Addictions

Food Addictions, Symptoms and Treatments

It’s becoming clear that people can become addicted to food in the same way that we can become addicted to drugs, alcohol, smoking and other substances. The difference that makes this a special case is that we have to eat to survive; we don’t have to drink, smoke or take drugs. That means that people who overeat cannot simply quit, they will be facing not only the desire, but the necessity of eating all their lives. It’s when this obsession gets out of hand that illness like anorexia nervosa and bulimia arise. This paper discusses food addictions/obsessions in general, then describes binge eating, bulimia, and anorexia, as well as the consequences of each, treatment options; it also discusses the epidemic of obesity in the U.S.
Food addiction is very real, but the reasons for it vary, just as the reasons for all other addictions vary from person to person. We start with an overview of food addiction, then move to the various types.
Overview of food addiction: Food addiction can drive a person just as hard as any addiction, if anecdotal evidence is to be believed. Her need for chocolate once drove Dana Littleton out in freezing weather: “l just couldn’t get through my day without chocolate, I’d be positively frenzied if I didn’t have it and feet calm and at ease when I did” (Eller, 2006, p. 170). When she ran out one day, she took her two children, a toddler and an infant, out in 20 degree cold to get Snickers bars (Eller, 2006). Littleton claims she was totally out of control: “I wasn’t even out of the parking lot before I had inhaled two candy bars” (Eller, 2006, p. 170). The reason for Littleton’s addiction appears to be the death of her father when she was very young; she used food to numb the pain (Eller, 2006). Her constant intake of chocolate—she ate it all day long—pushed her weight to 250 pounds; “her back and knees hurt, and she had chest pains” (Eller, 2006, p. 170). People would tell her she was lucky not to have had a “serious” addiction, such as one to drugs or alcohol, and her response is to tell them her food addiction was serious (Eller, 2006).
Many scientists now believe that people do in fact have addictions to food, though some remain skeptical. However, recent “high-tech medical exams have revealed surprising similarities in the brain chemistry of drug addicts and chronic overeaters–resemblances that have caught the attention of the National Institute on Drug Abuse” (Eller, 2006, p. 170). There appears to be a link between compulsive overeating and compulsive drug taking, which lends credence to the idea that overeaters might be addicted to food, and not, as some would insist, simply people with no willpower (Eller, 2006). Other things indicate an addiction because the behaviors of “compulsive overeaters” often mirror those of addicts: “the cravings and preoccupation with food, the guilt, the way these overeaters use food to relieve bad feelings, and the fact that binges are frequently conducted at night or in secret” (Eller, 2006, p. 170). Some experts are now speculating that food addictions may be responsible, at least in part, for the rising number of obese persons in the U.S. (Eller, 2006).
Mark Gold, chief of addiction medicine at the University of Florida College of Medicine suggests that one way to determine if food is an addiction is to use some of the same questions used when considering drugs, such as “’Do you continue to use the substance despite its negative effects?’ or ‘Do you have a preference for more refined substances?’–and then replace substance with food” (Eller, 2006, p. 170). When we do that, it’s easy to see that food addictions do exist (Eller, 2006). No one is suggesting that food addictions are as strong as those to heroin or cocaine, but they are still serious; Littleton (above) suffered from physical problems because of her weight, and that was due to her chocolate addiction.
It also appears that food addicts’ brains may be “wired” differently from people of normal weight. In 2001, Gene-Jack Wang of Brookhaven and his colleagues compared brain scans of normal-weight and obese volunteers, and found that the obese had fewer dopamine receptors; in fact, the heavier they were, the fewer receptors they had (Eller, 2006). Dopamine, put simply, is the chemical that is associated with pleasure (the thing that makes us go “aah,” says Wang) (Eller, 2006). If the obese have fewer dopamine receptors, they will not respond as quickly or as intensely as normal weight people to the things that normally bring pleasure and “ought to make them feel good” (Eller, 2006, p. 170). That could be why they overeat: they need to consume more of the things that make them feel good than normal people do; that is, it takes more to satisfy them than it would if they weighed less and had more receptors (Eller, 2006). Says one researcher, “If you have someone who is not responsive to natural reinforcers, that person may be more vulnerable to taking drugs … If you get stimulated only by food, guess what happens? You can easily fall into patterns of compulsive eating” (Eller, 2006, p. 170).
