Guest Post: Even if Oprah Can’t, Maybe You Can?

Today’s guest post is a response to my recent post about Oprah and her weight-loss struggles. The post comes from Dr Vera Tarman, MD, FCFP, ABAM, and author of Food Junkies: The Truth About Food Addiction and Mike MacKinnon a fitness trainer (Fit in 20). Oprah’s experience of losing and regaining her weight on a regular basis, alongside Sarah, the Duchess of York and Kristie Allie – all spokespersons for weight loss programs ‐ certainly send us a dismal message. Sure, weight loss can occur but keeping it off is the challenge that trips up 90% of people who have tried these and other programs. So, isn’t it more compassionate to dissuade people from the inevitable yo‐ yo lifestyle and accept their current obese weight? But … what if there are actually many success stores that we are not hearing about? As an addictions physician I witnessed patients who have lost an average of 60 to 100 pounds and have kept that weight off for years. They are food addicts in recovery from their addiction. They have adopted a radical diversion from the traditional bariatric or eating disorder menu recommendations: Rather than ‘learning’ how to eat all foods in moderation, these people have identified and abstained from the trigger foods that spur their addictive eating. Sobriety, food serenity and long term weight loss result – on a consistent basis. Look to the recovery circles and addiction treatment programs. Here you will unearth people who have succeeded where Oprah has not. We don’t hear about these victories because many have pledged anonymity in the church basements where they meet, strategize and buffer the messages that we are saturated with by our food‐obsessed culture. Because there is no money to be made with the simple abstinence of sugar, flour or processed foods, and no drugs, herbs or patented food packages to sell – no one is advertising or promoting this approach. Abstinence. Here is the story of one clinician who has found long ‐ term weight loss. His is a case in point: Weight loss for 13 years and counting. He is not a “rare’” individual who has achieved the impossible. He and his clients have simply applied the solution to the underlying problem of their obesity – an undiagnosed food addiction. I’m a strength and nutrition coach who specializes in helping people lose weight. My typical clients are female, age 35 and… Read More »

100+ Putative Causes Of Obesity – Take Your Pick

Listening to (or reading the bestsellers written by) pundits, one may easily think that the entire obesity problem can be brought down to a couple of factors – sugar-sweetened beverages, fast food, sedentariness, screen-time, – take your pick. Now, Morgan Downey, former CEO of the Obesity Society on his blog – the Downey Obesity Report – provides an update of previous lists of putative causes of obesity – a list that now included 104 items. As he is careful to point out, “The links are not meant to be definitive or best study but merely a demonstration of the interest in the particular cause.” Given that many of these factors are implicated based largely on observational studies, which by their very nature cannot prove causality, some scepticism is in order. However, for many factors on this list there is biological plausibility, often backed by findings from animal or experimental studies. Here is Downey’s list of putative causes of obesity: 1. agricultural policies 2. air conditioning, 3. air pollution, 4. antibiotic usage at early age, 5. arcea nut chewing, 6. artificial sweeteners, 7.  Asian tiger mosquitos, 8. assortative mating, 9. being a single mother, 10. birth by C-section, 11. built environment, 12. celebrity chefs, 13. chemical toxins, (endocrine disruptors) 14. child maltreatment, 15. compulsive buying, 16. competitive food sales in schools, 17. consuming skim milk in preschool children, 18. consumption of pastries and chocolate (in Burkina Faso), 19. decline in occupational physical activity, 20. delayed prenatal care, 21. delayed satiety, 22. depression 23. driving children to school 24. eating away from home 25. economic development (nutrition transition) 26. entering into a romantic relationship, 27. epigenetic factors, 28. eradication of Helicobacter pylori, 29. family conflict, 30. family divorce, 31. first-born in family, 32. food addiction, 33. food deserts, 34. food insecurity, 35. food marketing to  children, 36. food overproduction, 37. friends, 38. genetics, 39. gestational diabetes, 40. global food system,(international trade policies) 41. grilled foods, 42. gut microbioata, 43. having children, for women, 44.  heavy alcohol consumption, 45.  home labor saving devices, 46. hormones (insulin,glucagon,ghrelin), 47. hunger-response to food cues, 48. high fructose corn syrup, 49. interpersonal violence, 50. lack of family meals, 51. lack of nutritional education, 52. lack of self-control, 53. large portion sizes, 54.  living in crime-prone areas, 55. low educational levels for women, 56. low levels of physical activity, 57. low Vitamin D levels, 58.  low socioeconomic status, 59. market economy, 60. marrying in later life 61. maternal employment, 62. maternal obesity, 63. maternal over-nutrition during pregnancy, 64. maternal smoking, 65. meat consumption, 66. menopause, 67. mental disabilities, 68. no or short term breastfeeding, 69. non-parental childcare 70. outdoor advertising, 71. overeating, 72. participation in Supplemental Nutrition Assistance Program (formerly Food Stamp Program) 73. perceived weight discrimination, 74. perception of neighborhood safety, 75. physical disabilities, 76. prenatal  maternal exposure to natural disasters, 77. poor emotional coping 78. sleep deficits, 79. skipping… Read More »

Does Leptin Reduce the Reward Response to Exercise?

