scientific evidence for “food addiction”


Public attitudes about addiction as a cause of obesity addiction?

Colleen Barry (2012)

  • Large random sample of news articles in the US about childhood obesity 2000 – 2009

  • 53% of the news stories identified individual behaviour (parent and/or child) as a cause

  • Only 1% mentioned food addiction as a possible cause 


From the front lines addiction?

Philip Werdell (2012)

  • Has worked with over 4000 “late-stage food addicts” since 1986

  • Recently developed the Food Addiction Institute in Sarasota, Florida

  • “[In my experience] most doctors, dieticians and therapists discount or minimize chemical dependency on food”


Can an obese compulsive overeater get treatment in nz
Can an obese compulsive overeater get treatment in NZ? addiction?

  • Survey of:

    21 addiction services

    20 eating disorder services

  • July/August 2012

  • Services rung by a fake inquirer

    – a sister of a person who has a weight problem

  • Auckland, Wellington, Christchurch

    Whangarei to Dunedin, Greymouth to Gisborne


Hullo, my name is Natalie Smith and I'm addiction?

ringing up on behalf of my sister Shiree.

The problem is that Shiree is about 110kg in weight

…and seems to have an addiction to food. She doesn't have any other addictions as far as I know

…and seems to have an eating disorder. She doesn't binge or purge as far as I know and has never been anorexic.

She just compulsively eats food.

I really want to find out what help your service can give her or where to go for help.


Addiction service findings
Addiction Service addiction?Findings

  • 4 of the 21 services not surveyed

  • Of the 17 services surveyed:

    - 2 said yes, come for an assessment (12%)

    - 6 declared it was an eating disorder (35%)

    - 7 advised Overeaters Anonymous (41%)

    - 10 advised GP consultation (59%)


Not us
Not us addiction?

- “We don’t deal with eating disorders, first place to go is to your GP who will refer you on to an appropriate service like a dietitian and an exercise regime”

- “It’s really an eating disorder so you’ll need to go to your GP and get a list of people who deal with eating disorders or get a referral for counselling”


Come for an assessment
Come for an assessment addiction?

- “Food addiction is similar to other addictions so it would be appropriate to come in for an assessment” (large city)

- “Not a normal focus for us but as it is an addiction there is no reason we couldn’t work with her” (small city)


Eating disorder service findings
Eating Disorder Service addiction?Findings

  • 3 of the 20 services not surveyed

  • Of the 17 services surveyed:

    - 1 said yes, come for an assessment (6%)

    - 0 declared it was a food addiction (0%)

    - 4 advised Overeaters Anonymous (24%)

    - 12 advised GP consultation (71%)


Come for an assessment1
Come for an assessment addiction?

- “We’re happy to help with overeating as well as undereating, just come in for an assessment” (small city)


Not us1
Not us addiction?

- “You will be horrified to hear this, but as an eating disorder service we only treat people with undereating problems”

  • “Obesity is not considered an eating disorder and therefore we are not funded to work in that area”

  • “Overeating is an eating disorder but its not in the DSMIV… there’s a possibility in the new DSM so we may be able to cater for it then”

  • “We could see her if she had underlying psychological issues”


Main points from both surveys
Main points from both surveys addiction?

  • Less than 10% of either addiction or eating disorder services said yes to an assessment (of a morbidly obese person with out-of-control overeating)

  • 28% advised OA

  • 55% advised a GP consultation


BMI addiction?

< 18.5 underweight

18.5 – 24 normal weight

25 – 29 overweight

30 – 34 obese

35 – 39 clinically obese

> 40 morbidly obese


Percentage of overweight people addiction?

in the Anglosphere

United States 74%

New Zealand 68%

Australia 67%

United Kingdom 63%

Canada 61%

Ireland 47%


Five strategies
Five Strategies addiction?

Take Control

Get Active

Eat Well

Persist

Enjoy Life


Adult obesity in nz
Adult Obesity in NZ addiction?

2008/09 Adult Nutrition Survey

  • 28% of people 15+ years were obese

  • 45% of Maori

  • 58% of Pacific

  • Increase in males from 17% in 1997 to 28% in 2008/09

  • Increase in females from 21% in 1997 to 28% in 2008/09


Demographics
Demographics addiction?


Weight loss at last weigh in up to 18 months
% Weight Loss at Last Weigh in addiction?(Up to 18 months)


Nestle addiction?

Aero Singles

“In the event of a chocolate craving, please take care of your craving first before helping others with theirs.

Remove bar. Bite to release bubbles. Enjoy normally.

Be prepared! Ensure Aero Singles are stowed in close proximity”


Food Addiction: A Personal Story addiction?

Anne Rosenberg (2012)

Am I really and truly a “food addict?”

I am not a scientist and I am not too concerned with the exact label.

But I do know I could not eat just one of those Nestle Aero Singles. And I am not alone. Nestle is banking on that!


What is addiction? addiction?

  • From the Latin addictus - devotion/attachment

  • Outdated term of the 1950’s and 1960’s, replaced by “dependence” in the 1970’s

  • Currently undergoing a revival - good for destigmatisation


Theodosius Dobzhansky, 1973 addiction? (1900 - 1975)

“Nothing in biologymakes sense,

Except in the light of evolution”


Charles Darwin addiction?1809 -1882

“I have called this principle, by whicheach slight variation, if useful, is preserved, by the term Natural Selection.”

   (from ‘The Origin of Species’)


Approximate Time Estimates addiction?

