Food Addiction and Obesity- Boston Globe Op Ed

NO ONE needs another government study to know that America is drowning in an ocean of adipose, so the state’s anti-obesity initiative announced Jan. 8 is a welcome step. But it ignores the most basic fact about why so many Americans are fat and getting fatter.

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That fact is food addiction.

To many, this omission won’t seem odd, for it is true that the medical establishment has not yet officially acknowledged the links between foods and addiction, and popular culture still thinks fat people are just weak and lazy and ought to just straighten themselves out.

Until the mid-’30s, folks said the same thing about drunks, but then, as now, it was just ignorance talking. It is well accepted today that alcohol, drugs, and many other substances affect some people far more severely than others, and that sufferers are sick, not bad.

That change in attitude did not originate in science, but has come to be proven by research, and it will undoubtedly surprise many that science has already begun to catch up on the matter of food addiction, in the form of hundreds of peer-reviewed studies.

Among the most impressive studies is the brain-imaging work conducted in 2004 at the McKnight Brain Center at University of Florida, which suggests “there are important similarities between overeating highly palatable and hedonic foods and the classic addictions.”

A study published in 1994 found that the brain’s D2 dopamine receptor, already implicated in alcoholism, is also involved with obesity and with cocaine and tobacco dependence. And just last month, Princeton psychology professor Bart Hoebel presented research to the American College of Neuropsychopharmacology that suggests sugar is an addictive substance.

Beyond pure research, a growing cadre of nutritionists, counselors, and clinicians are facilitating and witnessing patients’ long-term success by applying the methods that have helped other addicts. Some of their leaders will gather this week in Houston for the first International Conference of Food Addiction Professionals.

Though I believe in science, I became convinced about food addiction in the most personal way possible: I was severely obese for most of my first 33 years, and weighed 365 pounds on Oct. 21, 1991, the day I was admitted to the eating disorders unit of South Oaks Hospital, an accredited psychiatric hospital on Long Island.

During a nine-week stay, my counselors deployed the same methods their counterparts were using in the alcohol wards across the green, at the gambling ward around the corner, and elsewhere in the hospital. The treatment cost $54,000, but what insurance didn’t cover, the hospital waived, and my life was saved: I’ve been living in sanity, serenity, and a normal-sized body for better than 15 years.

The insurance angle is a key part of the story. For several reasons, including the advent of managed care, coverage essentially is no longer available, even while insurers helped pay the estimated $4.4 billion in bariatric-surgery costs last year. Changing that inequity should be a priority of lawmakers if they want to make a dent in the obesity epidemic. Certainly, not everyone who is overweight is an addict, but the more overweight people are, the more likely that they have crossed the line from big eater to habitual user. And it is the most obese people who need the most disproportionate share of medical resources.

If there isn’t enough money to support both treatments, obviously the surgical option should go. Most people didn’t get fat because their stomachs could hold too much food, and surgically shrinking stomachs isn’t going to address the emotional and spiritual deficits that drive most overeaters.

Instead of seeing a fat person and thinking, “How could he let himself go like that?” it might be better to ask, “Did he have any choice?” Would anyone in his right mind endure so much discomfort, not to mention public shame?

That’s what addicts do, engage in activities they know are killing them. In short, not acting in their right minds. There’s help for that.

Michael Prager is a writer and author living in Arlington.