Twelve Steps Out of Obesity?

There’s chocoholism, and then there’s true addiction. Whether or not food can actually be called an addictive substance has long been debated in the medical community, but now a group of obesity and nutrition researchers is taking the notion seriously enough to host a first-of-its-kind conference at Yale to discuss the issue. Obesity might be caused by more than just overeating, lack of exercise, and genetics, scientists say; severely overweight people may be actual food addicts.

The problem could lie with the neurotransmitter dopamine, which is associated with pleasure and reward, explains conference speaker Nora Volkow, director of the National Institute on Drug Abuse, in USA Today:

‘Impaired function of the brain dopamine system could make some people more vulnerable to compulsive eating, which could lead to morbid obesity,’ Volkow says. ... For some compulsive eaters, the drive to eat is so intense that it overshadows the motivation to engage in other rewarding activities, and it becomes difficult to exercise self-control, she says. This is similar to the compulsion that an addict feels to take drugs, she says.

Still, she acknowledges that there are plenty of differences between drug addiction and a compulsive drive to chow down:

Food is necessary for survival, and eating is a complex behavior involving many different hormones and systems in the body, not just the pleasure/reward system, Volkow says. ... She does not believe that most people are overweight because their brains’ dopamine systems don’t function properly.

OK, so only some people have dopamine-related food addictions. But what bugs me about this whole hypothesis is that it still essentially psychologizes the problem of morbid obesity: You can call it a disease instead of a lack of will power, but it’s still construed as a problem of the brain. And the Yale researchers don’t seem to mention what seems like a really important physical component of obesity that does lead to addictive-type behavior: insulin resistance, a prediabetic condition that affects a third (registration required) of all American adults and that leads to uncontrollable cravings for carbohydrates.

Studies have shown that insulin resistance is associated with fast-food consumption; sugary, low-fiber, and high-salt diets; and with eating meals at irregular hours. These lifestyle factors may cause insulin resistance in the first place, and they definitely exacerbate it, causing more weight gain. (I came across all this stuff while doing research on polycystic ovary syndrome, a relatively common women’s condition that is strongly linked with insulin resistance.) So I’d be interested to see research that discussed the role of the Western diet—not just the brain—in promoting addictlike behavior toward food.

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