Compulsive overeaters are much like other addicts; their habit has taken over (Eller, 2006). “Like the alcoholic who continues to drink despite seeing her life crumbling around her, the overeater will consume food to the detriment of her social and family life” (Eller, 2006, p. 170). The overeater may be well aware that her disorder is harmful to her health, but she doesn’t care (Eller, 2006). One addict likens her experiences with food to an alcoholic on a bender: “I actually passed out once … It was a total binge, with a gallon of ice cream, cookies, candy bars” (Eller, 2006, p. 170). This person eats to keep her emotions in check, which is often a cause in many eating disorders; but is having trouble with her addiction: if there’s food in the house “it calls my name” (Eller, 2006, p. 170). Like drug addicts who can’t stop until all the coke is gone, food addicts can’t stop until everything is consumed (Eller, 2006). While some people say that’s what they do on Thanksgiving, the difference is that food addicts “do this all the time” (Eller, 2006, p. 170).
So, it appears that food addiction is an eating disorder that is real, serious, and one contributing factor to the epidemic of obesity in the U.S. Now we’ll turn to some of the other disorders, which are now very well known.
Binge eating: We’ve already seen this mentioned in connection with the Eller article: the woman who binged on ice cream, cookies and candy bars. Binge eating is just that: going on a binge. Binge eating or compulsive eating is “probably the most common eating disorder” (Binge eating disorder, 2008). As noted above, most people overeat occasionally, but binge eaters are characterized by certain behaviors: they “eat more quickly than usual during binge episodes”; they eat “until they are uncomfortably full”; they eat a great deal of food even though they may not even be hungry; they usually eat alone “because they are embarrassed about the amount … they eat”; and they feel guilty, disgusted or depressed after they are finished overeating” (Binge eating disorder, 2008).
Approximately 2% of all U.S. adults are binge eaters, and perhaps as many as 10-15% of people “who are mildly obese and who try to lose weight on their own or through commercial weight-loss programs have binge eating disorder” (Binge eating disorder, 2008). Binge eating disorder is slightly more common in women than men; but affects blacks and whites equally (Binge eating disorder, 2008). No one is certain what causes the disorder, but it is likely that one cause is depression, which affects more than half of those with the condition (Binge eating disorder, 2008). However, it’s not known if depression causes the disorder, or if the disorder brings on the depression (Binge eating disorder, 2008). There are also theories that people may choose to handle their emotions through this mechanism, which is common with other eating disorders (Binge eating disorder, 2008).
People who binge are setting themselves up for other complications including depression (brought on by the dislike of themselves for their behavior); and obesity (Binge eating disorder, 2008). Weight gain brings another whole set of complications with it, including the potential of developing type 2 diabetes, “high blood pressure, high blood cholesterol levels, gallbladder disease, heart disease and certain types of cancer” (Binge eating disorder, 2008).
Binge eating disorder is an emotional and psychological illness, so help has to come from people in these fields, such as a “psychiatrist, psychologist, or clinical social worker” (Binge eating disorder, 2008). There are several treatments for the disorder including “cognitive-behavioral therapy” that teaches the sufferer “how to keep track of their eating and change their unhealthy eating habits … how to change the way they act … and … helps them feel better about their body shape and weight” (Binge eating disorder, 2008). A second technique is “interpersonal psychotherapy,” in which the binge eater looks at his relationships with family and friends and makes changes where necessary to solve problems (Binge eating disorder, 2008). Finally, there are some people who will be helped by drug therapy; some by exercise; and others by combinations of therapeutic treatments (Binge eating disorder, 2008). The point is that people who suffer from binging can be helped. They apparently have a much better prognosis than people with other disorders such as bulimia and anorexia.
Anorexia Nervosa: Anorexia nervosa, usually called anorexia, is an eating disorder but also a psychological complaint in which an individual expresses their desire to manifest control over their body by greatly restricting their food intake (Stöppler, 2007). That is, they feel that by dieting they can create a “sense of control over the body (Stöppler, 2007). They soon become obsessed with weight loss and their fears and concerns manifest in the obsessive need to lose even more weight to maintain control; and the pattern becomes cyclical (Stöppler, 2007). Anorexia is more likely to strike young people than older people; women more often than men; whites more often than blacks; and higher income people more often than lower income (Stöppler, 2007). The National Institute of Mental Health estimates that “0.5% to 3.7% of women will suffer from this disorder at some point in their lives” (Stöppler, 2007).
Like the other eating disorders, there has been no definitive cause pinpointed for anorexia, but some experts think that societal pressures may be responsible, at least in part (Stöppler, 2007). Society tells people, young women in particular, that they must be thin to be attractive, and if they internalize this message they may become anorexic (Stöppler, 2007). Low self-esteem and poor self-image exacerbate the problem (Stöppler, 2007). Other studies suggest that a dysfunctional family, in which members cannot achieve independence from one another, may be one of the causes of the disorder (Stöppler, 2007).
