A resource for health professionals, parents, teachers, counselors & kids on the childhood obesity epidemic.

For members of the Task Force concerned with the conceptual evolution of DSM-5 (Regier, Narrow, Kuhl, and Kupfer), the primary goal was “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.” This is where we return, as promised, to the words of Prof. Graham Davey:

DSM-5 has continued the process of attempting to align its diagnostic criteria with developments and knowledge from neuroscience, when there is in fact very little new evidence from neuroscience that helps define specific mental health problems…

What? What was Dr. Davey thinking? Since the previous edition of the Diagnostic and Statistical Manual came out in 1994, the advances in neuroscience have been enormous. That was, after all, almost 20 years ago. Surely one of the more attention-getting obesity news events of 2011 was the publication of “Neural Correlates of Food Addiction,” in which brain scans showed:

Similar patterns of neural activation are implicated in addictive-like eating behavior and substance dependence: elevated activation in reward circuitry in response to food cues and reduced activation of inhibitory regions in response to food intake.

In other words, when you put certain people into MRI machines and tell them to think about milkshakes, their brains light up just like those of cocaine addicts contemplating their drug of choice. This was big news!

That study, and subsequent brain-scan explorations, have undeniably sparked discussion about the validity of the food addiction paradigm. In laboratories from coast to coast, lab rats have shown neuronal changes and addiction-like behaviors. Study authors Adrian Meule and Ashley N. Gearhardt wrote:

This increased scientific interest in this topic was in part driven by the rise of neuroimaging and subsequent findings that obesity and binge eating are associated with alterations in dopaminergic signaling and food-cue elicited hyperactivation of reward-related brain areas which are comparable to processes seen in drug users.

How did the DSM-5 Task Force, or Dr. Davey, or anyone, manage to hold onto a notion that the advances in neuroscience in the last 20 years have been negligible or nonexistent? Actually, the newest edition does acknowledge that the hallmark of addiction is the activation of the brain’s reward system, though it does this without using the word “addiction.” Medical writers interpret freely and just kind of work around it. This example is from addiction expert Elizabeth Hartney, PhD, specifically outlining “DSM 5 Criteria for Substance Use Disorders”:

While the pharmacological mechanism for each class of drug is different, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, which is often referred to as a “high.”

Another example is from TranscendRecoveryCommunity.com:

The DSM explains that the activation of the brain’s reward system is the key to drug abuse problems. Once the cycle of addiction activates the internal reward system, a rush in the brain, that behavior can become the sole focus of one’s life to the exclusion and detriment of other life-activities.

Your responses and feedback are welcome!

Source: “Changes in DSM-5,” Blogspot.com, 02/13/13
Source: “Neural Correlates of Food Addiction,” YaleRuddCenter.org, 04/04/11
Source: “Food addiction in the light of DSM-5,” NIH.gov, 09/06/14
Source: “DSM 5 Criteria for Substance Use Disorders,” About.com, 09/03/14
Source: “From Addiction to Recovery: Learning Leads the Way,” TranscendRecoveryCommunity.com, 05/14/14
Image by torbakhopper

As Childhood Obesity News has discussed before, the latest edition of the Diagnostic and Statistical Manual managed to omit recognition, in any way, shape, or form, of the reality of food addiction. What causes this ongoing delay? The medical establishment in Great Britain, as in other places, seems to have made up its mind. For a BBC Radio 4 program titled “Constant Cravings: Does Food Addiction Exist?” journalist Frankie Mullin wrote:

Addiction is defined by the National Health Service as “not having control over doing, taking or using something, to the point where it could be harmful to you.” Although addiction is most commonly associated with gambling, drugs, alcohol and nicotine, the NHS goes on to say that it is possible to be addicted to “anything.”

Yes, that word is “anything.” But DSM-5 is strangely silent on the addictive potential of edible products. Its chapter on “Feeding and Eating Disorders” includes anorexia and bulimia, but nothing about the most prevalent eating disorder on the planet, the one that causes millions to morph into grotesque, bloated caricatures of human beings. While anorexia and bulimia are serious and even life-threatening, they affect a very small fraction of the populace compared, for instance, to the devotees of chips or soda.

