Addiction to Food

"We're involved in studies of brain changes associated with obesity," says Nora D. Volkow, MD, director of NIDA, whose 2001 study pioneered some of the food-addiction research. "We're doing it because many compounds that inhibit compulsive eating may also inhibit compulsive drug intake. The neurocircuitry overlaps."

The behavior of compulsive eaters also lends credence to the idea of food addiction--the cravings and preoccupation with food, the guilt, the way these overeaters use food to relieve bad feelings, and the fact that binges are frequently conducted at night or in secret. Now some addiction and obesity experts have started to use the "A" word in connection with food and even to speculate that it may be partly responsible for America's rising obesity rate.

"Food might be the substance in a substance-abuse disorder that we see today as obesity," says Mark Gold, MD, chief of addiction medicine at the University of Florida College of Medicine. "If you ask some of the questions that are used to diagnose drug abuse--for instance, 'Do you continue to use the substance despite its negative effects?' or 'Do you have a preference for more refined substances?'--and then replace substance with food, it's not all that difficult to imagine that food addictions exist."

No one--Gold included--is suggesting that an food addiction could be as strong as the one that drives people addicted to cocaine or heroin. Still, the research into the connection between overeating and addiction isn't just academic. It may finally put to rest the idea that anyone who eats excessively simply suffers from a lack of self-discipline. More important, the emerging evidence points to some very concrete steps anyone can take to eat in a saner, healthier way.

Blame It on the Brain

People like Littleton have long been accused of lacking willpower. But research at the US Department of Energy's Brookhaven National Laboratory in New York suggests they may be missing something else instead: adequate brain receptors for dopamine, a chemical that is part of the brain's motivation and reward system. "Dopamine is the chemical that makes you say aah," says Gene-Jack Wang, MD, clinical head of positron emission tomography imaging at Brookhaven and leader of a series of studies investigating the brain chemistry of chronic overeaters. "It gets us to go over and grab something that will make us feel good."

In 2001, Wang and his colleagues, Volkow among them, compared the brain scans of obese and normal-weight volunteers, counting up dopamine receptors. Obese people, Wang realized, had fewer dopamine receptors--and the more obese they were, the fewer of these crucial receptors they had. In fact, he says, the brains of obese people and drug addicts look strikingly similar: "Both have fewer dopamine receptors than normal subjects."

It's possible that drug use or compulsive overeating actually lowers the number of dopamine receptors. But it's also possible that some people are born with fewer--and if that's the case, say researchers, it could explain a lot. If overeaters or drug addicts are short on receptors for the aah chemical, they might not respond as readily to social interaction, art, sex, and other pleasures that ought to make them feel good. And that could be the reason they're driven to consume things that prompt dopamine's release--like illicit drugs (the most potent activator) or foods high in fat, sugar, and possibly salt.

"If you have someone who is not responsive to natural reinforcers, that person may be more vulnerable to taking drugs," Volkow says. "If you get stimulated only by food, guess what happens? You can easily fall into patterns of compulsive eating."

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