The most visible symptom of the disease is the unhealthy weight loss, but there are a great many other signs, both behavioral and psychological. Significant weight loss can lead to “depression and social withdrawal,” irritability and problems with social interaction (Stöppler, 2007). They may suffer from sleep disorders; be unable to concentrate or pay attention in class; become obsessed with food (though not to eat it but to ritualize it); and have mood swings, anxiety and develop personality disorders (Stöppler, 2007). Physical symptoms are even more alarming and most are related to starvation, which is basically what the anorexic is doing (Stöppler, 2007). These symptoms can include an “abnormally slow heart rate (bradycardia) and unusually low blood pressure (hypotension),” both of which are of minimal importance; but starvation can also cause heart arrhythmia, which can be serious (Stöppler, 2007). Because the anorexic is so dramatically impacting their digestive processes by starvation and/or purging, gastrointestinal complications can result including constipation, abdominal pain, and liver damage (Stöppler, 2007).
Other systems are damaged as well, including the endocrine system: “The complex physical and chemical processes involved in the maintenance of life can be disrupted, with serious consequences” (Stöppler, 2007). Anorexic women may disturb their menses, which will impact their fertility as well as bone density, which is “very important to a woman’s health as she ages” (Stöppler, 2007). Kidney damage may also occur, and anorexics who use laxatives to purge or induce vomiting may throw their electrolytes out of balance, a very serious condition which can be life-threatening (Stöppler, 2007). Anorexics are often anemic, and they may have other physical signs such as yellowish skin, fine hair growth on the body, and tooth loss due to erosion of dental enamel by stomach acid (Stöppler, 2007).
Anorexia is difficult to diagnose because anorexics are secretive about their behavior; even worse, they often refuse to believe that they have a problem (Stöppler, 2007). Once an anorexic does see a professional, she is likely in such a state that the information she gives is unreliable, so the doctor will have to talk to the family to evaluate the situation (Stöppler, 2007). There are four basic criteria that have to be met to “label” someone anorexic: they refuse to gain body weight; they have an “intense fear of gaining weight or becoming fat,” despite the fact that they’re severely underweight; they have a grossly distorted body image; and menstruating women must have missed three consecutive periods (Stöppler, 2007).
Anorexia requires psychiatric treatment to discover the underlying cause of the behavior and unfortunately, the disease has a poor prognosis (Stöppler, 2007). It is the eating disorder with the highest mortality rate, “with an estimated 6% of anorexia victims dying from complications of the disease” (Stöppler, 2007). Treatment options include individual therapy, “cognitive behavior therapy, group therapy, and family therapy” conducted by a clinical psychologist, a medical doctor or both (Stöppler, 2007). With appropriate treatment “about half of those affected will make a full recovery” (Stöppler, 2007). The other half have varying degrees of success in their struggle: some gain weight and then relapse, in effect establishing a “yo-yo” pattern while others “experience a progressively deteriorating course of the illness over many years and still others never fully recover. It is estimated that about 20% of people with anorexia remain chronically ill from the condition” (Stöppler, 2007).
Bulimia: Bulimics are similar to anorexics in many ways, so we’ll concentrate on the differences. Bulimics by definition also purge (vomit or use laxatives), something anorexics may do but do not always do (Stöppler, 2006). In addition, bulimics “experience significant weight fluctuations,” but their changes in weight are “usually not as severe or obvious as anorexics” (Stöppler, 2006). The prognosis for bulimics is “slightly better” than for anorexics (Stöppler, 2006).
Like anorexia, bulimia is a “secret” disease of which the sufferer is greatly ashamed (Stöppler, 2006). The binge eating that precedes a purge is not caused by hunger but by stress, depression or “other feelings related to body weight, shape, or food” (Stöppler, 2006). The bulimic often feels euphoric during and immediately after eating, but then feelings of self-loathing arise; the sufferer feels that he has lost control during the binge and seeks to regain that control over the body by purging (Stöppler, 2006). While bulimics often induce vomiting or use laxatives, some may fast or resort to “excessive exercise” to get rid of the weight they fear they gained during the binge (Stöppler, 2006).
As with anorexia, there is no definitive cause for bulimia, but it is generally felt that bulimics experience a great dissatisfaction with their own body, and have a distorted view of it (Stöppler, 2006). When the bulimic looks in the mirror they don’t see the real image but an image they have created in their mind, which of course is larger than they really are (Stöppler, 2006). They start dieting because they feel “fat,” and then the cycle begins.
