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Addicted to Food, Hungry for Drugs

Abstract

There is a growing consensus among neuroscientists that people can become addicted to food, and that at least some cases of obesity have addiction as their cause. By contrast, the rest of the world continues to see obesity as either a disease of the metabolism, or as a reckless case of self-harm. Among obesity researchers, there has been a lively debate on the issue of whether obesity ought to be considered a disease. Few researchers, however, have suggested that obesity is a disease in the same sense as addiction is usually claimed to be a disease—that is, a disease of behaviour with a neurological cause. In this piece, I review what is now a compelling body of evidence for food addiction, to establish that many or most cases of obesity have addiction at their foundation. I then argue that in spite of this, obesity ought not to be considered a neurobehavioural disease in the sense usually attributed to drug addiction. Given the link between addiction and obesity, this implies that the disease conception of addiction must be abandoned. I conclude by assessing some of the implications this move has for policy and ethics, with regard to both obesity and drug addiction.

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Notes

  1. Of course, though drug use itself is often criminalized, overeating is not, and people who commit crimes in service of overeating will be relatively rare, since food is cheaper and more abundant than drugs are. Nevertheless, it is reasonable to presume that some overeaters have committed crimes in service of their appetite.

References

  1. Hebb, D. 1949. The organization of behavior: A neuropsychological theory. New York: Wiley.

    Google Scholar 

  2. Colantuoni, C., et al. 2001. Excessive sugar intake alters binding to dopamine and mu-opioid receptors in the brain. NeuroReport 12(16): 3549–3552.

    Article  Google Scholar 

  3. Colantuoni, C., et al. 2002. Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence. Obesity Research 10(6): 478–488.

    Article  Google Scholar 

  4. Wang, G.J., et al. 2003. Positron emission tomographic evidence of similarity between obesity and drug addiction. Psychiatric Annals 33: 104–112.

    Google Scholar 

  5. Wang, G.J., et al. 2004. Similarity between obesity and drug addiction as assessed by neurofunctional imaging: a concept review. Journal of Addictive Diseases 23(3): 39–53.

    Article  Google Scholar 

  6. Pelchat, M., et al. 2004. Images of desire: food-craving activation during fMRI. Neuroimage 23(4): 1486–1493.

    Article  Google Scholar 

  7. Avena, N.M., P. Rada, and B.G. Hoebel. 2007. Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev.

  8. Volkow, N.D., et al. 2008. Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 363(1507): 3191–3200.

    Article  Google Scholar 

  9. Pelchat, M.L. 2009. Food addiction in humans. The Journal of Nutrition 139(3): 620–622.

    Article  Google Scholar 

  10. Tataranni, P., et al. 1999. Neuroanatomical correlates of hunger and satiation in humans using positron emission tomography. PNAS 96(8): 4569–4574.

    Article  Google Scholar 

  11. Liotti, M., et al. 2001. Brain responses associated with consciousness of breathlessness (air hunger). PNAS 98(4): 2035–2040.

    Article  Google Scholar 

  12. Denton, D., et al. 1999. Neuroimaging of genesis and satiation of thirst and an interoceptor-driven theory of origins of primary consciousness. PNAS 96(9): 5304–5309.

    Article  Google Scholar 

  13. Bash, K. 1939. Contribution to a theory of the hunger drive. Journal of Comparative Psychology 28(1): 137–160.

    Article  Google Scholar 

  14. Bruch, H. 1973. Eating disorders: obesity, Anorexia Nervosa and the person within. New York: Basic Books.

    Google Scholar 

  15. Chang, G.Q., et al. 2008. Maternal high-fat diet and fetal programming: increased proliferation of hypothalamic peptide-producing neurons that increase risk for overeating and obesity. The Journal of Neuroscience 28(46): 12107–12119.

    Article  Google Scholar 

  16. Santel, S., et al. 2006. Hunger and satiety in anorexia nervosa: fMRI during cognitive processing of food pictures. Brain Research 1114(1): 138–148.

    Article  Google Scholar 

  17. American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th ed. Washington: American Psychiatric Association.

    Google Scholar 

  18. Batterham, R.L., and S.R. Bloom. 2003. The gut hormone peptide YY regulates appetite. Annals of the New York Academy of Sciences 994: 162–168.

    Article  Google Scholar 

  19. Holst, B., and T.W. Schwartz. 2004. Constitutive ghrelin receptor activity as a signaling set-point in appetite regulation. Trends in Pharmacological Sciences 25(3): 113–117.

    Article  Google Scholar 

  20. Dakin, C.L., et al. 2004. Peripheral oxyntomodulin reduces food intake and body weight gain in rats. Endocrinology 145(6): 2687–2695.

    Article  Google Scholar 

  21. Ahima, R.S. 2008. Revisiting leptin’s role in obesity and weight loss. Journal of Clinical Investigation 118(7): 2380–2383.

    Google Scholar 

  22. Ahituv, N., et al. 2006. A PYY Q62P variant linked to human obesity. Human Molecular Genetics 15(3): 387–391.

    Article  Google Scholar 

  23. Görtzen, A., and R.W. Veh. 2007. Obesity—an introduction to molecular mechanisms. Dtsch Arztebl 104(17): 1166–1171.

    Google Scholar 

  24. Wall, T.L., et al. 2007. Differences in pharmacogenetics of nicotine and alcohol metabolism: review and recommendations for future research. Nicotine & Tobacco Research 9(Suppl 3): S459–S474.