Maybe that explains the silence. If the Drug Enforcement Agency had to define chips and soda as Schedule I or II substances along with heroin, methamphetamine, and cocaine, it would lead to a legislative nightmare and a great deal of societal awkwardness. For instance, school sports teams, which are not currently allowed to let South American drug cartels pay for their uniforms, would no longer be allowed to accept sponsorship from food and beverage corporations.

The easiest and most superficial reason for the omission of food addiction could be that while experts do recognize the basic phenomenon, they just haven’t been able to classify it to their own satisfaction. Does compulsive overeating stem from the addictogenic nature (either inherent or contrived) of some foods? Or has it really been a behavioral addiction all along? But still — many other disorders are included and acknowledged as illnesses, even though they are not understood in every detail.

Is There Motion? Yes. Is it Body-Focused? Yes. Repetitive? Yes.

Food addiction might have fit into the book under “Obsessive Compulsive and Related Disorders.” Consider a person’s need to repeatedly cut a slab of meat with a knife; or to repeatedly clench a pizza slice between the teeth and sever a bite; or to repeatedly plunge the hand into a popcorn bag and then bring the fingers to the mouth; or to repeatedly chew or swallow. A case could be made that all those things are body-focused repetitive behaviors, or even (in a different chapter) stereotypic movement disorders.

Why not? When someone compulsively bites her or his own lip, cheek, or nails, “These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” That’s according to the book — which, by omitting compulsive eating, seems to imply that the daily habit of robotically ingesting many pounds of food somehow does NOT cause distress and impairment.

But we know that it does — in every possible functional realm, not just occupational and social, but in basic physical health. Indeed, compulsive overeating is so destructive, it could easily fit into the section on “Nonsuicidal Self-Injury” or even make its debut as star of the “Suicidal Behavior Disorder” category. Again — why not?

By the way, anyone who thinks that the newest edition of the Diagnostic and Statistical Manual makes sense, even to professionals, or who believes that the latest set of changes went down easily, is invited to read Dr. Stuart Gitlow’s “DSM-5: New Addiction Terminology, Same Disease.”

Your responses and feedback are welcome!

Source: “Food addiction: know the facts,” Food.UK.MSN.com, 01/05/2013
Source: “DSM-5 Table of Contents
Psychiatry.org, 2013
Image by Valerie Everett

Recently, Childhood Obesity News talked about the advantages and pitfalls of self-reporting as a research tool, and there is more to say on the subject. More was, in fact, said at the most recent European Childhood Obesity Group meeting, where Session 4 included Dr. Pretlow’s invited keynote talk, “Treatment of Child/Adolescent Obesity Using the Addiction Model.”

In the scientific realm, reports must fulfill certain criteria in order to be published. Publication implies that at least some of a researcher’s colleagues find plausibility in the proposed new addition to the literature. On the question of successfully treating obesity as an addiction, it seems that only two programs — Overeaters Anonymous and Energy Up — have published material, and both depend on their human subjects to self-report honestly.

Not long ago, we looked at Pathways to Health, a school-based program with an interesting origin story. It began as a way of dealing with substance abuse and violence. What do those behavioral problems have in common with the compulsive overeating that leads to obesity?  All three stem from an inability to regulate emotions, make good decisions, or control impulses. But even this highly-regarded program has a weakness — it is based on self-reported information. As Healio.com described, students fill out surveys with over 100 questions.

Inquiry … included questions such as, “How often did you eat any fruit, fresh or canned?” Questions about physical activity asked students to self-report how often they were very active in certain situations or whether they were involved in sports. Other questions were posed based on sedentary activity, such as amount of time spent watching television or playing video games.

Is it churlish to wonder how much fudging of the truth, or even how much self-deception, might be involved in self-reporting situations? But what alternative could be satisfactory? Unlike lab animals, humans cannot be observed 24 hours a day. When they are, the psychological disruption is enough to negate the usefulness of any experimental results.

