Obesity: The Worst-Case Scenario

Noodle looking out the window

Hector Garcia called himself “the worst-case scenario” for reasons clear to anyone familiar with the thorough and revelatory account of his last four years on earth, as compiled by San Antonio Express-News staffers Jessica Belasco and Lisa Krantz. Garcia started out as an overweight child and ended up weighing over 600 pounds and dying of an officially unspecified cause, though it was probably chronic obstructive pulmonary disease, as he himself had predicted. He was working on a memoir called “Life Behind the Glass,” relating to the idea he expressed like this:

I always pictured myself as a child with my head up against glass looking at life happening and I was stuck behind the glass. Because no one, no one wanted the fat kid.

That was a bit of emotional exaggeration. Hector Garcia was not shunned like a leper, or tarred and feathered, or ridden out of town on a rail. In actual fact, he had a slew of relatives who were fond of him, as documented by the reporter/photographer team. With such a large family, he was probably seldom alone, unless he wanted to be.

Of course, loneliness comes in various flavors, and he did miss out on other kinds of relationships. He told the news team how he regretted being unable to marry or father children. Technically, he could have done either, especially during the intervals when his bulk was drastically reduced (once by bariatric surgery and another time by diet and exercise). But Garcia explained that because of being an overweight child and teenager, he had never developed social skills, especially with girls. He had learned at an early age, he said, that it was better if he kept to himself.

The Bitter End

Still, it is not true that no one wanted the fat kid. His mother, Elena Garcia, doted on him. In a video clip, the two of them ride scooters through the aisles of a grocery store, symbolizing with grim appropriateness that for both, feeding Hector was a top priority. Still, there is something not just touching, but disturbing, about the photos of Hector and his mom tossing a basketball back and forth. Back home, on his 49th birthday, Hector embraces the cake, as his mother sings to him.

Of all the strands making up this tragic tapestry, the most devastatingly ironic detail is how Hector Garcia met his end – indirectly, through the mother who cared for him so devotedly for almost 50 years. Discharged from a short hospitalization, she did not call ahead but arrived home unexpectedly and rang the bell. Hector answered the door, his breathing labored as usual. Then he collapsed, turned purple, and expired.

Toxic Environments

The news story mentioned the various factors that make up the current “toxic food environment” in America, but never suggested the possibility of a toxic parent. It was not the job of the reporter and photographer to psychoanalyze their subject or his parents, diagnose their mental states, or even point out their human shortcomings, if any. To suggest anything awry in this family dynamic would be a serious overstepping of bounds. Sensitivity is always of primary importance when dealing with a bereaved family.

Unconditional love is a miraculous thing, and no one provides it better than mothers and fathers. Still, encountering a similar story to this one, a cynic influenced by Freudian theory might point an accusatory finger at one of the obese person’s parents. Feeding a son or daughter into a state of un-dateable obesity could effectively keep that child at home forever, with the parent never challenged by a rival. Surely, somewhere in the world there has been a mother so crippled by insecurity or a father so blinded by possessiveness as to carry out such a plan.

In the context of a movie based on a Stephen King story, the birthday cake scene would look pretty creepy. In this true-life documentary, the editor chose to place these words immediately before that scene. Hector Garcia says:

A lot of the times we’re like this not because we want to be but because certain circumstances in our life have set the table in a certain way. This is a path that we’ve almost been forced to follow, and we don’t know how to get out of that path.

He said something else that could be interpreted in more than one way:

I want people to know what happened to me…. I don’t want other people to go through the suffering that I went through.

Your responses and feedback are welcome!

Source: “A Life Apart: The Toll of Obesity,” expressnews.com, 12/27/14
Image by MsSaraKelly

 

The Quality of Life Conundrum

The Grim ReaperOnce they have become obese, children may experience a diminished quality of life for many reasons, some of which are more obvious than others. A lot of things in the material world are too small for their comfort — clothes, school desks, airplane seats, and restaurant booths, to name a few. They tend to be teased or bullied. Relatives are always bugging them to turn off the video game and go run around the block. A large number of quality-of-life issues arise as a consequence of carrying extra weight.

