Is Obesity Like Alcoholism?

Regular readers will recall that last week I attended a scientific symposium on addictions.

One of the books I picked up at that conference, and read on my flight to Montreal yesterday, is A. J. Adams’ UNDRUNK: A Skeptic’s Guide to AA.

While this book is a very quick and highly readable introduction to AA (Alcoholics Anonymous), about which I knew very little, today’s post is NOT about this book.

Rather, it is about a definition of alcoholism that I came across in the book, which apparently is the WHO definition for this condition.

The definition reads as follows:

Alcoholism is a primary chronic disease with genetic, psycho-social and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol despite adverse consequences and distortions of thinking, mostly denial.

Let us look at this definition of alcoholism and see what aspects of it (if any) apply to obesity.

No doubt, as readers of these pages know, obesity is most definitely a chronic condition, whose development and manifestations are influenced by genetic, psycho-social and envrionmental factors. In some cases obesity may be more genetic, in others more psycho-social and sometimes purely environmental, but certainly, obesity would fit the bill as far as this statement goes.

And yes, obesity is often progressive and fatal. Most people, let alone those struggling with obesity, experience progressive weight gain over time. Sometimes periods of rapid weight gain are followed by periods of weight stability or even weight loss, but in the long term, no one with obesity would carry their excess weight had they not progressively gained it over time (and often continue to do so).

And yes, obesity is no doubt fatal. This may not seem as obvious as in the case of the alcoholic who dies of liver cirrhosis or totals his car (and himself) whilst DIU, but when you start looking at the many ways in which obesity can kill you, from heart attacks to cancer, there is no doubt that obesity is fatal (often after ruining most of your life first – another similarity to alcoholism).

Many of my patients would also be the first to admit that their weight problems stem directly from their continuous or periodic impaired control over their eating (or drinking of caloric beverages – including alcohol). This is not a moral judgement – whether their loss of control is genetic, psycho-social or simply a consequence of our obesogenic environment, it is still a loss of control. Were they able to control their intake of excess calories, they would obviously not have the problem.

And of course many people who struggle with excess weight are preoccupied with their drug (food). Whether they are thinking about their next meal, trying to suppress their cravings, planning their diet, feeling guilty about their last binge, hoping to find the strength to say no to that dessert or second helping, or simply giving in and longing for the comfort and satisfaction that they get from eating – no doubt food is on their mind – one way or another.

And all the obvious adverse consequences don’t seem to deter. I have yet to meet a patient who wants to be obese (even the patients, who admit that their excess weight protects them from unwanted attention). Even those, who do not relate their many health problems to their excess weight, cannot but help thinking how much easier life would be, would they not have to carry around their excess weight for the world to see, every single step and moment of their waking day (and interestingly, not just the waking day – given the profound effects of excess weight on sleep).

Finally, is it not the profound distortion in thinking that keeps the commercial weight loss industry in business? The idea that obesity can be “cured” with some magical potion or herb that will burn fat or rev up metabolism or suppress appetite. The idea that, “If I can only kick-start my weight loss and lose the first 10 lbs, the next 100 will surely follow”. The illusion that the next diet will be the last for sure. The fantasy that if I only lost some weight, my brain would readjust its “setpoint” and I could return to the weight I had as a 21 year old. The unrealistic expectation, that an hour in the gym each day will help melt away the lbs, or skipping meals will help cut calories.

But most of all I see denial – denial to see excess weight as a problem, even when it clearly affects your health, your well-being, your appearance, your self-image, your sex life, your relationship, your happiness. Perhaps, in an ideal world, excess weight should have none of those negative consequences, but in reality it does. The options are to either wait till the world changes (and becomes fairer to people with excess weight) or to step out of denial and seek the help you need to conquer those lbs (and I am not talking about signing up for the next commercial weight-loss program).

Many, if not all of us have accepted that alcoholism is a disease. Does obesity, not often meet the very same criteria?

Unfortunately, however, one important difference remains – in obesity, food abstinence is not an option (even if some of my patients have done just fine by completely giving up certain foods).

I look forward to what my readers have to say to this striking analogy.

Montreal, Quebec