Tuesday, March 22, 2011

Food Addiction: the new taboo

In the world of bariatric surgery, food addiction is almost a taboo subject. Maybe that’s because no one wants to admit that they’ll be saddled with an eating problem for the rest of their lives. They want and need to believe that weight loss surgery will permanently free them from their slavery to food. I wish I had a dollar for every time I’ve heard a WLS patient say, “I’m a good eater, I just eat way too much,” as if the “way too much” part was as “harmless” as watching too much TV or driving your car too fast. I’m certainly a good eater and always have been. At age 17, I was taught how to cook by a professional chef, and I’ve been preparing delicious, wholesome food ever since then. I ate meals consisting of lean proteins, complex carbs, and good fats, and what’s the problem with that? So I ate twice as much as my husband, who does manual labor for a living – so what? Was I, and am I, a food addict, or am I just a healthy eater who loves to eat and chooses to overeat?

Even experts in psychology and addiction can’t seem to agree on that. Historically, addiction has been defined as physical and psychological dependence on psychoactive substances (for example alcohol, tobacco, heroin and other drugs) which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain. By that definition, food doesn’t really qualify as an addictive substance (although the food we ingest does affect our entire body, including the nervous system).

The American Society of Addiction Medicine uses this definition for addiction: addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in the individual pursuing reward and/or relief by substance use and other behaviors (italics mine). The addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviors and interpersonal relationships. Like other chronic diseases, addiction involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Addiction can also be viewed as a continued involvement with a substance or activity despite the negative consequences associated with it. Over a period of time more and more involvement with the substance or activity is required to achieve the pleasure and enjoyment the user originally sought, and eventually that involvement is needed just to feel “normal.” Some psychology professionals and many laymen now include abnormal psychological dependency (on such things as gambling, food, sex, pornography, computers, internet, work, exercise, idolizing, watching TV or certain types of non-pornographic videos, spiritual obsession, cutting and shopping) in their definition of addiction. By this definition, the addict experiences a recurring compulsion to engage in some specific activity, despite harmful consequences to his individual health, mental state, or social life.

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