But there is another dimension to quality of life. Namely, what degree of quality existed in the life they had prior to gaining weight? Because that life contained the seeds of whatever psychological and emotional challenges sent them off the rails seeking happiness through food consumption.

When the patient is a child, his or her unhappiness is inextricably linked to the relationship with one or both parents, or the relationship between the parents, or to the lack of any parental attachment. The biggest predictors of any child’s quality of life are the parents or caregivers. When something is wrong at home, the child usually is not the problem, but is instead a living, breathing symptom of a dysfunctional family.

Back to Square One

Every type of intervention or treatment for childhood obesity takes for granted that the parents will be happy to have somebody straighten them out, and grateful for the guidance. In practice, things don’t always go smoothly, because some parents resent what they see as interference. When shown the need to help a child struggling with obesity, parents might be relieved and eager to respond. Or they might be totally indifferent or even actively hostile.

A child might be awarded a scholarship to the best residential rehab facility or most innovative camp, and make wonderful progress. The trouble is, this child cannot go forth into the world and start a new life. Because of her or his status as a minor and a dependent, this child will be returned to the exact same environment where the problem originated, under the care of the same responsible adults.

Heavy on Denial

The thought-provoking story of Hector Garcia included a quotation from his mother:

He himself told me, “Mom, you do know that that I’m gonna die of COPD.”
I said, “Don’t talk like that Hector.” I hated to hear him talk about that.

At the time, Garcia weighed over 600 pounds and could barely move. His mother presented him with a birthday cake topped with a single candle and said:

We’re not counting any more, right? No, we won’t count no more.

Avoiding talk of death staves off mortality, and by not counting the years, the Grim Reaper can be vanquished. The strategy didn’t work, of course. But although steeped in denial, Elena Garcia’s remark turned out to be strangely prophetic. What the news camera recorded was the 49-year-old’s final birthday. The story included another quotation, this one from Hector himself:

A lot of the times we’re like this not because we want to be, but because certain circumstances in our life have set the table in a certain way. This is a path that we’ve almost been forced to follow, and we don’t know how to get out of that path.

Those words are disturbingly reminiscent of something Dr. Pretlow wrote:

Several youth in our studies reported that they have been overweight so long that they are accustomed to it. They are fatalistic that they will always be that way and don’t know how to change.

Your responses and feedback are welcome!

Source: “A Life Apart: The Toll of Obesity,” expressnews.com, 12/27/14
Image by Maxwell Hamilton

The Unknown Enablers

junk food

When 600-pound Hector Garcia died in December, his life had been documented for several years by a team from the San Antonio Express-News. His mother told the reporter that “if she tried to refuse his requests for food, her son would get angry.” Dr. Pretlow remarked on a situation from his own experience:

We recently had a 287-pound, 10-year-old boy in one of our studies. The mother told me that she gave treats to her son, because he would get very angry if she did not. Initially, a parent may give treats to get love from the child…

This may enable addiction to eating in the child, and parental co-dependence. Nevertheless, at some point the parent may realize that this is hazardous to the child’s health, and the parent tries to stop. The addicted child may then become very angry when cut off.

When a parent is enabling to the point of being toxic, is that parent a victim or a perpetrator? Unfortunately, toxic parents do exist, unbeknownst even to themselves. Enablers and codependents always give plausible reasons for their destructive actions. Some online forums are full of troubling details, like those disclosed about a dangerously obese 15-year-old with two obese parents and the right heredity for heart disease and metabolic syndrome. A worried relative deplored the mother’s fatlogic:

She complained that the diet is useless because the bully who tormented him isn’t in his class any more; because his pediatrician says that overweight people don’t need to lose weight if they’re fine with their bodies; … because she can’t cook two different meals; because he always asks to eat whatever unhealthy food they’re eating…

Simultaneously entering the four search terms “Reddit,” “obese,” “toxic,” and “mother” brings back 250,000 results. Still, probably 99% of parents are confident that they are doing the right thing, while observers wonder how some parents can possibly believe the precepts they apparently live by. No matter how innocently oblivious the enabler might be, and no matter how diligently the therapist tries to cultivate compassion, there must be times when a criminal level of cognitive dissonance seems to be involved. How could anyone possibly look at a child almost as wide as he is tall, and believe that his temper tantrum is weightier than the pounds of lard strangling his liver?