In my conversations with skinny runners, they often cannot stop telling me how much satisfaction and enjoyment they get from their “runner’s high”. No wonder, they so often seem “addicted” to their runs (or other workouts). In contrast, a “runner’s high” seldom comes up when any of my patients living with obesity talk about their exercise experiences (yes, many people with obesity exercise regularly). Now, work by Maria Fernandes and colleagues from the University of Montreal, published in Cell Metabolism, reports findings in rats, which, if applicable to humans,  may provide a biological explanation for this observation. Building on previous studies showing that leptin modulates multiple components of brain reward circuitry, particularly in dopamine (DA) neurons of the ventral tegmental area (VTA), an area of the brain allegedly responsible for the “runner’s high”. Using an elegant set of experiments, the researchers showed that leptin markedly reduces mice’s willingness to work for access to a running wheel or show other signs of seeking out exercise-induced reward. In contrast, mice with a deletion of the signal transducer and activator of transcription-3 (STAT3), involved in leptin signalling in dopamine neurons of the VTA, showed greater interest in voluntary running. In other words, STAT3 deletion increased the rewarding effects of running whereas intra-VTA leptin blocked it in a STAT3-dependent manner. Together these findings strongly suggest that leptin influences the motivational effects of running via LepR-STAT3 modulation of dopamine tone. Or, in other words, higher levels of leptin (as seen in people living with obesity) directly inhibit the rewarding nature of running, making it less likely to experience a runner’s high, than in someone with low leptin levels (as seen in people with low fat mass). As to why this may be the case, the authors offer the following explanation: “We speculate that in conditions of restricted food availability the mesolimbic DA system engages motivational processes concerned with obtaining food and more readily responds to leptin to decrease appetitive physical activity. On the other hand, during fed states, the actions of leptin may be biased toward hypothalamic processes that could increase physical activity as a means to maintain energy homeostasis.” “While heightened physical activity during food restriction seems paradoxical to the maintenance of energy reserves, it is considered an expression of increased food acquisition behaviors. The capacity for endurance running in cursorial mammals is considered to enable food attainment when it is distant or requires pursuit. Correspondingly, the runner’s high may have evolved to… Read More »

How To Tell If You May Be A Food Addict

Following the recent guest posts by Drs Vera Tarman and Pam Peeke on food addiction, many readers have left comments about how this notion rings true to them and how the ideas of treating their “eating disorder” as an addiction has helped them better control their diet and often lose substantial amount of weight. Others have asked how to tell if they might be food addicts. For them, I am reproducing the following list of 20 questions taken from Food Addicts in Recovery Anonymous. Although it is important to note that “food addiction” has yet to be officially recognized as a medical/psychiatric condition and the following questions are by no means “diagnostic”, I would still support the idea that the more of these questions you answer with yes, the more likely you may benefit from discussing this problem with someone who has expertise in addictions (rather than simply going of on another diet or exercise program). 1. Have you ever wanted to stop eating and found you just couldn’t? 2. Do you think about food or your weight constantly? 3. Do you find yourself attempting one diet or food plan after another, with no lasting success? 4. Do you binge and then “get rid of the binge” through vomiting, exercise, laxatives, or other forms of purging? 5. Do you eat differently in private than you do in front of other people? 6. Has a doctor or family member ever approached you with concern about your eating habits or weight? 7. Do you eat large quantities of food at one time (binge)? 8. Is your weight problem due to your “nibbling” all day long? 9. Do you eat to escape from your feelings? 10. Do you eat when you’re not hungry? 11. Have you ever discarded food, only to retrieve and eat it later? 12. Do you eat in secret? 13. Do you fast or severely restrict your food intake? 14. Have you ever stolen other people’s food? 15. Have you ever hidden food to make sure you have “enough?” 16. Do you feel driven to exercise excessively to control your weight? 17. Do you obsessively calculate the calories you’ve burned against the calories you’ve eaten? 18. Do you frequently feel guilty or ashamed about what you’ve eaten? 19. Are you waiting for your life to begin “when you lose the weight?” 20. Do you feel hopeless about your relationship with food?… Read More »

Guest Post: Treatment For Addictive Eating: Many Shades of Grey

Continuing with the theme of food addiction, here is another guest post – this one by Dr. Pam Peeke, a Pew Foundation Scholar in Nutrition, Assistant Clinical Professor of Medicine at the University of Maryland, and Senior Science Advisor to Elements Behavioral Health, the USA’s largest network of residential addiction treatment centers. She is author of the New York Times bestseller The Hunger Fix: The Three Stage Detox and Recovery Plan for Overeating and Food Addiction. Her website is http://www.drpeeke.com/ For years, the popular culture has embraced the relationship between food and addiction. It permeates our daily vernacular— “I’m hooked on bread”, “I need a candy fix”, “I can’t get off the stuff”, “I’m a carb addict”. Grocery store shelves are filled with colorful cereal boxes labeled “Krave”, as the food industry capitalizes on the consumers’ never ending hunger for another fix. History was made when a major weight management company aired its first Super Bowl commercial, choosing a “food as drug” theme, narrated by Breaking Bad actor Aaron Paul. Close your eyes, listen to the words, and you’d never guess that food, not drugs, was the focus. Companies and communities, however, cannot validate the phenomenon of addictive eating behavior—only science can do that. Heeding the call to arms, nutrition and addiction researchers, led by Dr. Nora Volkow, Director of the National Institute of Drug Abuse, have spent the past ten years generating a critical mass of valid and credible science associating specific food products and addictive eating behavior. A tipping point was reached in 2012, when the peer reviewed and edited professional textbook Food and Addiction was published. A month later my consumer book, The Hunger Fix: The Three Stage Detox and Recovery Plan for Overeating and Food Addiction, was released and the single most common response from my readers was “What took you so long?” We needed, and finally benefited from, new groundbreaking research. We now know that certain foods, namely the “hyperpalatables”–sugary, fatty, salty food combinations— affect the brain’s reward center in a way identical to drugs and alcohol, triggering an abnormally high level of release of the pleasure chemical dopamine. Repeated hyper-stimulation of these reward pathways can trigger neurobiological adaptations that can lead to compulsive consumption despite negative consequences. In 2009, Yale researchers developed the first assessment tool, the Yale University Food Addiction Scale, or YFAS, to identify individuals who demonstrated an addictive response to specific foods. Subsequent studies… Read More »