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Food and Eating Addictions May Not Be the Same



As my regular readers know, this week, I am attending a Scientific Symposium called “Recovery From Addiction“, organised as part of the Alberta Family Wellness Initiative of the Norlien Foundation.

Anyone familiar with addictions is well aware of the discussions in this field about harm reduction (or controlled use) versus abstinence. In people where obesity is a consequence of an addiction, abstinence of course is not an option. Thus, the default in weight management is harm reduction.

Obviously, this does not make obesity management any easier. In alcohol dependence, abstinence is an option – no one would try to manage their alcohol addiction with a “drinking plan”. But in “food-addiction”, clients are often presented with and are expected to follow “diet plans”. When they fail to stick with these “plans”, they are simply labelled as non-compliant and often discharged from these programs.

In addition, it appear to me that “compulsive overeating” is perhaps as often a “process” addiction as it can be a “substance” addiction.

Readers may be aware that a process addiction is an addiction to an activity or process, such as eating, spending money, gambling, or working too much rather than an identifiable agent or substance. Unfortunately, these addictive behaviors can be as debilitating as those associated with substance addictions.

However, while with substance addictions, clients can be expected to simply give up or reduce use of the substance and can be monitored for compliance, process addictions provide much of their reward from the behaviour itself.

Sometimes, these behavioural patterns of process addictions can be transferred to other seeminlyg unrelated activities. Thus, as one speaker presented at this conference, people with gambling addictions, can get the same “reward” from running a yellow light, people with shopping addictions, an get hooked on the simple act of trying to find bargains or comparing prices. Thus, “eating addicts” can get “addicted” to the process of fantasizing about, finding, buying, preparing, and eating food – it may not be one food that they are addicted to, because their addiction it to the processes around acquiring food and eating it and not to a particular food or food group.

This adds a level of complexity to applying an addiction model to obesity, that may not be quite appreciated by the people who pass out the well-meant but useless “eat-less-move-more” (ELMM) mantra.

Indeed, it appears that applying an addiction model to obesity requires a level of sophistication that may well surpass what is normally provided in weight-loss programs.

Overall, I was fascinated by the many things I learnt at this addiction conference – the similarities between many of the issues relevant to treating addictions and obesity are striking and I must admit, often blindingly obvious.

My advice to anyone in the business of weight management – read and familiarize yourself with the addiction literature and embrace treatments that have worked in addictions (including relapse prevention) into your practice (and I mean more than just embracing motivational interviewing).

Hoping that someone, who meets the criteria for food (=substance) or eating (=process) addiction will change their behaviour simply by teaching them about healthy eating, is just as futile as hoping that a crack addict will stop using after attending a seminar on the dangers of crack use.

AMS
Banff, Alberta

10 Comments

  1. Dr Sharma,
    Your observations are very interesting. Dealing with intervention really needs to be on an individual basis. Dealing with addiction is a very personal thing. You are so right about needing to learn about this process.
    Understanding the complexity of obesity management is as important as it is treating the obesity problem. Trying to find the “one size fits all” solution is so outdated as to make the “eat less move more” syndrome seem brand new.
    Thanks for your thoughts.
    Pierre Trudel
    theequest.com

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  2. “Anyone familiar with addictions is well aware of the discussions in this field about harm reduction (or controlled use) versus abstinence. In people where obesity is a consequence of an addiction, abstinence of course is not an option. Thus, the default in weight management is harm reduction.”

    But abstinence is an option. I abstain from sugar in all forms, processed grains, and manufactured oils. This reduced my weight without hunger.

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  3. I think you have hit the nail on the head, Dr. Sharma. This is yet another example of how much obesity and overeating are disorders of the brain, not just the stomach. Unfortunately, it appears we still have a long way to go on figuring out how to fix this problem in the brain…

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  4. All addictions are process addictions. Heroine addicts may have a more violent physical reactions in withdrawl or craving, but the thought process of choice is likely very similar. The cognitive behavior model in addictive behavior works best in my clinics. Many people with food addictions use drugs as a comparason saying things like, “At least alcoholics can just avoid alcohol”. Addicts who get healthy make a choice every day all day. We ‘move away” from unhealthy behaviors when we make healthy choices. Obese needs to think the same way. How many times have i heard, “if I eat one, I will eat the whole bag”. Abstinence and discipline are key in moderate weight therapy. I’m addicted to your blog Sharma, no harm there thank goodness!

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  5. Thank you so much for this post. I am a weight management coach — many of my clients are referred by physicians. I always ask clients what food(s) they feel they cannot give up or unwilling to live without. Even if they say chocolate, pasta, or bread (I find these to be three very common responses), I find that when we explore their eating behaviors the unwillingness is not just the thought of giving up (which I don’t counsel) or limiting the food but the act of choosing/buying/preparing/eating it. Clearly substance and process — and heavily weighted toward process.

