Addiction model for obesity

[worriedwell]

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It occurs to me that obviously, from a broad public health perspective, obesity is an evil to the health and welfare of western society.

I've heard and talked about obesity prevention and treatment loosely with colleagues and I happen to think that obesity, if treated appropriately can be curbed.

For example, if media portrayed obesity the way they have portrayed smoking, I believe that less young people would spiral into obesity.

I also believe the government could put financial pressure on foods that lead to obesity again similar to taxes on cigarettes.

But I am wondering what role that psychiatrists can play either on a large scale in the public health arena or more specifically in tailoring certain treatments for obesity.

I am wondering if people know what exists in terms or an addiction model for obesity, and whether it has merit in a subset of obese people. And given the dismal treatment options we have for addictions in general, plus the fact that food is essential for life, makes me wonder whether it is fruitless to pursue heavily this model. On the other hand, it does strike me potentially in many patients as a pleasurable circuit gone overboard in terms of overeating and subsequently becoming obese (but in a different way than bulimia).

Does anyone have any thoughts?

And of course I recognize that there are numerous physiologic, metabolic, endocrine aspects that go into obesity, but there is no reason to think that we can't as psychiatrists contribute to the research and improvement of obesity given the fact that at its nature the BEHAVIOR of put calories into one's body is a NECESSARY and fundamental component of obesity and thus I am surprised more psychiatrists aren't active in this area. Or are they?

 

[Anuwolf]

I've heard and talked about obesity prevention and treatment loosely with colleagues and I happen to think that obesity, if treated appropriately can be curbed. For example, if media portrayed obesity the way they have portrayed smoking, I believe that less young people would spiral into obesity.

The media is already discussing the obesity issues, Just that most people are still in denial that McDonald’s, Burger King or whatever the fast food restaurants that people go to are highly dangerous and will cause obesity. If you notice that theirs a new law that took place just recently stating that people cannot sue a restaurant for the reason of getting fat. Unfortunately you cannot help everybody who’s obese, just the ones who actually have an obesity addiction. A lot of people are too lazy to cook so they go to Burger king, McDonald’s, etc to avoid cooking and to get an already cooked meal.

I also believe the government could put financial pressure on foods that lead to obesity again similar to taxes on cigarettes.

That can help but I think that the government should pressure the farmers and local grocery stores to LOWER the prices of fruits and vegetables and all of their healthy foods. When you go back to your local grocery store checkout the fattening foods and the healthy foods, you’ll notice that the fattening foods are A LOT cheaper then the healthy ones. People do not have the kind of money that they use to so they get something cheaper. We need to LOWER the price of the health foods so that EVERYBODY can afford it.

But I am wondering what role that psychiatrists can play either on a large scale in the public health arena or more specifically in tailoring certain treatments for obesity.

The psychiatrist’s role can be of controlling the emotions of somebody who is over weight. People eat because they do not feel comfortable about themselves, They feel that nobody wants them.. This causes somebody to get depressed. The way that some people can demolish depression is by the satisfaction of food. The treatment could be to treat the depression and to treat it by building Self Esteem, which are the therapist’s jobs 🙂

 

[Solideliquid]

The media is already discussing the obesity issues, Just that most people are still in denial that McDonald’s, Burger King or whatever the fast food restaurants that people go to are highly dangerous and will cause obesity. If you notice that theirs a new law that took place just recently stating that people cannot sue a restaurant for the reason of getting fat. Unfortunately you cannot help everybody who’s obese, just the ones who actually have an obesity addiction. A lot of people are too lazy to cook so they go to Burger king, McDonald’s, etc to avoid cooking and to get an already cooked meal.



That can help but I think that the government should pressure the farmers and local grocery stores to LOWER the prices of fruits and vegetables and all of their healthy foods. When you go back to your local grocery store checkout the fattening foods and the healthy foods, you’ll notice that the fattening foods are A LOT cheaper then the healthy ones. People do not have the kind of money that they use to so they get something cheaper. We need to LOWER the price of the health foods so that EVERYBODY can afford it.