  • 13.8 billion years ago – The Universe began

  • 4.5 billion years ago – Earth began

  • 3.5 billion years ago – Life on Earth began

  • 2.5 billion years ago – Photosynthesis began

  • 0.6 billion years ago – Adequate ozone layer

  • 0.5 billion years ago – Abundant complex life


ERA PERIOD EPOCH addiction?

Cenozoic Quaternary Holocene

(65 million - present) (10,000 - present)

Pleistocene

(1.8 million – 10,000)

Tertiary Pliocene

Miocene

Oligocene

Eocene

Paleocene

Mesozoic Cretaceous

(248 - 65 million) Jurassic

Triassic

Paleozoic Permian

(544 - 248 million) Carboniferous

Devonian

Silurian

Ordovician

Cambrian


What is drug addiction george koob 1947 present
What is drug addiction? addiction?George Koob (1947 - present)

A chronic relapsing disorder characterised by:

Compulsion to seek and take the drug

Loss of control in limiting intake

Emergence of a negative emotional state (dysphoria, anxiety, irritability)


Inhibitory addiction?

Dysfunction

Reward

Overdrive

Drug Drug

Use Craving


NEURAL CIRCUITRY OF ADDICTION addiction?

(Hammer 2002)


In non-hungry, non-thirsty rats, sweetened water is more rewarding than intravenous cocaine, independent of prior cocaine history

Most heroin dependent rats eventually cut down heroin use to drink more sweet water

Ahmed (2012)


Interaction between normal regulation of food intake and reward pathway
Interaction between normal regulation of food intake and reward pathway

  • The major anorexigenic hormones – leptin, insulin, PYY (incentive modulation) - plus the single orexigenic hormone, ghrelin, act on VTA dopaminergic system as do “drugs of abuse” (Mason et al 2012)

  • Many neuropeptides that regulate food intake and body weight including proappetitive peptides orexin, ghrelin and neuropeptide Y, as well as appetite suppressing hormones - leptin and melanocortin – also shown to regulate addictive behaviours (Dagher 2012)


Mouse on the left unable to produce leptin becomes obese

Ghrelin reward pathway

Orexin

Neuropeptide Y (NPY)

Mouse (on the left) unable to produce leptin becomes obese

Melanocortin

Leptin

Peptide YY (PYY)

Insulin


  • The increasing prevalence and impact of obesity in our society and the urgent need to develop better therapeutic interventions that help mitigate the pathologically intense drive for food consumption are clear.

  • We have an opportunity in DSM-V to recognize a component of obesity as a mental disorder.

    (Volkow & O’Brien, AJP 2007)


Alcohol addiction society and the urgent need to develop better therapeutic interventions that help mitigate the

Food addiction


How many people with obesity have food addiction
How many people with obesity have “food addiction”? society and the urgent need to develop better therapeutic interventions that help mitigate the


Diagnosis of food addiction society and the urgent need to develop better therapeutic interventions that help mitigate the based on

DSM-IV SUBSTANCE DEPENDENCE

1. Consumption is often more than intended (quantity or time)

2. Unsuccessful attempts to cut down or control consumption

3. Much time is spent in consumption (time +++)

4. Important activities given up or reduced

5. Continued consumption despite knowledge of associated medical or psychological problems

6. Tolerance (acquired)

7. Withdrawal


How many people with obesity have food addiction according to the yale food addiction scale yfas
How many people with obesity have “food addiction” according to the Yale Food Addiction Scale (YFAS)?

  • YFAS validation study

  • 67 weight loss surgery patients

  • 63% female, 87% Caucasian

  • Mean age of 43 years


How many people with obesity have yfas food addiction
How many people with obesity have YFAS “food addiction”? according to the Yale Food Addiction Scale (YFAS)?

Use often more than intended 22%

Failed attempts to reduce or stop use 71%

Time+++ 24%

Giving up other important activities 10%

Continued use despite 28%

Tolerance 14%

Withdrawal 16%

54% met YFAS criteria for food addiction


Behind every addiction is an engineered moreish product according to the Yale Food Addiction Scale (YFAS)?


Non essential energy dense nutritionally deficient neednt foods
Non-essential, energy-dense, nutritionally-deficient (NEEDNT) foods

Dr Jane Elmslie

Dietitian - NAC


George Eman Vaillant, 1988 (NEEDNT) foods

(1934 - present)

“What is needed is that addicts alter

their whole pattern of living”


Key elements of an addiction approach to recovery
Key elements of an addiction approach to recovery (NEEDNT) foods

  • Permanent lifestyle change

  • Details unique for each individual

  • Ongoing support and encouragement for at least five years

  • New food rules as “addiction interrupters”


A research based self help obesity recovery network kia akina be encouraged and supported
A research-based (NEEDNT) foodsself-help obesity recovery networkKia Akina“Be encouraged and supported”


“Food can act on the brain as an addictive substance. Certain constituents of food, sugar in particular, may hijack the brain and override will, judgement and personal responsibility, and in so doing create a public health menace.

The foods most likely to trigger an addictive process appear to be those marketed most aggressively by industry, which manipulates its products to maximize palatability”

Kelly Brownell & Mark Gold (2012)


“Food is the most available and inexpensive drug around” Certain constituents of food, sugar in particular, may hijack the brain and override will, judgement and personal responsibility, and in so doing create a public health menace.

Elissa Epel, Janet Tomiyama, Mary DallmanStress and Reward – Neural Networks, Eating and Obesity (2012)


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