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  6. I enjoyed our brief exchange in Banff and hearing your insights into the psychological and relational underpinnings and ramifications of obesity! Not all physicians are sensitive to how health is a mutli-dimensional phenomenon. Physical, psychological, relational, spiritual, environment factors are inextricably linked. We would be amiss to consider obsesity as only a physical/physiological issue.

    Whether a process or behaviour is considered an addiction, we must assess it along a continuum — commonly known as the 3 C’s — craving, compulsivity, and adverse consequences. These manifestations can migrate over time, hence addiction can be a slippery slope.

    So my guess is eating/food addiction can be also be gauged along a continuum, and not everyone who overeats or is overweight is necessarily a “food addict.”

    I would love to explore with you further the psychological and relationship aspects of obesity. Please get in touch!

    Bonnie

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  7. Hi there,

    I am very thankful to see that there is getting to be an understanding of the problem of excessive food intake whether it be process, addiction, or a bit of both. That health providers will be encouraged to look beyond simply handing out a diet to the compulsive eater is a major step in the right direction. Its not like over eaters like myself want to be fat; rather, we get to a point that we have tried so many diets, with or without exercise, that we don’t believe we actually can lose weight. Also we are afraid that if we actually do that it will come back and then some. I think that what we really need most of is understanding. Also, I think a big part of what we need is to be helped with where to channel the energy (addictive/process behaviour) that we will no longer be putting into eating. It has become such an ingrained part of our day to day life, that we need some sort of retraining not only in what to eat, but how to live without “using” food to cope.

    I am sincerely grateful for your blog,

    Rosemary Dinsdale

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  8. I have been following your discussion of the addiction conference with much interest. I have lost weight over the last year by calorie counting, moving from BMI 27-22 over several months, and started reading your site during this process. Another internet forum I follow closely is the Three Fat Chicks site, which hosts discussion forums for a variety of weight-loss and exercise topics. One comment that crops up very often on the boards there is an individual’s concern that they have become too “obsessed” with losing weight, and the activities connected with it — meal planning, seeking out and shopping for foods appropriate to their respective diets (vegetables, organic, high fiber etc) and/or exercise, and that it has become too all-consuming in their lives. These are normally not people who are underweight — at least according to their stated weights — but still wonder if their behavior falls under healthy “dedication” or unhealthy “obsession”. Yet these people often are quite successful in losing weight, and I wonder whether the link is that they have been able to re-steer an interest in food/eating/cooking slightly, from one leading to overconsumption, more toward loss and eventual maintenance. I feel a bit like this has happened to me; where I once might have been excited about trying out a new brownie recipe, now I am spending an equivalent amount of time working to perfect a whole-grain-rye loaf or experimenting with different ways to prepare vegetables. One does worry though, whether this is “normal” or not … But at the same time there are plenty of communities of ‘foodies” out there whose interests are regarded as trendy rather than unhealthy.

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  9. This topic strikes a familiar chord. My 1st encounter with weight watchers turned me into an obsessive neurotic; my youthful energy helped with all the planning shopping cooking trying of new recipes and exercising and compensated somewhat for ADD. My addictive processes served me well; exercising sometimes up to 3 times/day (30 min.) at a time and it wasnt long before I reached my goal weight. I also became addicted to the positive attention and encouragement I received along the way which disappeared as everyone got used to my new look. Tired of feeling deprived I began to reward myself with old favorite food treats as well as shopping treats which tended to be impulsive and often later returned. Addictive processes at play in my work were transferred to reviewing weekly flyers to find the best deals shopping on-line and addiction to a silly computer game wasting countless hrs. I need CBT in the worst way as my ADD is only mildly helped by medication. I feel desperate to lose lbs without the corresponding ability to make it happen. Does your clinic do laporoscopic banding and would this be an appropriate option for me? Thankyou for your much needed work in this area.
    Kay

    u

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  10. Many people find help in Food Addicts in Recovery Anonymous. Some of us have been diagnosed as morbidly obese while others are undereaters. Among us are those who were severely bulimic, who have harmed themselves with compulsive exercise, or whose quality of life was impaired by constant obsession with food or weight. We tend to be people who, in the long-term, have failed at every solution we tried, including therapy, support groups, diets, fasting, exercise, and in-patient treatment programs.

    FA has over 500 meetings throughout the United States in large and small cities such as Boston, San Francisco, Los Angeles, New York, Charlotte, Grand Rapids, Atlanta, Fort Lauderdale, Austin, and Washington, D.C. Internationally, FA currently has groups in England, Canada, Germany, New Zealand and Australia. If you would like more information about FA, please check out our website. If there aren’t any meetings in your area, you can contact the office by emailing fa at foodaddicts dot org, where someone will help you.

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