Obesity, Addiction, Alcohol and Bariatric Surgery Part II

We know that the factors behind each individual’s struggle with obesity are unique, with a long list of physiologic, psychological, and environmental factors as potential contributors. We are also learning increasingly that there are many areas of neurophysiologic (brain), psychological and behavioral overlap in the realms of obesity and addiction.

In part I of this two-part blog post, we discussed some of the changes that happen after bariatric surgery, as discussed in a recent review.

Now, some threads that weave a connection for some people between obesity and addiction:

1. For some people, food is an addictive substance. People who have high scores on food addiction questionnaires have similar patterns of brain activation as in people with other addictions. Also, overconsumption of certain nutrients (eg sugar) elicits chemical responses in our brains, similar to those that result from consumption of drugs or alcohol.Some people think that combatting a food addiction is no different than trying to quit smoking. But remember, a person who quits smoking can (and ideally will) lead their life without ever touching another cigarette. But the person battling a food addiction can’t stop eating – they have to continue to eat for the rest of their lives, while controlling the addictive component that leads to overeating: a very, very difficult thing to do.

2. Some people with obesity have more ‘turbo-charged’ food reward circuits in their brains, which results in a powerful drive to seek high calorie food. Obesity can also be accompanied by a reduced brain-driven ability to resist temptation and control impulses to eat, with data suggesting that there is a genetic component to these differences. After gastric bypass surgery, research has identified some changes in this brain activity, and these changes may be associated with the amount of weight lost after surgery.Know that feeling of: I am so hungry I don’t care what it is it just has to happen RIGHT NOW…?
For some people, this feeling may come only if meals are skipped for many hours, or after a fierce workout. For others, they may feel like this until their body is at a higher body weight ‘set point’. The level of energy reserves, or time from last meal that contributes to the threshold for this feeling to set in, is very different from person to person.

So for people who have a food addiction, as well as for people who have a more powerful reward circuitry, weight management will be difficult, but not impossible – having a psychologist with professional training in obesity management is an important part of the team to help manage their weight struggles.

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