Might As Well Face It-We’re Addicted to Food

[[{"type":"media","view_mode":"media_crop","fid":"14198","attributes":{"alt":"food addiction","class":"media-image media-image-right","id":"media_crop_7990778613016","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"710","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 6px; float: right;","title":" ","typeof":"foaf:Image"}}]]chocoholic (noun)
A person who craves or compulsively consumes chocolate.
–Merriam-Webster

From chocoholics and beyond, references to food cravings have been found in pop culture since the dawn of time. However, food addiction hasn’t been taken as seriously as addiction to narcotics, opiates, alcohol, and the like. Now, with new research, that just may change.

In a first of its kind study, researchers have found an intense activation of the nucleus accumbens following a meal with high-glycemic index. The randomized, blinded, crossover study, which was published in the American Journal of Clinical Nutrition, followed overweight or obese men aged 18 years to 35 years (N = 12).¹ The men were assigned to high- or low-glycemic index meals in shake form over 2 occasions; the meals were controlled for calories, macronutrients, and palatability. Researchers found an initial surge in plasma glucose followed by a dramatic drop in plasma glucose as well as excessive hunger four hours following the high-glycemic index meals. This “crash” was also associated with the selective stimulation of brain regions linked to reward and craving.

Interestingly, unlike previous studies of food addiction that asked participants to consume diverse foods such as cheesecake versus vegetables, this is the first study in which all participants received similar looking and tasting milkshakes, which eliminated some bias. This is also the first study to use functional MRI during the late postprandial period, which has special significance to eating behavior at the upcoming meal. Previous research with MRIs studied brain activity shortly after the meal.

Put all this together and it might mean a giant step forward in understanding food addictions as well as obesity. And that’s perfect timing, given the American Medical Association’s new statement that obesity should be considered a chronic medical disease state.²That statement reads:

That our AMA: (1) recognize obesity and overweight as a chronic medical condition (de facto disease state) and urgent public health problem; (2) recommend that providers receive appropriate financial support and payment from third-party payers, thus ensuring that providers have an incentive to manage the complex diseases associated with obesity; (3) work with third-party payers and governmental agencies to recognize obesity intervention as an essential medical service; and (4) establish a comprehensive ICD code for medical services to manage and treat obese and overweight patients.²

Based on this war cry, if obesity is a direct result of food addictions, then psychiatrists will surely be called on to join the frontlines of the fight.

Meanwhile, this study gives some hope and provides some preliminary answers. For starters, David Ludwig, MD, PhD, director of New Balance Foundation Obesity Prevention Center and study co-author, noted to the press, “these findings suggest that limiting high-glycemic index carbohydrates like white bread and potatoes could help obese individuals reduce cravings and control the urge to overeat.”³ Plus, these results might help propel further research into food addictions.

Until we have more answers, feel free to indulge in that chocolate bar.

References:

References 1. Lennerz BS, Alsop DC, Holsen LM, Stern E, Rojas R, Ebbeling CB, Goldstein JM, Ludwig DS. Effects of dietary glycemic index on brain regions related to reward and craving in men. Am J Clin Nutr. 2013 Jun 26. [Epub] http://ajcn.nutrition.org/content/early/2013/06/26/ajcn.113.064113. Accessed June 28, 2013.
2. Fryhofer SA (presenter). Report of the Council on Science and Public Health. http://www.ama-assn.org/assets/meeting/2013a/a13-addendum-refcomm-d.pdf#page=19. Accessed June 28, 2013.
3. Boston Children’s Hospital Press Release. New brain imaging study provides support for the notion of food addiction. June 26, 2013. http://www.eurekalert.org/pub_releases/2013-06/bch-nbi062413.php. Accessed June 28, 2013.