Would obesity stigma decrease if we viewed obesity as a food addiction?

In order to combat rising incidence of obesity worldwide, public health campaigns have focused on the negative health consequence of obesity, including heart disease, type 2 diabetes and cancer. Obesity is viewed as a public health threat with global health officials often promoting the view that lifestyle changes, such as consuming more fruits and vegetables and participating in more physical activity, can significantly reduce obesity risks. Although these campaigns have good intentions, their message tends to strengthen the view of obesity as a result of an individual’s “choice” and its only solution is once again dependent on an individual’s decision to change her or his unhealthy lifestyle.

By discrediting biological and environmental factors, it is not surprising that obesity stigma has been increasing worldwide. A recent New York Times article highlights the “globalization of fat stigmatization.”  The article focuses on a survey completed by 700 individuals in 10 countries (US, American Samoa, Tanzania, Mexico, Puerto Rico, Paraguay, Argentina, New Zealand, Iceland, UK), which found negative attitudes towards overweight individuals in all of the countries. Most troubling is that cultures historically more accepting of larger bodies, such as American Samoa and Puerto Rico, responded similarly to the other countries. Although this study has its limitations, including a relatively small sample size and not including Arab and Asian cultures, it still highlights the pervasiveness of fat stigma throughout the world. The view of obesity as an individual “choice” that can be corrected through diet and exercise appears to doing more harm than good. But, what is the alternative?  Is it better to view obesity as a food addiction rather than an accumulation of poor lifestyle choices?

Recent research provides evidence for a possible association between addiction and obesity. Researchers at Washington University at St. Louis are exploring the relation between obesity and addiction in families. The National Longitudinal Alcohol Epidemiologic Survey includes 40,000 American adults questioned about alcoholism in their families both in 1990-1991 and 2001-2002. The earlier survey found no relationship between family history of alcoholism and obesity. In contrast, the 2001-2002 survey found adults with a family history of alcoholism were 30-40% more likely to be obese compared to those individuals with no family history of alcoholism. The risk was higher for women who were 50% more likely to be obese compared with women with no alcoholism in their families. Most importantly, these results remained significant after controlling for other variables, including smoking, alcohol intake, age, and education. The authors propose this change is likely due to changes in our food environment, including the increasing access to foods high in calories, fat and salt or “hyper-palatable” foods. The first author Richard Grucza, PhD hypothesized that, “as Americans consumed more high-calorie, hyper-palatable foods, those with a genetic risk for addiction would face an elevated risk because of the effects of those foods on the reward centers in the brain.”

Further supporting the view of the neurological similarities between eating behaviors and addiction is a recent study examining the relation between food addiction symptoms (assessed by the Yale Food Addiction Scale (YFAS)) and neural activation (measured via functional magnetic resonance imaging). In this study, food addiction scores and neural activation were measured in response to cues signaling delivery of a highly palatable food (chocolate milk shake) vs. a tasteless control solution and actual consumption of these products in a sample of 48 healthy young woman (weights ranging from lean to obese). The authors write,

“Elevated food addiction scores were associated with greater activation of regions that play a role in the encoding of motivational value of stimuli in response to food cues. The anterior cingulate cortex (ACC), medial orbitofrontal cortex (OFC) have both been implicated in motivation to feed and to consume drugs among individuals with substance dependence. In sum, these findings support the theory that compulsive food consumption may be driven in part by an enhanced anticipation of the rewarding properties of food. Similarly, addicted individuals are more likely to be physiologically, psychologically and behaviorally reactive to substance-related cues.”

The question still remains if a worldwide shift from viewing obesity as a set of unhealthy personal choices to obesity as a food addiction would be destigmatizing. Although individuals with substance addictions are not often viewed in a positive light, society in general has recognized both their psychological and physiological struggle with the drugs they abuse. We just don’t expect an alcoholic battling a thirty year addiction to wake up one morning and put down the bottle forever. So why do we think it would be any easier for an obese individual with a long history of eating highly rewarding foods to stop without proper treatment and support? Maybe this new view will help, but maybe it won’t. The good news is it’s an empirical question. And with obesity stigmatization increasing steadily throughout the world, isn’t it at least worth a try?

~Danielle Gagne, Research Assistant

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