Buying Love With Food

In homes throughout America, more than half the pet dogs and cats are overweight, for no good reason whatsoever. In relationships between caregivers and animals, as well as between caregivers and kids, Dr. Pretlow suspects a certain amount of commercial intent. People are trying to buy love, as they have been advised to do by the hundreds of commercials produced by the food industry. This attempt accomplishes nothing except to undermine the quality of everyone’s life.

It is a truism in therapy that while the addict is hooked on the substance, the co-dependent is hooked on the addict. Fittingly, that co-dependent dynamic follows the arc of the addiction story. At first, an addict gets high. Then after a while, it’s all about shooting up so you don’t have to get dopesick — in other words, just to ward off the withdrawal sensations.

Likewise, an enabling parent (or partner) can buy love for a while, but the glitter wears off. Subsequently, it might be possible to buy a public display of love, which is not quite the same thing. Inevitably, the devalued currency can only purchase, at most, a polite concealment of contempt. Eventually, all it can buy is avoidance of active hostility. Maybe.

Your responses and feedback are welcome!

Source: “My aunt’s fatlogic is ruining my cousin’s health”
Reddit.com, November 2014
Image by cthoyes

Toxic Parents and Quality of Life

little emperorFrom the moment any child is born, the main factor determining that child’s quality of life is the chief caregiver, often the mother. When this works out well, everybody wins. But the planet is full of less-than-perfect parents. Sometimes governments attempt to step in and fix parental problems, with mixed results.

When ideologically-motivated social engineering clashes with reality, reality always wins. Childhood Obesity News has previously covered governmental response to obesity in China, where the one-child policy has created a generation of so-called “little emperors” who are often doted on.

Many Strands

Despite governmental “fat camps” and other efforts, childhood obesity is on the rise in China, particularly among more affluent families.

Here are some grim statistics:

…more than 12% of China’s minors are overweight and one-third of children under 17 suffer from at least one cardiovascular risk factor, including 1.9% of China’s 12-18 year olds suffering from diabetes, four times the number of their peers of the same age group in America.

Meanwhile 14.9 percent of Chinese children and adolescents show early symptoms of diabetes such as elevated blood sugar, while 12.1% of Chinese teenagers have a high incidence of arterial inflammation which is the main cause of cardiovascular disease.

There are several things going on here. First, parents with disposable income have only one child to spend it on, and much of it goes toward food treats and Western-style fast food. Second, the cultural norms are different: “fat” is traditionally associated with “wealth” in a country where food scarcity is a recent memory. Education about childhood obesity is almost entirely absent in the country, as well.

The Mask of Love

Governmental interference probably isn’t the answer here. Currently, in America, a court can order parents to attend anger management classes or take other remedial measures to show they are worthy to raise their kids. But no one has figured out how to force people to be such good parents that their children will never experience psychological trauma or emotional emptiness.

Emotional problems lead to compulsive overeating, and the worst thing about that is, the problematic parental behavior is often disguised as love. To complicate the situation even further, the disguise of love is so effective that even the people who do the damage are unaware of it. The world is full of regrettably bad parents who honestly believe they are doing the best for their kids.

Your responses and feedback are welcome!

Source: “Childhood Obesity In China, A Rich Kid’s Problem,” WorldCrunch.com, 10/30/14

Image by James Creegan

Obesity’s Puzzling Questions

untitled

Can a mother make her child morbidly obese? Mothers are easily blamed for anything, rightly or wrongly, for reasons that seem obvious to those who do it.

