FOOD AND ADDICTION – SUGARS, FATS AND HEDONIC OVEREATING

Abstract

‘Food addiction’ has been postulated as one possible cause of the obesity epidemic [1–4]. This has been a controversial topic, with many wondering whether it is appropriate or even reasonable to categorize food, which is something we all need to consume in order to survive, with drugs of abuse, which are generally considered along with other ‘natural reinforcers’ such as sex, to be very different from gambling, alcohol and illicit drugs. However, there has been mounting evidence that supports the idea of ‘food addiction’. Preclinical studies, beginning in Bart Hoebel's laboratory at Princeton University, have shown that rats overeating a sugar solution develop many behaviors and changes in the brain that are similar to the effects of some drugs of abuse [5,6], including naloxone-precipitated withdrawal [7], and others have shown complementary findings that suggest reward dysfunction associated with addiction in rats that overeat highly palatable foods [8]. These studies are supported by clinical research showing similarities in the effects of increased body weight or obesity and abused drugs on brain dopamine systems, as well as the manifestation of behaviors indicative of addiction [9–12]. Gearhardt and colleagues [13] ask the next important question in furthering our understanding of ‘food addiction’: if food addiction is real, what should we do about it? Drawing on examples from what we have learned from efforts to reduce tobacco use, the authors discuss potential approaches to reduce excessive intake of ‘hyperpalatable’ foods that contribute to obesity. Advertising, availability, public health and cost-related measures are discussed, each of which has proved successful with tobacco and alcohol. If these policy measures could similarly reduce the incidence of obesity and its concomitant threats to health and wellbeing, it would be of great importance, as the damaging effects of obesity are even more widespread than those of tobacco. Gearhardt et al. address the need for additional research to understand the effects that specific components of ‘hyperpalatable’ foods have on the development of addiction. Indeed, it is important for researchers to refine the terminology associated with the study of ‘food addiction’. Clearly, not all foods would be candidates for addiction: Gearhardt et al. argue that ‘hyperpalatable’ foods rich in fats, sugars and/or salts, which are often comprised of synthetic combinations of many ingredients, may have greater addictive potential than traditional foods such as fruits, vegetables and lean protein. We know from studies of feeding behavior that different nutrients can affect specific brain neuropeptide and neurotransmitter systems [14,15]. Further, preclinical studies suggest that overeating sugar produces different addiction-like behaviors compared with overeating fat [5]. There is also a nutrient specificity in the effect that some pharmacological treatments have on reducing overeating [16,17]. Thus, additional knowledge of how different food elements activate brain systems that affect addiction-like behavior will be crucial to developing targeted interventions for people who exhibit signs of ‘food addiction’. Further, pharmacotherapies may be aimed at reducing resultant reinforcing effects of ‘hyperpalatable’ foods, rather than hunger or eating behavior per se. This may give rise to a treatment paradigm in which the reduction of body mass may depend on reducing reinforcement and attachment for certain foods. In conclusion, Gearhardt et al. have taken a controversial, yet important and emerging line of research and brought it to the forefront for us to consider on a more global level. While ‘food addiction’ certainly does not explain all obesity, it seems that the overwhelming interest that many individuals have in eating, for reasons other than energy intake, suggest that it is no longer only for survival. With the soaring number of individuals affected by obesity, many whom are children, we need to begin to consider alternatives to traditional efforts for combating this often deadly and costly condition. Perhaps ‘food addiction’ will soon join other non-drug addictions, such as sexual compulsivity and gambling. None.

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