Like anorexia, bulimia has certain specific criteria that must be met in order for the condition to be labeled as bulimia. First, there must be “recurrent episodes of binge eating”; second, there must be a feeling of lack of control over the eating; and third, there must be “accompanying inappropriate compensatory behavior … to prevent weight gain” (Stöppler, 2006). Fourth, both the binge eating and compensatory behaviors “must occur at least two times per week for three months and must not occur exclusively during episodes of anorexia” and finally, the behavior must be “unduly influenced by body image” (Stöppler, 2006).
Complications from bulimia include tooth loss from damage to enamel from stomach acid as well as damage to the esophagus and colon (Stöppler, 2006). There can be systemic complications as well, such as edema; compromised elimination by overuse of laxatives; and electrolytic imbalance, which can be life threatening (Stöppler, 2006). Like anorexia, bulimia is both a physical and emotional condition requiring both a doctor and psychologist/psychiatrist (Stöppler, 2006). “The extent of the medical complications generally dictates the primary treatment manager. A psychiatrist, with both medical and psychological training, is perhaps the optimum treatment manager” (Stöppler, 2006). Antidepressants may help in these cases, and some patients do well with “weekly counseling and monitoring by a practitioner” (Stöppler, 2006). The goal of the treatment is to “restore physical health and normal eating patterns” (Stöppler, 2006).
Obesity in the U.S.: Obesity is a problem not only in the U.S. but worldwide. It can lead to heart disease, breast and colon cancer, stroke, diabetes and other complications (Brown, 2000). In the U.S., the CDC estimates “that 300,000 Americans now die each year from obesity-related illnesses” (Brown, 2000). Brown argues that while most experts think first of lowering caloric intake as a means of combating weight gain, “there is growing evidence that exercise deprivation is also a major contributor to obesity” (Brown, 2000). The human has four million years of hunter-gatherer experience behind him, and people “may not be able to maintain a healthy body weight without regular exercise” (Brown, 2000).
Also, for the “first time in history, a majority of adults in some societies are overweight. In the United States, 61 percent of all adults are overweight” (Brown, 2000). The figure is 54% in Russia, 50% in Germany and 51% in the U.K. (Brown, 2000). In Europe, over half those between the ages of 35 and 65 are overweight (Brown, 2000). Not only are more people overweight, but they are getting fatter faster than ever before; and children are becoming obese as well (Brown, 2000).
Our sedentary lifestyle is one important factor in the obesity epidemic, and since most people try to lose weight by dieting alone, they are doomed to fail, since “this is physiologically difficult given the abnormally low calorie use associated with our sedentary lifestyles” (Brown, 2000). Exercise of some kind must be part of a weight control program. Other suggestions on how to fight this problem include having the federal government design a national strategy to help combat obesity (Segal and Goodman, 2007). The plan should involve “every federal government agency, define clear roles and responsibilities for states and localities and engage private industry and community groups” (Segal and Goodman, 2007).
Second, it should be easier to make better choices (Segal and Goodman, 2007). Government at all levels should devise and put policies in place that make it easier for all Americans to do the things they need to do to remain healthy (Segal and Goodman, 2007). That includes making it easier to engage in physical activity, and providing easier to understand information about nutritional content of foods served in restaurants and available in stores (Segal and Goodman, 2007). There should be wellness programs in place at all businesses, and there should be further research on how to make good choices (Segal and Goodman, 2007). If these suggestions were implemented, we would be making progress toward beating the obesity epidemic.
Conclusion
Eating disorders, the obesity epidemic, and unhealthy Americans, both adults and children, seem to go hand in hand. Given the fact that these conditions are serious, we should become equally serious about finding ways to solve these problems.

REFERENCES

Binge eating disorder. (2008). Retrieved March 2, 2008 from http://www.medicinenet.com/binge_eating_disorder/article.htm
Brown, L.R. (2000). Obesity epidemic threatens health in exercise-deprived societies. Retrieved March 2, 2008 from http://www.earth-policy.org/Alerts/Alert11.htm
Eller, D. (2006). Are you addicted to food? Prevention, 58, 170-189.
Segal, L. & Goodman, E. (2007). New report finds U.S. obesity epidemic continues to grow; Mississippi tops list for adults; D.C. for youths. Retrieved March 3, 2008 from http://healthyamericans.org/newsroom/releases/release082707.pdf
Stöppler, M.C. (2007). Anorexia nervosa. Retrieved March 2, 2008 from http://www.medicinenet.com/anorexia_nervosa/article.htm
Stöppler, M.C. (2006). Bulimia. Retrieved March 2, 2008 from http://www.medicinenet.com/bulimia/article.htm