Guest Post: Food Abstinence for Food Addicts: Deprivation or a New Freedom?

Today’s guest post comes from Dr Vera Tarman, addictions specialist and Medical Director of Renascent, Canada’s largest drug and alcohol rehabilitation facility. She has spoken internationally on the subject of food addiction and is the co-author of Food Junkies: The Truth about Food Addiction (reviewed here). Her website is addictionsunplugged.com. Countless times during my public talks, the question comes up: “You have to eat! If food is addictive, what can you eat?” “Yes”, I agree. “ You do have to eat, but not desserts, bagels, pastries, or any junk food. You don’t need sugar, honey, maple syrup or molasses to survive.” How about vegetables, fruits, meats and fish? For most people, even end-stage food addicts, these foods are not addictive. Food abstinence is not about being on a diet, restricting calories, counting points, eating specially packaged foods – it is a recommendation that we eat the foods our body was metabolically designed to eat and enjoy with satisfaction. Our evolutionary hormonal and neurochemical “checks and balances” have been designed for the natural foods of our ancestors. In other words, we are programmed to desire food when we are hungry and are satisfied when we have sufficient energy reserves from that food. In a perfect nutritional ecosystem, most people can stop with satisfaction when they are full. Willpower, the front-lobe strongman of the brain, is actually quite short-lived and fragile, but works sufficiently well under normal conditions. The food industry has created foodstuffs that provide an highly efficient delivery system to our brain’s reward center. This manipulation gives us a copious amount of delight immediately: the quick fix. The fiber from fruit and vegetables has been peeled away, the hovering bees that discourage an overly eager hand from taking gobs of honey have been removed, the bark of a maple tree or sugar cane that would have made it impossible to get more than a lick of sap or sugar have been stripped. Our primal brain which is accustomed to moderate pleasure is overwhelmed with the euphoric bliss of highly palatable foods. Willpower sags under the strain. This is why you choose the apple cheese cake over the apple. Foods have become irresistible, even to a normal eater. To a food addict, they are the kick-start of a downward spiral to endless overeating, misery and self-loathing. The question that typically follows is, “If you restrict your foods, aren’t you encouraging abnormal… Read More »

Obesity Weekend Roundup, February 13, 2015

As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Does Food Addiction Require Abstinence? Severe Obesity Is Easier To Manage in Kids Than in Teens Does Physical Activity Calorie Equivalent Labeling Make Sense? Obesity In Cardiovascular Disease – A Canadian Perspective Canadian Obesity Network To Engage People Living With Obesity Have a great Sunday! (or what is left of it) @DrSharma Edmonton, AB

Obesity Weekend Roundup, September 19, 2014

As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Upcoming Dr. Sharma Shows Update on New Medications for Obesity Is Food Addiction Better Described As Eating Addiction? Does Mandatory Weight Loss Before Surgery Harm Patients? Efficacy of Vagal Blockade For Obesity Treatment Remains Vague Have a great Sunday! (or what is left of it) @DrSharma Edmonton, AB

Update on New Medications for Obesity

Last week, while I was off on a brief holiday, two important events took place in the US with regard to obesity medications. On September 10, the US-FDA granted approval for Contrave, a fixed combination of bupropion and naltrexone, two centrally active compounds, also used in the treatment of addictions. Then, on September 11, an advisory panel appointed by the FDA, voted strongly in favour of approving the GLP-1 agonist liraglutide at the 3.mg dose for the treatment of obesity. These two new entities would bring the currently approved prescription medications for the treatment of obesity in the US to six – a dramatic change from just a couple of years ago. This is still a long shot away from the many effective treatments we have for treating other common conditions (e.g. there are more than 20 prescription medications approved for treating diabetes and almost 100 compounds for the treatment of hypertension). Why would we need this many different medications for obesity? For the simple reason that not everyone will respond favourably or tolerate all of these compounds. Given that obesity is a remarkably heterogeneous disorder and that these drugs have distinctly different modes of action, I would not expect all of these medications to work in all individuals. It is also important to note that all of these drugs work best when combined with intense behaviour modification – no pill will ever serve as a substitute for a healthy diet and a daily dose of moderate to vigorous physical activity. But we also know that the latter alone, will rarely produce sustainable weight loss in the long-term. Obviously, given the chronic nature of obesity, medications for obesity will need to be used long-term in the same manner that we use medications to treat other chronic conditions (e.g. diabetes, hypertension, etc.). This means that we will need more long-term data on the efficacy and safety of these compounds. Nevertheless, there is reason to hope that for many people with obesity related health problems, these new obesity medications will provide much-needed therapeutic options. @DrSharma Vienna, Austria Disclaimer: I have served as a paid consultant and/or speaker for the makers of Contrave and liraglutide.

Mental Health and Obesity Conference, Toronto, May 14, 2014

Today I am in Toronto attending the 2nd National Conference on Mental Health and Obesity organised by the Canadian Obesity Network. The program of this year’s conference focuses on the clinical management of managing obesity in individuals with mental health problems, a not uncommon problem in clinical practice. The sessions also include an update on behavioural treatments and dealing with addiction issues. I certainly look forward to a most interesting conference on an issue that I think is of prime importance to our patients. @DrSharma Toronto, ON