The Skinny on America’s Obesity Problem with Mark Gold
I recently was the Co-Chair of what has been described as a historic meeting at Yale University. This Conference of the Nation’s leading experts on eating, addictions, and obesity discussed the scope of the problem, the scientific literature, and prospects for the future. Clearly, overeating and obesity are major public health problems.
The Surgeon General has even said that these problems are the nation’s number one public health problem. Usually medical experts have focused on the effects of obesity such as the epidemic of type 2 diabetes, knee and joint replacements, cancer, high blood pressure, and gall stones.
Obesity is now a major problem in adolescents and adults and the major treatment, diet and exercise are not changing the epidemic or consequences.
It is like telling people to stop smoking. Sure we new that tobacco smoking caused cancer, heart disease, impotence and other problems. However, that knowledge and association between disease and smoking did little to help people to stop.
Usually, as physicians we think about de-stigmatizing mental or other illness. Oddly enough, stigma and stigmatizing smokers helped. Public policy law and protection of non-smokers helped. Just making it harder to buy cigarettes by removing vending machines and increasing the cost per pack helped. Public health measures were much more effective in reducing teen smoking and smoking rates than any number of medical treatments.
Even if you added all of the medical treatments together, public health approaches were more effective and reduced smoking, death, and disability. Experts at the Yale Conference debated whether addiction models might apply to some people with overeating, binge eating, and/or obesity.
Evidence from animals was presented and clearly sugar is self administered in rodents in a manner reminiscent of a drug of abuse. Withdrawal may even be demonstable to sugar in Princeton University’s Bart Hoebel, Ph.D. group studies. Basic science suggests a great deal of overlap between the messengers used in the brain to reinforce eating and those hijacked by drugs of abuse.
Drugs of abuse increase dopamine release and so does food. Anticipation of food and eating has similar effects. Great food that smells good, feels good, looks and tastes great is highly rewarding and much different than just having a cracker or even beef broth.
Broth is boring and Kobe beef quite unlike it in ability to change mood and behavior. In man, evidence of stirking similarities were reported for drugs of abuse and food in imaging studies using PET and fMRI.
Drugs of abuse and highly palatable food appear to compete in the brain for reinforcement sites so that drugs are more reinforcing during starvation and much less so after eating.
Drug addicts and alcoholics who stop using tobacco, alcohol, cocaine, or any other drug of abuse find that their appetite increases. Overeating and weight gain is so common after addiction treatment that preventative programs of diet, exercise, and counseling are commonplace in most of the Nation’s best drug and alcohol rehab programs. Go to any AA meeting and what you will hear is if you have drug craving, eat.
You also hear never get to hungry or you might relapse.
Clearly, in those prone to alcoholism or recovering from alcohol dependence or addictions, food may be much more drug-like than otherwise. Still, in all of us we can identify that we crave some foods and go to great lengths to get them.
Can someone really be addicted to food or a food addict when everyone eats and food, naturally, must be considered reinforcing lest the species fail to survive. Continued use, harmful use, use more than intended and other Substance Use Disorder criteria are commonly seen in food addicts.
They dream about food and plan meals and eating like an addict plans for drug use. Overeating to the point of physical, social, and occupational harm is common in food addicts. In a culture that can “hunt” or “fish” without expending energy at the market and has the world’s food types at its fingertips, boredom is a thing of the past.
Lets face it, our brains were unprepared by evolution for so much food, such great food, and the brain’s idea of saving for a rainy day makes obesity more likely now than ever.
Medical treatments are years away and bariatric surgery reserved for only those who are so obese that their body fat is going to be their cause of death without it. Prevention — and if that fails early intervention and diet and exercise — are the only current methods which we have available. They can work but they are less reinforcing than eating is.
So, we need group support. We need to go to Overeaters or Weight Watchers meetings or the Gym and get social support and reinforcement from our family, friends, and employers to make it and develop healthy eating and exercise balance and reverse the trend.
Science will help us understand what is happening and help by developing newer and more effective pharmacological treatments. However, fitness is preferable to even successful weight loss and a pill may work for the former but not with the later.
Fitness requires motivation, commitment, and sweat. That is the hard part but well worth the time. Invest in your health and your body and you can spend the dividends as you age.
Mark Gold is a professor and chief of Addiction Medicine at the McKnight Brain Institute
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