Do you struggle with your weight? Are you obese? Have you tried again and again to lose weight, and had short-term success but then slip back into old patterns? Have you lost weight only to find yourself gaining the weight back with interest?
As a physician who enjoys helping people lose weight, I am almost as frustrated as my patients when things aren’t going well. One thing that makes weight loss particularly difficult is food addiction.
Food addiction is just starting to be recognized as a major underlying factor in overweight and obesity. Just like alcoholism and drug addiction, there are changes in the brain in some overweight and obese people that make it difficult or impossible for them to lose weight without help.
Researchers at Yale developed a questionnaire, published in 2009, to assess food addiction. This questionnaire, the Yale Food Addiction Scale, is a 25-question tool that helps dig into symptoms and behaviors of food addiction.
What is addiction? Psychiatrists and psychologists recognize addiction as a persistent pattern of abnormal behavior that results in significant distress in the patient. Abnormalities include
- Tolerance (needing more of the substance in question to get the same effect)
- Cravings and withdrawal symptoms when not using
- Consuming larger amounts than intended
- Unsuccessful attempts to cut down in spite of wanting to cut down or abstain
- A lot of time spent using or recovering from use
- Continued use or overuse in spite of known consequences
- Giving up important activities in order to use
You may already recognize some of these markers in yourself. I certainly do. For instance, I have a really bad sweet tooth. I sometimes find myself eating more sugar than I know is good for me. If I stop eating sugar, I will have sugar cravings, headaches and body aches. Sugar is addictive and I know I have withdrawal symptoms if I overuse it for awhile then stop.
The same group that developed the Yale Food Addiction Scale published an article looking at almost 200,000 people, and found that about 25% of people who were overweight or obese met the criteria for food addiction. Food addiction was more common in women, those over 35 years of age and those with clinically disordered eating, like binge eating, anorexia and bulimia.
Addiction is a complicated topic and I could write for days about it. A VERY over-simplified explanation of addiction is that the reward centers of the brain have low levels of dopamine, the pleasure hormone. Using the drug of choice (opiates, food, sex, sugar, etc) raises dopamine levels in these areas. Also, these substances interact with the endogenous opioid (endorphin) systems, giving a morphine-like “high.”
Taken together, the presence of the “high” with use and low dopamine levels without use make it very difficult to resist the urge to overeat and very difficult to stop overeating once started.
Do some foods trigger food addiction more than others? Well sure, nobody really binges on green beans and broccoli, right? So called “highly palatable” foods are much more likely to trigger overeating. The food industry knows this, and adds saturated fat, salt and sugar to processed foods to create this super-tasty addiction trigger. Chips, cookies, candy, soda, cheeseburgers, French fries, white bread and ice cream are examples of foods likely to trigger an addiction response and binge eating behavior.
My personal belief is that weight loss is much harder than dealing with alcoholism, smoking, even heroin addiction. You can’t just not eat, right? However, when you understand what foods and situations trigger addiction, you can avoid them like an alcoholic avoids beer and stays out of bars.
What about people who are motivated to kick their food addiction for good? What is available to help them? There are twelve-step programs for food addicts, similar to Alcoholics Anonymous. One such program is Food Addicts In Recovery Anonymous. (I have no experience with this program, I just know it exists.) And like alcoholism and opiate addiction, medications can help.
There is a medication called Contrave which has been shown to promote weight loss. When you understand food addiction, it’s easy to see how Contrave would be helpful. Contrave is a combination of bupropion, which raises dopamine levels, and naltrexone, which blocks the endorphin response.
Bupropion, an antidepressant, is well known to help people quit smoking and is the only antidepressant that promotes weight loss. Raising dopamine levels decreases the need to eat, or smoke, or do other things to raise these levels in the brain. Naltrexone blocks the “high” from drinking alcohol, using opiates like heroin, or binge eating.
While Contrave is very expensive and only rarely covered by insurance, both bupropion and naltrexone are available in generics and are inexpensive to purchase if not covered. GoodRx.com can give you an idea what prices would be like near you.
If you believe you may be a food addict, please print and fill out the Yale Food Addiction Scale and take it to your doctor. You can also print out the scoring instructions, it’s a little tricky to score. This will help your doctor help you.
Like many similar problems, a combination of medication and counseling is going to be the most effective way to deal with food addiction. If you are overweight or obese and feel out of control with respect to your eating, don’t give up! See your doctor and ask for help. If he or she isn’t comfortable diagnosing and treating food addiction ask for a referral to a bariatric center near you.
Like alcoholism and opiate addiction, food addiction can impact every part of your life. It can alienate you from friends and family, and can even take your life. Proper treatment starts with recognizing the problem and asking for help.
QUESTION: Do you or someone you love have a food addiction? Will you do something differently based on the information in this post?