food addictions july 2008

Food Addiction, Eating Disorders and “Normal”

Overeating: What’s the Difference?

• Understand the difference between normal overeating, eating disorders and food addiction.

• Review recent literature on food addiction.

• Understand treatment of food addiction.

OBJECTIVES

• The Problem• The Solution• What Works

OVERVIEW“NORMAL” EATER (WITH OBESITY),

EATING DISORDERS, FOOD ADDICTION

Philip Werdell, copyright, 2007

• The PROBLEM is physical:– Weight

“NORMAL OVEREATER (WITH OBESITY)

• The SOLUTION is physical:– Medically approved dieting.– Moderate exercise.– Support for eating, exercise and

lifestyle change.

“NORMAL OVEREATER (WITH OBESITY)

• What Works:– Willpower– Bariatric Surgery– Diets

“NORMAL OVEREATER (WITH OBESITY)

• The PROBLEM is physical AND mental-emotional– Binge eating, restricting and/or

purging over feelings (use food to numb or medicate feelings).

– Unresolved trauma.– Possibly weight (sometimes

underweight, sometimes overweight, sometimes normal weight).

EATING DISORDERS(EMOTIONAL EATER)

• The SOLUTION is mental-emotional and physical– Develop skills to cope with feelings

other than restricting binging and/or purging.

– Resolve past trauma and irrational thinking.

• The SOLUTION is also physical as with the “Normal” overeater (with obesity), (diet, exercise, support).

EATING DISORDERS

• WHAT WORKS:– Moderation (along with feeling your

feelings).

EATING DISORDERS

• The PROBLEM is physical, mental-emotional AND spiritual (i.e. – 12 step solution as with alcoholic and drug addicted).– Physical craving (false starving)

produced by eating addictive foods.

– Mental obsession (false thinking).

FOOD ADDICTED(CHEMICALLY DEPENDENT)

• The SOLUTION is spiritual, and mental-emotional, & physical– Abstinence from binge/trigger foods

and abusive eating behaviors.– Rigorous honesty about all thoughts

and feelings.– A disciplined spiritual program (12

step).– And the mental-emotional and physical

solutions.

FOOD ADDICTED(CHEMICALLY DEPENDENT)

• WHAT WORKS:– Surrender to a food plan which

eliminates addictive foods.– Surrender to rigorous honesty

about thoughts and feelings.– Surrender to whatever structure

and support is needed.

FOOD ADDICTED(CHEMICALLY DEPENDENT)

• Dieting to lose weight– Assumes you need to

take control.– Focus on physical

recovery.

• Abstaining to be in recovery– Assumes control by

will is not possible (addictive foods take over brain).

– Works on mental-emotional and spiritual recovery as well as physical recovery.

THE COMPARISON BETWEENDIETING AND FOOD ABSTINENCE

• DIETING– Focus on putting

distractions out of mind.

– Time frame is limited-you lose weight and you are done.

• FOOD ABSTINENCE– Focus on sharing

thoughts and feelings that are in the way and dealing with them.

– The time frame is one day at a time for the rest of your life.

DIETING AND FOOD ABSTINENCE CON’T

• DIETING– The best plans

are straight forward and reasonable (i.e. – sugar in moderation eliminates craving).

– The work is a matter of willpower.

• FOOD ABSTINENCE– The best plans

sometimes seem paradoxical (i.e.- eliminating sugar decreases craving).

– The work is to gracefully surrender.

DIETING AND FOOD ABSTINENCE CON’T

COMPARISON BETWEEN EATING DISORDERS AND FOOD

ADDICTION RECOVERY WORK

• EATING DISORDER– Traditional eating

disorder therapy assumes the problem is not the food .

– Biopsychosocial (emphasis on psychological).

• FOOD ADDICTION– Food addiction

recovery work assumes the problem is the food, as well as feelings, trauma and sometimes weight.

– Biopsychosocial (all are emphasized).

• The obese “normal” overeater can diet successfully.

• The morbidly obese “normal” overeater is an excellent candidate for bariatric surgery.

IN SUMMARY:“NORMAL” OVEREATER

• Anorexics, bulimics and binge-eaters are successfully treated by a range of therapies from CBT to expressive as well as guidance from dietician, some medication management.

IN SUMMARY:EATING DISORDERS

• SSRI’s• TOPOMAX• LUVOX• NALTREXONE

MEDICATION MANAGEMENT FOREATING DISORDERS

• A decade ago, there was little scientific evidence that food addiction exists as a chemical dependency.