    Article  Google Scholar 

  25. Gold, M., K. Frost-Pineda, and W. Jacobs. 2003. Overeating, binge eating, and eating disorders as addictions. Psychiatric Annals 33: 117–122.

    Google Scholar 

  26. Mitchell, J.E. 2008. Binge-eating disorder: clinical foundations and treatment. New York: Guilford Press.

    Google Scholar 

  27. Striegel-Moore, R. 2000. The epidemiology of binge eating. Europeatn Eating Disorders Review 8: 344–346.

    Article  Google Scholar 

  28. Garfinkel, P.E., et al. 1995. Bulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups. The American Journal of Psychiatry 152(7): 1052–1058.

    Google Scholar 

  29. SAMSHA, Results from the 2006 Survey on Drug Use & Health: National Findings. 2007, Substance Abuse and Mental Health Services Administration: Rockville, MD.

  30. Leshner, A.I. 1997. Addiction is a brain disease, and it matters. Science 278(5335): 45–47.

    Article  Google Scholar 

  31. Hyman, S.E. 2007. The neurobiology of addiction: implications for voluntary control of behavior. The American Journal of Bioethics 7(1): 8–11.

    Article  Google Scholar 

  32. Principles of Drug Addiction Treatment: A Research-Based Guide. 2009, National Institute on Drug Abuse: Bethesda, MA.

  33. Neuroscience of psychoactive substance use and dependence. 2004, World Health Organization: Geneva.

  34. Conway, B., and A. Rene. 2004. Obesity as a disease: no lightweight matter. Obesity Reviews 5(3): 145–151.

    Article  Google Scholar 

  35. Heshka, S., and D.B. Allison. 2001. Is obesity a disease? International Journal of Obesity 25(10): 1401–1404.

    Article  Google Scholar 

  36. Boorse, C. 1977. Health as a theoretical concept. Philosophy of Science 44: 542–573.

    Article  Google Scholar 

  37. Foddy, B., and J. Savulescu. 2010. A liberal account of addiction. Philosophy, Psychiatry and Psychology 17(1). (In press).

  38. Nordenfelt, L. 2007. The concepts of health and illness revisited. Medicine, Health Care and Philosophy 10(1): 5–10.

    Article  Google Scholar 

  39. Foddy, B., and J. Savulescu. 2010. Relating addiction to disease, disability, autonomy and the good life. Philosophy, Psychiatry and Psychology 17(1). (In press).

  40. Caplan, A.L. 2006. Ethical issues surrounding forced, mandated, or coerced treatment. Journal of Substance Abuse Treatment 31(2): 117–120.

    Article  Google Scholar 

  41. Klag, S., F. O’Callaghan, and P. Creed. 2005. The use of legal coercion in the treatment of substance abusers: an overview and critical analysis of thirty years of research. Substance Use & Misuse 40(12): 1777–1795.

    Article  Google Scholar 

  42. Nace, E.P., et al. 2007. Socially sanctioned coercion mechanisms for addiction treatment. The American Journal on Addictions 16(1): 15–23.

    Article  Google Scholar 

  43. Tsai, A.G., D.A. Asch, and T.A. Wadden. 2006. Insurance coverage for obesity treatment. Journal of the American Dietetic Association 106(10): 1651–1655.

    Article  Google Scholar 

  44. Gabel, J.R., et al. 2007. Substance abuse benefits: still limited after all these years. Health Affairs 26(4): w474–w482.

    Article  Google Scholar 

  45. Gastrointestinal surgery for severe obesity. 1996. NIH consensus development conference, March 25-7, 1991. Nutrition 12(6): 397–404.

    Article  Google Scholar 

  46. Merskey, H. 1986. Variable meanings for the definition of disease. The Journal of Medicine and Philosophy 11(3): 215–232.

    Google Scholar 

  47. EEOC v. Watkins, 463 F.3d 436 (6th Cir. 2006)

  48. Cook v. Rhode Island, Dept. of Mental Health, Retardation and Hospitals, 10 F.3d 17 (1st Cir. 1993), aff’g 783 F. Supp. 1569 (D.R.I. 1992)

  49. ADA Amendments Act of 2008. 2008, available at http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgidbname=110-cong-bills&docid=f:s3406enr.txt.pdf: USA. p. 3553.

  50. Sidney, S., et al. 1997. Marijuana use and mortality. American Journal of Public Health 87(4): 585–590.

    Article  Google Scholar 

  51. Hu, F. 2008. Obesity and mortality. In Obesity Epidemiology, ed. F. Hu, 216–233. Oxford University Press: New York.

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Correspondence to Bennett Foddy.

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Foddy, B. Addicted to Food, Hungry for Drugs. Neuroethics 4, 79–89 (2011). https://doi.org/10.1007/s12152-010-9069-1

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Keywords

  • Addiction
  • Obesity
  • Binge-eating
  • Drugs
  • Neuroscience