The DSM-5 is the current edition of the major reference book of Psychiatry and Psychology defining the many different deviations of the psyche for purposes of classification, treatment and therapy. Anorexia nervosa, bulimia and even obesity have been included in DSM for over 30 years (Kaplan & Sadock, 1981).
But now Dr Suzanne Dickson, a researcher at the Sahlgrenska Academy at the University of Gothenburg, Sweden, is reported to have suggested that binge eating obesity may be a type of food addiction (Brauser, 2013). Dr Dickson was speaking at the 26th European College of Neuropsychopharmacology Congress in Barcelona, Spain.
Addiction theory
The popular press has been buzzing with articles that liken foods, especially fatty and sweet foods, to narcotics and claim that sugar is as addictive as a drug.
“Sugar’s secret power over the mind” an article by Cherrill Hicks published in the Sunday Times (2013), explains the concept of “hedonic hunger”, a powerful drive that makes certain foods irresistible. According to the article, hedonic hunger is how our bodies respond under the influence of the brain’s reward centre which makes us eat certain foods for the simple pleasure of eating them. These foods are invariably not broccoli or steamed fish, but high-fat, high-sugar and also high-salt foods. Evidently our brains light up during neuro-imaging when we are exposed to such foods in the same way that the brains of opiate and alcohol addicts glow when they are presented with their chosen drugs. The reaction is linked to the release of dopamine in the brain which is in turn associated with the reward system. In addition, ghrelin the hormone we usually produce in our stomachs when we need energy that stimulates hunger and the eating response, is also produced when we see or smell or even think of these high-fat, high-sugar foods.
The theory postulates that this hedonic hunger system was developed as a survival mechanism over aeons of feast and famine during human evolution. Because food was scarce for millennia, when energy-rich, calorie-laden foods suddenly became available (e.g. a successful mammoths hunt or finding a bee hive!), hedonic hunger made humans overeat so that we would have a store of energy tucked away in our fat depots for the lean and hungry times which dominated until about a century ago. Then alas, we became adept at controlling our food supply and famines were no longer the rule in certain areas of the globe. But our primitive neurological make-up which is probably closer to that of our hunter-gatherer ancestors than that of an astronaut, still drives us to overeat when we are faced by these survival foods.
Dutch reaction
Lawmakers in the Netherlands have called for legislation to force sweetened drinks to carry health warnings that sugar is ‘highly addictive and dangerous’ (Daily Telegraph, 2013). According to a front-page article in The Times, the head of health services in Amsterdam, Paul van der Velpen, said that “Just like alcohol and tobacco, sugar is actually a drug.” He went on to state that, “The use of sugar should be discouraged. And users should be made aware of the dangers.” This concern about a newly identified addictive substance in a city where dagga can be purchased legally, does make one wonder about the priorities of these Dutch lawmakers.
The obesity conundrum
While the addiction theories of food consumption are plausible, the suggestion that obesity is a food addiction as suggested by Dr Dickson, needs additional investigation. She argues that up to 20% of obese patients also suffer from binge eating disorder, but that people of normal weight also often suffer from this condition without gaining weight.
At this point Dr Dickson says that “The evidence itself is insufficient to support the idea that food addiction is a mental disorder.” I, for one, am relieved that although binge eating disorder has been included in the DSM-5 as a mental condition, binge eating obesity has not yet been classified as such. Although we are wired to react physiologically to signals from our nervous system and brain, obesity is such a complex condition which has its origins in multiple interwoven factors that I would not welcome this type of classification. On the one hand it would make life marginally easier for obese patients not to be judged as ‘weak and out of control’, but it could also be used as an excuse for overeating. “I can’t help gorging on fat and sugar because I have a mental illness!’
Opposing views
I was interested to read that Dr Hans-Ulrich Wittchen, who acted as session moderator at the above mentioned Congress in Barcelona, cautioned the delegates that trying to classify some types of obesity as an addiction due to a mental illness, was “premature. “ As one of the individuals who was responsible for the development of DMS-5, Dr Wittchen from the Institute of Clinical Psychology and Psychotherapy of the Technical University of Dresden, Germany, said that it is difficult to say if certain food components actually do create some disturbance in the brain that would justify classifying them as addictive. He also disputes the claim that the supposed reaction of the brain to high-fat and high-sugar foods is a ‘brain disease’ (Brauser, 2013).
A word of caution
I have always believed that moderation in all things is the golden rule and that also applies to witch hunts of certain foods, knee-jerk reactions to dramatic-sounding new research and trying to solve a global problem with multiple origins with one blanket solution. If we ban all high-energy foods, or force them to carry ‘health warnings’ and our population continues to suffer from obesity because of genetic factors or lack of physical exercise or poverty or lack of accessible healthy foods, then we may be doing our species a disservice. A many-pronged solution is required to solve a problem as great as the obesity epidemic here and globally and until more concrete evidence is produce by a large body of scientific research, I think the theories of food addiction and the classification of obesity as a mental illness should not yet be embraced as gospel until more research evidence is gathered.
Source - health24.com(References: Brauser D (2013). Is ‘Food Addiction’ real? http://www.medscape.com/article812650/; Daily Telegraph (2013). Sugar high too much for Dutch. The Times, Page 1, published on 18 September 2013; Hicks C (2013). Sugar’s secret power over the mind. Sunday Times, Page 17, published on 15 September 2013; Kaplan HI, Sadock BJ (1981). Modern Synopsis of Comprehensive Textbook of Psychiatry/III, 3rd Ed., Williams & Wilkins, Baltimore.)
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