Should obesity be classified as a brain disease?

Many of our most popular stories are about diets and weight management.

Did you know that some psychologists and psychiatrists would like to classify obesity as a brain disease? The reason for this is that there is mounting evidence that food, or certain types of food, can trigger the same addictive effects in the brain as drugs like heroin and cocaine. There is also substantial evidence that some people lose control over their food consumption and exhibit other behaviors (e.g. tolerance, withdrawal)  that may meet diagnostic criteria (see below) for substance dependence.

Laboratory scientists have used animal models borrowed from drug addiction research to study food addiction. In one study, rats were given access, not to cocaine or heroin but rather to a “cafeteria-style” diet including bacon, sausage, cheesecake, pound cake, frosting and chocolate.  As a result,  some of the rats became compulsive eaters. Compulsiveness is considered a hallmark of addiction in humans.

Psychology researchers at Yale University have developed a written test to identify people who may suffer from food addiction. The scientific background of this work is described in this video on UCTV.

Here are the diagnostic criteria for substance dependence according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:

  1. Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
  2. Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
  3. The substance is often taken in larger amounts or over a longer period than intended.
  4. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  5. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  6. Important social, occupational, or recreational activities are given up or reduced because of substance use.
  7. The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

So what do you think? Is obesity a disease of the body or the brain (or both)?

Michele Berman is a pediatrician who blogs at Celebrity Diagnosis.

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