By Mark S. Gold, MD and Kelly D. Brownell, PhD
In July of 2007, we hosted the first meeting of its kind, the Yale Conference on Food and Addiction. This Conference brought together 40 experts on nutrition, diabetes, obesity and addiction for two days to discuss and debate the controversies surrounding food and addiction. What emerged were the early signs of a developing field, one with experts from many disciplines, all of whom were interested in whether and how food might affect the brains in ways similar to classic substances of abuse.
Now, some five years later, there is a more coherent field, meetings, many journal articles, and the hint that food and addiction is beginning to enter the national and global debate about the obesity crisis. Food addiction connects experts who, because of the typical professional specialization we all engage in, might be unfamiliar with each other. Researchers from general addiction medicine may never connect with endocrinologists working on obesity from the point of view of metabolism and diabetes. Internal medicine experts may have little contact with the bariatric surgeons and even less contact with the neuroscientists or addiction researchers.
Food addiction reflects a broad range of issues, namely the brain and behavior, hedonic overeating, fat, sugar and desserts, and fMRI and PET research demonstrating strong similarities in ways drugs and certain foods affect/change the brain. Food, sex, gambling, and internet gaming cause changes that are quite similar, if not identical, to those produced by classical drugs of abuse in the reward systems of the brain. There are also phenomenological and psychological similarities between food cravings and cravings for drugs. Moreover, neuroscience in developing anti-obesity CNS agents that did not target eating, but rather shifted food preference (so broccoli might become as reinforcing as French fries) has failed. Obesity is one of the world’s chief public health problems and the intake of modern, processed foods may contribute to the addictive processes.
In the past, addiction was defined by tolerance and withdrawal. The definition of addiction changed after cocaine researchers showed that cocaine was as addicting as other drugs despite being classified by experts as non-addicting on the basis of the lack of a clear abstinence syndrome. Addiction was more like a pathological, often fatal attraction. The definition of addiction has been changed and now. Pathological gambling is widely considered an addiction, as an example. What will occur with food?
Loss of control over food, eating more than intended, eating to pain and discomfort, eating to the point of physical, psychological, and social distress characterize many food addicts. Failed diets and abortive attempts to control overeating, preoccupation with food and eating, shame, anger, and guilt look like traditional addictions. It is all-too common for people to eat more than they intend despite physician and family warnings about consequences such as high blood pressure, cancer risks, type 2 diabetes, and joint/bone pain. Shame, guilt, relapse, and denial are also common among addicts.
Overeating and obesity may be candidates for Addictive Disease and should be considered a viable and testable entity, which can produce novel approaches and treatments for a major disease of unknown cause and with no fast and effective treatment. We live in a time when food is in abundance, manufactured, and available on demand. Highly palatable and so-called “fast food” can produce similar effects as drugs of abuse.
One can look at the issue of food and addiction in a clinical context, whether there are food addicts for example. The public health significance of the concept a food and addiction might be even more important. A key question is whether certain foods act on the brain in ways that create craving, withdrawal, tolerance, and other features of addiction to a sufficient extent to create a public health hazard.
It is in this context where public policies and application of the law might be affected. Smokers continued to smoke despite warnings about cancer, stroke, and heart risks. The world finally made progress with tobacco addiction by combining educational campaigns with public policies that restricted access, limited marketing, and curtailed the ability of the companies to pedal their products, especially to youth. There are a great number of policies meant to address obesity following these same principles. Restricting marketing of unhealthy foods, limiting their sales in schools, creating regulations for maximum portion sizes, and taxing some products are a few examples of public policies being considered seriously in the United States and abroad. Work on food and addiction may add an important impetus for such policies.
Everyone agrees that obesity is pandemic. HBO has even aired a series about the weight of our nation. Where the controversy begins is in deciding what to do about it and how much government involvement should be sought in guiding our food and nutrition choices. We believe that work on food and addiction will add a key voice to this discussion and is likely to be important as time goes forward.
Much more could be said regarding global obesity, new public health, prevention, intervention and treatment approaches which are now possible thanks in large part to research evidence linking overeating to fat-sugar-salty diets which produce effects on the brain that are drug and addiction-like. Too bad, exercise and vegatables don’t have this effect on all of us. We invite others to comment and contribute to this dialogue.
Mark S. Gold, MD and Kelly D. Brownell, PhD are the authors of Food and Addiction: A Comprehensive Handbook, which brings together food addiction experts from many fields, hospitals, and universities. It is based on their collaboration on the science and evidence linking overeating and food preferences to basic and clinical neuroscience. They are speaking at the American Psychological Association Convention this week and you can stop by Booth #1001 (Oxford University Press) to find out more.
Mark S. Gold, MD is the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry. Dr Gold is a teacher of the year, researcher and inventor who has focused for much of his career on the development of models for understanding the effects of tobacco, cocaine, opiates, other drugs, and also food, on the brain and behavior. He began his work on the relationship between food and drug addictions while at Yale working with addicts in withdrawal. He has worked for 30+ years trying to understand how to change food preferences, make eating and drugs of abuse less interesting or reinforcing at the brain’s dopamine and other reinforcement sites.
Kelly D. Brownell, PhD is professor of psychology, epidemiology, and public health at Yale University and is director of Yale’s Rudd Center for Food Policy & Obesity. Dr. Brownell does work at the intersection of science and public policy. The Rudd Center assesses, critiques and strives to improve practices and policies related to nutrition and obesity so as to inform the public and to maximize the impact on public health.