From a website called StepsToRecovery.com, we learn that eating disorders  and substance misuse disorders often co-exist in the same person, and “they both involve urges to abuse the body.” This recalls how the singer Elvis Presley ate and drugged himself to death, surrounded by a cadre of sycophantic enablers:

Elvis demanded that every day he receive 3 separate doses of drugs that he called “attacks.” Each “attack” contained a dangerous combination of pills or shots of Valium, Nembutal, Demerol, Quaalude, and Seconal. David Stanley says the first “attack” was usually given between 2 and 3 a.m:
“After he’d take his attack, attack one, he would have a couple of cheeseburgers, potatoes. The “attack one” effect would get him groggy and sleepy…”
After sleeping for a few hours, Elvis would receive “attack” number two:
“That would last for several hours… Then it would be attack 3, which was the same contents of attack one and 2.”

Here was a man with all the fame and fortune the world could offer, who wanted nothing more than to assault his body with potent toxic chemicals, in between consuming equally suicidal meals. His story clearly shows the importance of treating underlying problems.

Your responses and feedback are welcome!

Source: “Childhood eating habits influenced by peers,” Healio.com, 2014
Source: “Starving Yourself to Achieve the Impossible Figure of Barbie,” StepsToRecovery.com, undated
Image by Ian Burt

People have trouble grasping the idea that all addiction is one phenomenon, expressed in various ways. Perhaps that might be because there is no recognized word for “an addictive thing” whether that thing is food or gambling, nicotine or Internet use, a substance or a behavior. For that concept, there is only the inaccurate and misleading use of “addiction.”

Logically, “addictor” should be that universally accepted word, but it isn’t. Almost the only instance of it is found in a book by Gene Smith and Lane Neihardt, which features the artwork shown on this page, with the caption, “I am habit, you’re chemical beings. I’ve GOTCHA!”

Addiction is a state or condition – and it takes a human person to be in that condition or state. An addiction is a strong interest or a need – which can only be experienced by a human. It is using something, which only a human can do. It is dependence, which only a human can experience.

“Addicted” is a state, like “allergic” is a state. A person can have an allergy, and a person can have an addiction. A person can be allergic to peanuts, but peanuts themselves are not “an allergy,” because an allergy is a condition, which only a human can experience. A person can be addicted to chocolate, but chocolate itself is not “an addiction,” because an addiction is a condition, which is experienced by a human.

The misuse of that single word has probably been responsible for a lot of the confusion in the field. So, what should the thing that causes the addiction be termed? “Addictogen” has been used occasionally, and fits the need quite well. Here are some examples of how “addictogenic” has been accepted as the adjective form:

“The propensity to produce “dependence”… is the red flag that sets apart this relatively small class of drugs, including alcohol, from the millions of other known chemical compounds. They are addictogenic… The exact molecular mechanism of addictogenesis is still the focus of scientific investigation.”

“Cocaine is a powerful stimulating agent of the central nervous system and a highly addictogenic drug.”

“America has devolved into an addictogenic culture….”

“Addictogenic” is an adjective with a clear and accepted meaning. So, why not make full use of the noun form? Something that is addictogenic is an addictogen, a much more sensible and logical word choice than what is currently, sloppily, and inaccurately applied. Either “addictogen” or “addictor” should be widely used. It is time to stop incorrectly saying “addiction” to denote what is really the addictor or addictogen.

It would not make sense to describe a test tube of pollen as an allergy. The pollen is not the allergy, but the substance that provokes an allergic reaction in people. A person can have an allergy, but an object cannot be an allergy. The gambling is not the addiction, it’s the activity that brings out an addictive reaction in people. A person can have an addiction, but an object can’t be an addiction. The wrong usage of that word only worsens an already confusing situation.

Your responses and feedback are welcome!

Source: “If Alcohol Were Invented Today,” blogspot.com, 10/30/10
Source: “Cocaine addiction,” sigmaaldrich.com, 05/01/13
Source: “Jane Unchained,” janeunchained.com, 11/28/14
Image by Gene Smith and Lane Neihardt