Introduction Regular readers must be well aware of the close link between addictions and some forms of overeating. This topic is now nicely addressed in a commentary by Valerie Taylor (McMaster, Hamilton), Claire Curtis and Caroline Davis (both York University, in this week’s edition of CMAJ. As they discuss, “The concept of food addiction, which more accurately may reflect addiction to specific components of food, can be described in much the same way as other addictive behaviors. Both food and drugs induce tolerance over time, whereby increasing amounts are needed to reach and maintain intoxication or satiety. In addition, withdrawal symptoms, such as distress and dysphoria, often occur upon discontinuation of the drug or during dieting. There is also a high incidence of relapse with both types of behavior.“
Study • To further support their arguments, they cite the many imaging studies showing that specific areas of the reward or mesolimbic system, such as the caudate nucleus, the hippocampus and the insula, are activated both by drugs and by food. • Thus, the easy accessibility of highly palatable foods together with our innate preferences for such foods, can increase the likelihood that vulnerable people will “misuse” food, in much the same way that addicts misuse other drugs to blunt negative emotional states, such as depression, anxiety, loneliness, boredom, anger or interpersonal conflict.
Findings • While the concept of addiction should not negate the role of free will and personal choice, it does provide a rationale for the including addiction screens as a routine part of assessment for obesity. It may also help explain the success of lifestyle programs that incorporate pharmacotherapy or behavioral strategies specifically designed to address the addictive component of this illness. • Thus, as pointed out by Taylor and colleagues, there is not only considerable overlap among the medications shown to interfere with food and drug abuse in animal models, but the many behavioral interventions developed for managing addictions (motivational interviewing, cognitive behavioral therapy and 12-step programs), are increasingly recognized as also being helpful in managing obesity.
Learning from Counseling? Health professionals and decision makers charged with tackling the obesity epidemic would do well to familiarize themselves with the science of addictions and utilize learning’s from addiction management in their counseling of patients presenting with excess weight.
About Dr. Arya M. Sharma Dr. Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair for Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Medical Director of the Edmonton Capital Health Region’s interdisciplinary Weight Wise Program. Dr. Sharma is also the Scientific Director of the Canadian Obesity Network funded through the federal Networks of Centres Excellence program. Dr. Sharma has authored and co-authored more than 250 scientific articles and has lectured widely on the etiology and management of obesity and related cardiovascular disorders. He sends his informative messages through his blog Dr. Sharma’s Obesity Notes. For more information on Obesity visit; Website: http://www.drsharma.ca/ Facebook: http://www.facebook.com/pages/Dr-Arya-Sharma/115328778486319