HAMILTON, Ontario—Therapies traditionally applied to the area of addiction may be helpful in managing weight problems, according to a commentary published in Canadian Medical Association Journal (CMAJ. 2009 Dec 21).
While “food addiction,” has caused much clinical and scientific controversy, the authors write it can be described in much the same way as other addictive behaviors, including tolerance, withdrawal symptoms and relapse. They also point out imaging studies have shown that specific areas of the mesolimbic system, such as the caudate nucleus, the hippocampus and the insula, are activated both by drugs and by food. Both also cause the release of striatal dopamine, a neurotransmitter that is an integral part of the reward system. Endogenous opiates, another group of players in the reward pathways, are also activated by drugs and by food. The write compounds that act as inverse agonists within the endocannabinoid system have been used both to treat substance addictions and to promote weight loss.
They argue binge eating should become a routine part of treatment for obesity, and, in the case of gastric surgery, that such screening should be an important part of postoperative follow-up. Food addiction may also explain the lack of success of lifestyle programs that do not incorporate pharmacotherapy or behavioral strategies specifically designed to address the addictive component
They conclude with, “We cannot ignore evidence highlighting the role played by biologic vulnerability and environmental triggers. To do so would represent a clinical disservice.”