Childhood Obesity News related the tragic story of morbidly obese Texan Hector Garcia, who died last month at age 49. San Antonio Express-News staffers Jessica Belasco and photographer Lisa Krantz had been shadowing him for 4 years, and their recent story included this information about a typical day in 2013:

His mother brought him food and took away the empty plates. For breakfast, it was two slices of toast, two eggs and bacon. For lunch, he ate what his parents ate: enchiladas, vermicelli, beans, hot dogs, hamburgers. For dinner, his mother … often brought him a box of 20 Chicken McNuggets from McDonald’s or other fast food he requested.

Not only mothers, but fathers, husbands, wives, and other caregivers seem like easy targets for blame whenever a story like this is publicized. An immobilized person who cannot move from the room somehow obtains endless amounts of food. Who can help noticing that there is only one channel? If the caregiver didn’t let the food in, it wouldn’t get in. Or at least, that is a conclusion many easily reach.

On the other hand, nobody can stay home every minute to stand guard over a situation. Caregivers have medical appointments of their own to attend, just like anyone else, and church, and shopping. They have other relatives and friends. They have emotional needs. The reporter asked Hector Garcia’s mother why she acquiesced to his fast food demands.

“They were the wrong things, but I would give in because I was so tired,” Elena said. If she tried to refuse his requests for food, her son would get angry.

Nobody likes to be yelled at or cold-shouldered, especially over something as stupid as chicken nuggets. And of course this is America. Since Hector Garcia was well over 21, that puts the ball back in his court. When a person has income from disability insurance, or from working at a home-based, telecommuting type of job, as he did, the paycheck can be spent in any legal way.

That includes sending out for pizza, and whether or not Garcia ever did, he would certainly be within his rights. In defense of his mom or any other caregivers, it could be argued that a reasonable person would see the economic sense in bringing home what her son wants — as long as he is going to get it anyway — rather than let him throw money away on delivery charges and tips. Married at age 14, Mrs. Garcia may have become sensitive to such unnecessary expenditures over the years, as she raised six children on very little money. The story notes:

His mother had to learn how to make food stretch, and the family ate the cheapest food available: Beans, rice, vermicelli, Kool-Aid, food cooked with lard … “I didn’t know anything about nutrition,” Elena said. If someone offered her a salad, she’d say she wasn’t a rabbit.

But that was years ago. Surely, by 2013, and with a 600-pound son, this particular mother had encountered opportunities to learn more about nutrition. To wrap up on a more optimistic note, there are many things that the modern parents of a young child or children can do to ensure against a future marred by crippling obesity.

Your responses and feedback are welcome!

Source: “A Life Apart: The Toll of Obesity,” expressnews.com, 12/27/14
Image by feifeilee
untitled (pizza)

San Antonio Sun Sets on a Tragically Obese Life

Sunset in San Antonio

Sunset in San Antonio

Reporter Jessica Belasco and photographer Lisa Krantz spent four years documenting the life of a morbidly obese man for the San Antonio Express-News. Last month, the task culminated in a lavishly-illustrated story after Hector Garcia, the subject of the story, died at age 49.

Always big, Garcia was treated as “less-than” by school bullies and grew up angry that while other groups are protected by a requirement for politically correct speech, the overweight and obese are still fair game for ridicule. Food was first a friend, then a crutch, during years when, according to Garcia, he didn’t know he was destroying himself. In his thirties he weighed more than 600 pounds, and belonged to the 6.3 percent of the American population known as severely obese. At some point he realized:

Even though the act of eating was enjoyable, the result was incredibly disastrous for me, and it made me unhappy.

He had gastric bypass surgery and lost hundreds of pounds, but reverted to his lifelong ways and gained all the weight back. He never fell victim to high blood pressure or diabetes, but suffered from arthritis, asthma, sleep apnea, and cellulitis. Unable to cope on his own, he moved back into his parents’ house. The weight had bowed his legs, and he tottered around on terribly damaged knees.

In order to qualify for knee replacement surgery, he decided to try weight loss again, this time with diet and exercise. He found a public swimming pool in which to walk and do other movements in the water, but getting out of the pool was such a strenuous, awkward, and humiliating performance that he almost gave up. Fortunately there was another pool with easier access. Eventually he shed more than 350 pounds.