• Today there is abundant evidence.• Some of the most convincing

evidence includes the following slides:

SCIENTIFIC EVIDENCEOF FOOD ADDICTION

• Genetic Evidence: A UCLA study showed obese people who binged on simple carbohydrates, had the same D2 Dopamine receptor as has been found in alcoholics and other drug addicts.

E.P. Noble, MD, et al, 1994

SCIENTIFIC EVIDENCEOF FOOD ADDICTION CON’T

• Brain Imaging Evidence: Pet imaging studies show that loss of control overeating and obesity produce changes in the brain similar to those produced by drug of abuse.

Mark Gold, MD, et al, 2004

SCIENTIFIC EVIDENCEOF FOOD ADDICTION CON’T

• Evidence of Opioid Involvement: Several studies show that excess sugar intake produces endogenous opioid release and dependency.

Adam Drewnowski, et al, 1992, Carlo Calantuani, et al,

2002, Nora Volkov and Roy Wise, 2002

SCIENTIFIC EVIDENCEOF FOOD ADDICTION CON’T

• Evidence of Cross Addiction from Alcohol to Food: There are several studies that show those who are addicted to alcohol are often helped to recover by abstinence of both sugar and alcohol.

A.R. Lefever and M Shafe – 1991, Katherine Kitchem and L. Ann Mueller - 1986

SCIENTIFIC EVIDENCEOF FOOD ADDICTION CON’T

• Evidence of Malfunction of Seratonin: Seratonin as well as dopamine is involved in food addiction.

A. Katherine, 1996

SCIENTIFIC EVIDENCEOF FOOD ADDICTION CON’T

• There are many variations in food plans.

• Common addictive foods that must be abstained from including sugar (most common), flour, wheat, fat, etc.

• There are varying “degrees of abstinence” (see chart 5)

FOOD PLANS FOR FOOD ADDICTS

• Diet and exercise alone do not work.• Therapy alone does not work.• Successful long term recovery from

food addiction almost always begins with abstinence from the offending food(s) and “weighing and measuring” if the problem is volume of all or some foods.

TREATMENT OPTIONS FORFOOD ADDICTS

• We see concurrent obesity, eating disorder and food addiction.

• In these case, when food addiction is advanced, we have seen success when the food addiction is treated as the primary disease, along with therapeutic interventions for the eating disorder.

HOWEVER, MORE COMMONLY

• Some food addicts have few underlying issues apart from their chemical dependency on food.

• These people are successful in Overeaters Anonymous and can be successful from the beginning without much need for additional professional support.

IN SUMMARY: FOOD ADDICTED

• Similar to other chemical dependence

• See charts 6 and 7

FOOD ADDICTIONIS PROGRESSIVE

• Present in the late stage food addict.

• Present in other late stage addictive disorders.

• Must be addressed in order for treatment to be successful.

ADDICTIVE (BIOCHEMICAL)DENIAL

Case Study

• 20 year old male• 5 year history of alcohol abuse• 7 year history of binge eating• General anxiety disorder• 5 attempts at outpatient therapy (refused

higher lever of care• Overweight as of middle school (puberty,

inactive for months due to fracture in foot and misdiagnosed heart condition)

• 5’9” – 210#• Biological family, in college

Case Study

• 28 year old female• 10 year history of amphetamine abuse• 14 year history of bulimia nervosa,

restricting, over exercising, caffeine major depressive episodes, recurrent

• 6 attempts at inpatient treatment, including 1 year hospitalization, 18 month halfway house

• Average weight• Divorced family of origin, step families,

raised by other family members

Case Study

• 32 year old alcohol and cocaine addicted female in residential treatment

• Night eating• Normal weight• Hoarding food

Additional Information

• History of ED?• History of obesity?• Evidence of purging?• Baseline weight?• Family history of ED or obesity?• History of trauma?

Differential Diagnosis

• “Normal” Overeater• Eating Disorder – BED or Bulimia• Food Addict• Hyperphagia from cocaine

withdrawal (cocaine detox)

Workup and Treatment Plan

• Labs• Food history• Therapy• Bathroom buddy• Eliminate trigger foods• OA

Case Study

• 35 year old female• 15 year history of alcohol dependence

and abuse• 5 year history anorexia nervosa• 1 attempt at inpatient treatment • substituted iced tea for alcohol in

treatment• Overly involved with food prep in

treatment setting• Married with children

Case Study

• 48 year old female• “weight issues as far back as I can

remember”• Repeated attempts at weight

management including twelve step programs with food plans

• Married with children

THANK YOU