Food is essential for
life, so how can you
have food addiction?
NZ Food Addiction Symposium
Christchurch, 6 September 2013
Prof Doug Sellman
National Addiction Centre
University of Otago, Christchurch
Acknowledgements
• Ria Schroder
• Daryle Deering
• Jane Elmslie
• Frances Carter
• Jim Mann
• David Schroeder
• 25 fellow travellers
Journey out of skepticism
1. My own experience of weight loss
2. The stories of 25 fellow travellers
3. Growing scientific evidence for
“food addiction”
Public attitudes about
addiction as a cause of obesity
Colleen Barry (2012)
•
Large random sample of news articles in the
US about childhood obesity 2000 – 2009
•
53% of the news stories identified individual
behaviour (parent and/or child) as a cause
•
Only 1% mentioned food addiction as a
possible cause
From the front lines
Philip Werdell (2012)
• Has worked with over 4000 “late-stage food
addicts” since 1986
• Recently developed the Food Addiction
Institute in Sarasota, Florida
• “[In my experience] most doctors, dieticians
and therapists discount or minimize chemical
dependency on food”
Can an obese compulsive
overeater get treatment in NZ?
• Survey of:
21 addiction services
20 eating disorder services
• July/August 2012
• Services rung by a fake inquirer
– a sister of a person who has a weight problem
• Auckland, Wellington, Christchurch
Whangarei to Dunedin, Greymouth to Gisborne
Hullo, my name is Natalie Smith and I'm
ringing up on behalf of my sister Shiree.
The problem is that Shiree is about 110kg in weight
…and seems to have an addiction to food. She
doesn't have any other addictions as far as I know
…and seems to have an eating disorder. She doesn't binge
or purge as far as I know and has never been anorexic.
She just compulsively eats food.
I really want to find out what help your service can give
her or where to go for help.
Addiction Service
Findings
• 4 of the 21 services not surveyed
• Of the 17 services surveyed:
- 2 said yes, come for an assessment
- 6 declared it was an eating disorder
- 7 advised Overeaters Anonymous
- 10 advised GP consultation
(12%)
(35%)
(41%)
(59%)
Not us
- “We don’t deal with eating disorders, first
place to go is to your GP who will refer you on
to an appropriate service like a dietitian and an
exercise regime”
- “It’s really an eating disorder so you’ll need to
go to your GP and get a list of people who deal
with eating disorders or get a referral for
counselling”
Come for an assessment
- “Food addiction is similar to other
addictions so it would be appropriate to
come in for an assessment” (large city)
- “Not a normal focus for us but as it is an
addiction there is no reason we couldn’t
work with her” (small city)
Eating Disorder Service
Findings
• 3 of the 20 services not surveyed
• Of the 17 services surveyed:
- 1 said yes, come for an assessment
- 0 declared it was a food addiction
- 4 advised Overeaters Anonymous
- 12 advised GP consultation
(6%)
(0%)
(24%)
(71%)
Come for an assessment
- “We’re happy to help with overeating as
well as undereating, just come in for an
assessment” (small city)
Not us
- “You will be horrified to hear this, but as an
eating disorder service we only treat people with
undereating problems”
- “Obesity is not considered an eating disorder and
therefore we are not funded to work in that area”
- “Overeating is an eating disorder but its not in the
DSMIV… there’s a possibility in the new DSM so
we may be able to cater for it then”
- “We could see her if she had underlying
psychological issues”
Main points from both surveys
• Less than 10% of either addiction or
eating disorder services said yes to an
assessment (of a morbidly obese person
with out-of-control overeating)
• 28% advised OA
• 55% advised a GP consultation
BMI
< 18.5
18.5 – 24
25 – 29
30 – 34
35 – 39
> 40
underweight
normal weight
overweight
obese
clinically obese
morbidly obese
Percentage of overweight people
in the Anglosphere
United States
New Zealand
Australia
United Kingdom
Canada
Ireland
74%
68%
67%
63%
61%
47%
Five Strategies
Take Control
Get Active
Eat Well
Persist
Enjoy Life
Adult Obesity in NZ
2008/09 Adult Nutrition Survey
• 28% of people 15+ years were obese
• 45% of Maori
• 58% of Pacific
• Increase in males from 17% in 1997
to
28% in 2008/09
• Increase in females from 21% in 1997
to
28% in 2008/09
Demographics
Variables
Age
Gender
Female
Ethnicity
Maori
Non-Maori
Mean Baseline Weight
n=25
48 years (34-63 years)
19 (76%)
13 (52%)
12 (48%)
106kg
% Weight Loss at Last Weigh in
(Up to 18 months)
Nestle
Aero Singles
“In the event of a chocolate cravIng,
please take care of your craving first
before helping others with theirs.
Remove bar. Bite to release bubbles.
Enjoy normally.
Be prepared! Ensure Aero Singles are
stowed In close proxImIty”
Food Addiction:
A Personal Story
Anne Rosenberg (2012)
Am I really and truly a “food addict?”
I am not a scientist and I am not too
concerned with the exact label.
But I do know I could not eat just one of
those Nestle Aero Singles. And I am not
alone. Nestle is banking on that!
What is addiction?
• From the Latin addictus devotion/attachment
• Outdated term of the 1950’s and 1960’s,
replaced by “dependence” in the 1970’s
• Currently undergoing a revival - good for
destigmatisation
“Nothing in biology
makes sense,
Except in the light of evolution”
Theodosius Dobzhansky, 1973
(1900 - 1975)
Charles Darwin
1809 -1882
“I have called this principle, by which
each slight variation, if useful, is preserved,
by the term Natural Selection.”
(from ‘The Origin of Species’)
Approximate Time Estimates