But complications turned the expected two surgical procedures into four operations, and the year of enforced immobility and joint rehabilitation led to weight gain that brought him back near the 600-pound mark again. In addition to all the other physical, psychological, and social problems, he began to experience COPD, chronic obstructive pulmonary disease, as the fat kept his lungs from being able to obtain enough air. He described the sensation as similar to drowning, “a whole new level of helplessness.”

In the News

Now middle-aged and immovably ensconced in his parents’ home, Hector Garcia spoke of his room as a prison, and talked about how he was metaphorically chained to his chair. But the outside world was a cruel place where people looked down on him and laughed. He totally admitted to abusing food:

The first opinion people have of me is, ‘he’s fat and he’s undisciplined,’ and while that may be true, that doesn’t make me a bad person … If I had to paint you a picture of my life, it would be of a little kid behind the glass of a store, with his hands pressed up against the glass looking at the world go by.

He was in fact writing a memoir called “Life Behind the Glass.” Describing himself as lonely, solitary, and “the worse-case scenario,” he told the journalist-photographer team that he never remembered being truly happy in his entire life. Talking to the press, he hit all the notes:

Unfortunately, I can’t stop cold turkey. An alcoholic stops alcohol completely, drug addict same thing. I can never stop eating. I always have to have a little bit of that thing that I’m addicted to. That’s what makes it so hard.

Yes, hard. Very, very hard. But not impossible, especially for a patient who had twice managed to reduce his bulk to less than 300 pounds. In preparation for the knee surgery, he had attained a svelte 260. So he knew it was do-able, but apparently, even among all the misery, physical and mental pain, and forced dependence, he could not find the motivation to save his life. He went on record stating:

I know there’s no tomorrow for me. Failure means death for me.

This dramatic language is perhaps more suited to a soldier in the face of battle. Undeniably it takes enormous courage and almost superhuman feats of self-governance to overcome a set of lifelong, ingrained habits. But the expression of these sentiments in such a self-conscious and, some might say, self-pitying way, could raise the hackles of grown-up bullies who lack the compassion Hector Garcia sought. It could certainly rouse some merciless criticism to hear him call himself, “a knight in shining armor, except they don’t make it in my size.”

How do we, as a society, prevent today’s 5-year-olds and 12-year-olds from growing up into replicas of Hector Garcia?

Your responses and feedback are welcome!

Source: “A Life Apart: The Toll of Obesity,” expressnews.com, 12/27/14
Image by Nan Palmero

 

The Lizard Brain Chases the Dragon

Red Dragon

The “lizard brain,” the primitive tenant in a person’s skull, is easily fooled into thinking that just because something feels good, it is actually beneficial. As writer Jim Dickey (25 years sober) says:

While the concept is no longer fully embraced by most of the scientific community, the term reptile brain, lizard brain, or monkey brain was picked up in recovery circles as a way of describing the parts of the brain which are evolutionarily primitive and control our emotions, drives and urges.

Although more of a metaphor than an anatomical reality, the evocative image was adopted by Terrance Hodgkins, an addiction researcher with 14 years of sobriety. The primitive lizard, or base, brain falls for the cruelest trick played by addictors and addictogens. A user starts out thinking this will be the romance of a lifetime, but the honeymoon ends swiftly. Hodgkins notes:

A “virgin high” is the high you get the first time you take a particular drug. It is often much higher than anything you will ever get from that drug again … if you keep on using that drug, then it stops working, and won’t kill your pain any more … You end up still in pain, just feeding a habit.

With its low IQ and lack of sophistication, the lizard brain just doesn’t get it. It keeps on “chasing the dragon,” trying to recapture the ecstatic initial experience with a substance or behavior, but the first time does not return for a repeat performance.

Last time, we talked about a young man whose first night of drinking awoke an inner voice that said, “This is who we are.” He came to feel that his alcoholism was like another sentient being that shared his body. Hodgkins (who quit nicotine along with alcohol) mentions the same phenomenon, a voice that says things like “Why don’t we sneak outside and smoke a quick one?”

