EXPERT ANALYSIS FROM THE AMERICAN COLLEGE OF PSYCHIATRISTS MEETING

HUNTINGTON BEACH, CALIF. (FRONTLINE MEDICAL NEWS)The way pioneering researcher Dr. Mark S. Gold sees it, food addiction is akin to dependence on alcohol, nicotine, and other drugs, and the earlier clinicians intervene and treat, the better.

“The evidence that sugar and other constituents of food can be an addiction is quite good, especially if you think about binging, craving, withdrawal, cross-sensitization, increased consumption, and drive for the ‘drug’ in a classic manner,” Dr. Gold said at the annual meeting of the American College of Psychiatrists. “If you focus on dopamine, sugar and food would be a drug. There’s anticipatory dopamine release if you’re presented with dessert, even after a huge meal, for example.”

Just as gambling, sex, and work can be addicting and result in a pathologic attachment, one’s drive for certain foods can lead to loss of control and/or continued use despite serious consequences such as the development of type 2 diabetes or knee and joint disease tied to weight gain. In the case of sugar, for example, “not only does it stimulate its own taking [in the form of] self-administration, loss of self-control, and binging, it can produce withdrawal as if the person is taking opiates,” said Dr. Gold, coauthor of “Food and Addiction: A Comprehensive Handbook” (New York: Oxford University Press, 2012) and the former chair of the department of psychiatry at the University of Florida, Jacksonville. “There’s an indirect opiate effect if naloxone (Narcan) produces withdrawal after sugar self-administration.”

And while obesity is currently the nation’s No. 2 health problem behind tobacco and secondhand smoke, it will be No. 1 soon, predicted Dr. Gold, a psychiatrist who has spent more than 40 years developing models for understanding the effects of tobacco, opiates, cocaine, other drugs, and food on the brain and behavior ( Physiol. Behav. 2011;104:157-61 ).He pointed to a recent comparison of data from the Medical Expenditure Panel Survey between 2000 and 2010, which suggests that obesity “is going to bankrupt the health system because, as compared to tobacco, where death and disability tend to occur in the last 7 years of a person’s life, obesity is an unwanted gift to the health system that keeps on giving, with type 2 diabetes and other complications,” he said. “Now, bariatric surgery is the fastest-growing operation in the United States, and it’s been successful in treating teenagers. Two-thirds of Americans now qualify for obesity treatment.”

He went on to note that Americans are “conditioned by fast food,” and cited potential addictive factors as a nutritionally imbalanced prenatal diet, child rearing, genetics, and lack of exercise. “We [Americans] eat abnormally fast,” Dr. Gold added. “Our group has shown in functional imaging that it takes about 12 minutes for a thin person’s brain to get the food signal. It takes 25 minutes for an obese person to get the signal. So if the obese person goes into a fast food restaurant” and starts eating, that person gets back in line because he’s still hungry.

When first meeting a patient with a suspected food addiction, he advises clinicians to measure the person’s body mass index and to administer the Yale Food Addiction Scale , “which is easy to use,” he said. “Think about intervening and treating people when they have a BMI of 25 or greater, rather than just when they have a pre–bariatric surgery evaluation. One size doesn’t fit all when it comes to treatment.

“It’s important to have a careful look [at what’s causing their obesity]. It could be due to a thyroid condition or to a medication they’re taking.”

In addition to early intervention, “you want cognitive-behavioral treatment, new psychopharmacologic treatment where relevant, and group treatment rather than individualized treatment alone. The food addiction model is leading to a new way of thinking and new pharmacological treatment based on addiction research.”

Dr. Gold reported having no relevant financial conflicts.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

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