13.8 billion years ago – The Universe began

4.5 billion years ago – Earth began

3.5 billion years ago – Life on Earth began

2.5 billion years ago – Photosynthesis began

0.6 billion years ago – Adequate ozone layer

0.5 billion years ago – Abundant complex life
ERA
Cenozoic
(65 million - present)
PERIOD
Quaternary
EPOCH
Holocene
(10,000 - present)
Pleistocene
(1.8 million – 10,000)
Tertiary
Mesozoic
(248 - 65 million)
Cretaceous
Jurassic
Triassic
Paleozoic
(544 - 248 million)
Permian
Carboniferous
Devonian
Silurian
Ordovician
Cambrian
Pliocene
Miocene
Oligocene
Eocene
Paleocene
What is drug addiction?
George Koob (1947 - present)
A chronic relapsing disorder characterised by:
1. Compulsion to seek and take the drug
2. Loss of control in limiting intake
3. Emergence of a negative emotional state
(dysphoria, anxiety, irritability)
Inhibitory
Dysfunction
Drug
Use
Drug
Craving
Reward
Overdrive
NEURAL CIRCUITRY OF ADDICTION
(Hammer 2002)
• In non-hungry, non-thirsty rats,
sweetened water is more rewarding
than intravenous cocaine, independent
of prior cocaine history
• Most heroin dependent rats eventually
cut down heroin use to drink more
sweet water
Ahmed (2012)
Interaction between normal
regulation of food intake and
reward pathway
• The major anorexigenic hormones – leptin, insulin, PYY
(incentive modulation) - plus the single orexigenic
hormone, ghrelin, act on VTA dopaminergic system as
do “drugs of abuse” (Mason et al 2012)
• Many neuropeptides that regulate food intake and body
weight including proappetitive peptides orexin, ghrelin
and neuropeptide Y, as well as appetite suppressing
hormones - leptin and melanocortin – also shown to
regulate addictive behaviours (Dagher 2012)
Ghrelin
Orexin
Neuropeptide Y (NPY)
Mouse (on the left) unable to
produce leptin becomes obese
Leptin
Melanocortin
Insulin
Peptide YY (PYY)
• The increasing prevalence and impact of
obesity in our society and the urgent need to
develop better therapeutic interventions that
help mitigate the pathologically intense drive
for food consumption are clear.
• We have an opportunity in DSM-V to
recognize a component of obesity as a mental
disorder.
(Volkow & O’Brien, AJP 2007)
Alcohol addiction
Food addiction
How many people with
obesity have “food
addiction”?
Diagnosis of food addiction
based on
DSM-IV SUBSTANCE DEPENDENCE
1. Consumption is often more than intended (quantity or time)
2. Unsuccessful attempts to cut down or control consumption
3. Much time is spent in consumption (time +++)
4. Important activities given up or reduced
5. Continued consumption despite knowledge of associated
medical or psychological problems
6. Tolerance (acquired)
7. Withdrawal
How many people with obesity have
“food addiction” according to the
Yale Food Addiction Scale (YFAS)?
• YFAS validation study
• 67 weight loss surgery patients
• 63% female, 87% Caucasian
• Mean age of 43 years
How many people with obesity
have YFAS “food addiction”?
Use often more than intended
Failed attempts to reduce or stop use
Time+++
Giving up other important activities
Continued use despite
Tolerance
Withdrawal
22%
71%
24%
10%
28%
14%
16%
54% met YFAS criteria for food addiction
Behind every addiction
is an engineered
moreish product
Non-essential, energy-dense,
nutritionally-deficient (NEEDNT) foods
Dr Jane Elmslie
Dietitian - NAC
George Eman Vaillant, 1988
(1934 - present)
“What is needed is that addicts alter
their whole pattern of living”
Key elements of an addiction
approach to recovery
• Permanent lifestyle change
• Details unique for each individual
• Ongoing support and encouragement for at
least five years
• New food rules as “addiction interrupters”
A research-based
self-help obesity
recovery network
Kia Akina
“Be encouraged and supported”
vm840402
“Food can act on the brain as an addictive substance. Certain
constituents of food, sugar in particular, may hijack the brain
and override will, judgement and personal responsibility, and
in so doing create a public health menace.
The foods most likely to trigger an addictive process appear
to be those marketed most aggressively by industry, which
manipulates its products to maximize palatability”
Kelly Brownell & Mark Gold (2012)
“Food is the most available and
inexpensive drug around”
Elissa Epel, Janet Tomiyama, Mary Dallman
Stress and Reward – Neural Networks, Eating and Obesity (2012)