Sometimes, it is almost like we are two people, a split personality … sometimes, what the higher brain thinks is the opposite of what the lower brain thinks … I developed the habit of calling it “The Addiction Monster.”

The Lizard Brain Addiction Monster wants what it wants now, and does not give a fig about long-term consequences. Instant gratification is the only game in town. As Jim Dickey phrased it:

The short term goal is to give in to the addictive behavior, which conflicts with the long term goals of being happy, productive and experiencing love and companionship while living a life which honors our values.

Even though dull-witted, the reptile brain is at the same time dangerously clever. The Orange Papers website contains comprehensive lists of all the sneaky, persuasive, undermining things the Addiction Monster will say to the recovering addict — and say, and say, and say. Fortunately, Hodgkins also includes ways to overcome the reptilian tactics and ploys.

Still, we have to give the lizard brain its props for keeping us alive by, for instance, pushing air in and out while we sleep. And it tells us to eat food, without which we would starve. It must create this need, or the whole ball game is over before it even starts. Hodgkins writes:

Food is our first addiction … If we don’t get our fix, we start to experience withdrawal symptoms like stomach aches and headaches, and then we develop a snappy short temper, and feel weak and shaky. Then we will start feeling desperate, and start thinking about stealing or mugging someone to get money for a fix. And the longer we go without a food fix, the worse it gets. That sure sounds like a strung-out junkie to me.

Your responses and feedback are welcome!

Source: “Reptile Brain?,” Reptiledysfunction.org, undated
Source: “The Lizard Brain Addiction Monster,” orange-papers.org, 11/17/14
Image by rumpleteaser

Substance Love at First Sight

love at first sight

Under the current model (as set forth in the 5th edition of the Diagnostic and Statistical Manual) for what used to be known as addiction, unhealthy dependency has become measured on a graduated scale. “Substance Use Disorder” is rated by degrees ranging from mild to moderate to severe. The severity depends on the number of symptoms that are ticked off from a checklist.

Still, many authorities hold that addiction denotes not a difference in degree, but a difference in kind. According to this mindset, the spectrum paradigm is inaccurate, because while some people are not addicts, others simply are. Even with 30 years of sobriety, the term “addict” still applies. A person with this kind of dependency never graduates to non-addict, only to recovering addict. As Dr. Stuart Gitlow says:

…no such continuum exists. Those with addictive disease generally recognize that they are using in a manner that differs from their peers from the time of their very first use.

Here is a real-life example. Growing up, professional comedian Jayson Thibault was so repulsed by the drinkers in his family, his rebellion took the form of shunning alcohol. But when he went away to school, all that changed. He told an interviewer:

The first time I got buzzed, my freshman year of college, something in me went “This is who we are.”

The seeming allusion to a split personality is explained by Thibault himself:

I always hear the word “we”… There’s no “I”… It’s me and this disease, this other thing, that addicts just naturally live with all the time…
There’s half of me that is always looking for an excuse, and there’s half of me that knows better. One of them is always driving the bus, the other one is always the passenger. It’s just a matter of who I give the car keys to…

“This is who we are” was said by an alcoholic discovering his nature for the first time. Probably a similar admission is made by a person on first experiencing the pleasure-center-rewarding rush of gambling. And DSM-5’s comprehension of this reward mechanism is so all-encompassing, it even includes gambling. But not compulsive eating.

The hallmark of the human condition that was formerly known as addiction is the activation of the brain’s reward system, and DSM-5 recognizes this — except when it comes to food and eating. Many studies have shown that eating food undoubtedly and demonstrably activates the brain’s reward system. Like Thibault did with alcohol, compulsive eaters have discovered the deceptive temporary comfort that is available. Here is an interesting side note:

… intense feelings of romantic love affect the brain in the same way drugs like cocaine or powerful pain relievers do… The hypothesis was that love affected the brain in the same way many addictive drugs do, by targeting the “feel good” chemical in the brain known as dopamine.

