Sunday, August 15, 2004

Just as federal health officials defined obesity as an illness, researchers at the University of Florida say mounting evidence suggests chronic overeating may be a substance abuse disorder and should be considered an addiction.

“What’s the difference between someone who’s lost control over alcohol and someone who’s lost control over good food? When you look at their brains and brain responses, the differences are not very significant,” said Dr. Mark Gold, chief of addiction medicine at UF’s College of Medicine.

Dr. Gold, also a professor of psychiatry at the school’s McKnight Brain Institute, was co-author of three studies published in a recent issue of the Journal of Addictive Diseases that linked overeating, obesity and addiction.

Publication of the studies came as Health and Human Services Secretary Tommy G. Thompson announced that obesity, the second most common cause of death in the country, qualifies as an illness that’s covered by Medicare, the federal health insurance program for the elderly and disabled.

“We’ve taken the position that overeating is, in part, due to food becoming more refined, more palatable, more hedonic. Food might be the substance in a substance abuse disorder that we see today as obesity,” Dr. Gold said.

Sixty-four percent of the U.S. population is overweight or obese, according to the federal Centers for Disease Control and Prevention (CDC). Obesity increases the risk of heart disease, stroke, diabetes, hypertension and sleep apnea, and it contributes to 400,000 deaths annually, the Atlanta agency reports.

Dr. Gold was an early proponent of the “food-as-drug” model. The medical community considered the idea radical a decade ago, he said, but many addiction specialists give it serious consideration today.

He said the change in thinking occurred as a result of advances in imaging technology, neurochemistry and other fields that have enabled researchers to map rodents’ brain pathways and show how food and drugs evoke similar responses.

At the same time, he and other clinical researchers have been investigating the relationship between food-seeking and drug-seeking behaviors in humans.

According to one of the reports, treatment for drug or alcohol addiction may be more successful if it includes a plan for a healthy diet and physical exercise. Those mechanisms are the two most effective for weight loss.

A review of 75 teenagers undergoing long-term residential drug treatment showed that they gained an average of 11 pounds during the first 60 days. Researchers think the teens were eating more to compensate for the loss of brain stimulation when their drug use ended. The patients were monitored with urine tests to ensure that they remained drug-free during treatment.

“The finding has the implication that … if the drugs are there, eating goes away; if drugs are gone, eating increases,” Dr. Gold said.

More supportive data for that hypothesis came from another UF study in the journal that examined obesity and self-reported alcohol use in female patients undergoing weight-loss therapy. Dr. William Jacobs, another UF addiction specialist, reviewed the files of 300 women, ages 16 to 79.

That study found that the more obese the patient, the less likely she was to drink alcohol.

Dr. Jacobs said: “The impression that a lot of folks have, including health-care providers, is that obese patients sit around and drink; that’s part of the reason they are obese. And this [study] has shown exactly the opposite. Eating is probably competing and substituting for alcohol in the reward pathways in these patients.”

He added that further research could help scientists find out which patients would benefit from being treated as food addicts. He noted that some people overeat because they suffer from underlying conditions such as depression and diabetes, and successful treatment of the underlying cause may reduce their food intake.

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