With other substance and behavioral hangups, the person might very well be able to remember the “love at first sight” moment, the “this is who we are” moment. The difference is that the joy of taking in nourishment is something we all discover as newborn babies, and have always known. It’s too bad, in a way, because it would make a great survey question. But with food, that first moment of revelation was so long ago it can’t even be recalled.

Your responses and feedback are welcome!

Source: “DSM-5: New Addiction Terminology, Same Disease,” Drugfree.org, 06/07/13
Source: “#189: Catastrophic Alcoholic (@TheTeeb),” libsyn.com, 10/20/14
Source: “Romantic Love Affects Your Brain Like a Drug,” WebMD.com, 10/13/10
Image by justine warrington

The Brain and Its Rewards

Symbol

“The artist formerly known as Prince” changed his name to this symbol.

 

The human brain’s pleasure/reward center likes three things: dopamine, serotonin, and noradrenalin. Upon receiving those molecules, the pleasure center translates them into good feelings such as confidence, energy, pleasure, and euphoria. In his latest book, The Future of the Mind, physicist and futurist Dr. Michio Kaku explains what addictive substances do:

These drugs first penetrate the blood-brain barrier and then cause the overproduction of neurotransmitters like dopamine, which then floods the nucleus accumbens, a tiny pleasure center located deep in the brain near the amygdala. The dopamine, in turn, is produced by certain brain cells in the ventral tegmental area, called the VTA cells. All drugs basically work the same way: by crippling the VTA-nucleus accumbens circuit, which controls the flow of dopamine and other neurotransmitters to the pleasure center.

The limbic system has been a part of us since before modern humans evolved, and sometimes we call it the lizard brain. Its primitive and very necessary function is to make us feel good about doing things that are good for us. Because the lizard brain is so simple, it is easily fooled by the chemical con artists known as substances. What they do is “hijack” the limbic system and give us good feelings about doing stuff that is actually bad for us.

The Inescapable Parallel

A person may do something that provides good feelings, but which is harmful when seen from an objective viewpoint. It also taps into the age-old conflict between immediate gratification (yummy taste right now) and delayed gratification (healthy body for the rest of life). An example might be eating a plate of chocolate-covered bacon with a side order of cheese with cheese sauce.

Edible substances very easily provide good feelings. That meal delivers immediate gratification — it’s not like taking a pill, where there is a delay while digestion releases the effects. It’s more like mainlining a hard drug by shooting it into a vein. Even though its long-range effects are devastating, food consumption will very often perform as advertised, making us feel better right away. In fact, it acts just like those substances and activities that are recognized by DSM-5 as dispensing pleasure to the brain’s reward center.

While the admission is made that substances and activities can enslave people in this particular way, the word “addiction” is all but absent from the book of definitions. Like “the artist formerly known as Prince,” it changed its name while remaining the same entity. Currently, the accepted term for what laypeople still call addiction is “Substance Use Disorder” or SUD. It comes in three degrees: mild, moderate, and severe. Some authorities dispute this model, seeing addiction as an either/or proposition.

In “Food Addiction in Children,” Dr. Pretlow noted how easily children learn that the pleasure of eating is a quick fix for pain, stress or boredom. He went on to say:

As the children continue to eat to ease emotional distress, dopamine receptor changes presumably take place in their brains. Once significant dopamine receptor changes have taken place in their brains, the children are unable to cease the comfort eating – they are addicted. … The addiction to the pleasure of food appears to be on a continuum: overweight children would seem to be partially addicted; obese children fully addicted; morbidly obese children are likely in tolerance mode.

Strangely, food overconsumption is exactly the type of substance abuse that might most appropriately be seen as a spectrum. It can be mild, moderate, or severe. Ironically, though it fits the incremental “Substance Use Disorder” paradigm well, food addiction isn’t recognized by DSM-5.

Your responses and feedback are welcome!

Source: “The Future of the Mind: The Scientific Quest to Understand, Enhance, and Empower the Mind
Mkaku.org, 2014
Image by Nicholas Babaian

 

DSM-5, Scientific Advances, and the A-Word

Don't tell your mother

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
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