The psychiatrist’s role can be of controlling the emotions of somebody who is over weight. People eat because they do not feel comfortable about themselves, They feel that nobody wants them.. This causes somebody to get depressed. The way that some people can demolish depression is by the satisfaction of food. The treatment could be to treat the depression and to treat it by building Self Esteem, which are the therapist’s jobs 🙂

I eat when I'm hungry. Usually.

 

[Anuwolf]

I eat when I'm hungry. Usually.

I'm talking about Obese people.

 

[Poety]

I eat when I'm hungry. Usually.

I think she means "comfort food" 😛

Worried, there are a lot of studies currently going on between psychs and internists to address the biological and psychological basis of obesity. If this is an area of study you'd like to get involved in I think there's some eating disorder clinics you could do your electives in (if I remember, you're a second year resident is that right?) When I was interviewing, I ran across a couple of programs that have eating d/o studies/clinics, but they weren't wide spread, I tink they handled both AN, bulimia and obesity. In fact, I vaguely remember hearing about an obesity clinic, but I'm not sure. This would be an excellent specialty to get into considering many patients after gastric bypass require extensive ongoing therapy and treatment.

From what I've learned, you can actually specialize in this aspect of addiction (food addiction) I imagine getting involved now, would almost make you a pioneer in the field as well since as you stated there aren't as many guidelines for treatment options as there could be.

 

[Psyclops]

Wow, it must be a cold day in hell, anuwolf is making sense. It is true that veggies are super high priced, while fattening nutritionally devoid foods are cheap and plentiful. Part of the reason is that our government in its infinate wisdom, subsidizes corn, and not veggies, making corn cheap (think corn syrup in everything) and veggies remain expensive. This wouldn't be such a problem except we have way too much corn, we have so much in excess that we don't know what to do with it. We have started turning it into ethonol for gas but that is a zero sum game, no fossil fuels saved. This aren't my ideas, there was a book that came out recently, if you listen to NPR you might ahve caught the piece abou it.

Personally I think that the idea of stigmatizing the overweight, worriedwell, although it has some logic to it on a first grade level, hasn't seemed to be working so far. They are already looked down upon by almost every media production. Furthermore, we know it doesn't work for other eating disorders, if that the way you wnat to look at them.

But I agree, it's a big problem.

 

[Psyclops]

I just want to add, that it isn't just an obeisity problem, we are getting obese and malnurished kids because all they eat are the calories from corn syrup, without any vitamins or minerals.

 

[Poety]

I just want to add, that it isn't just an obeisity problem, we are getting obese and malnurished kids because all they eat are the calories from corn syrup, without any vitamins or minerals.

Which is exzctly why CN can only eat "veggie" nuggets instead of chicken nuggets - yeah they're more expensive but I'm not raising my daughter addicted to saturated fat and hormones

I admit, I give her the gerber beef stuff, but thats going to stop too - any moms out there with ideas on how to prepare babies food for the week? I'd like her to eat a mostly vegetarian diet with a good size portion of chicken and/or fish QD, I'm not convinced she needs all that beef and we all know good eating habits start NOW.

 

[Faebinder]

Corn Syrup.... the root of all evil..


Seriously... we feed corns to cows, pigs and chicken and then eat them.

We put corn syrups in soda drinks, salad dressings, mayo....

We use corn to make chips and bread starch, some breads...

We use corn oils (of bad quality a lot of time) to fry things like french fries, chicken.

Take an awful example like the very good spicy chicken sandwich from wendys.

Chicken.... ate corn.
Batter.... Modified Corn Starch.
Fried .... in corn oil.
Bread... HAS CORN SYNRUP IN IT! WHY?!
Mayo... Corn Syrup.

Make it a meal?

French Fries fried in corn oil.

Soda... corn syrup.


And so.... we all eat corn.

So tell me this... if we know we fatten animals by feeding them corns... why are we making all human food including corn? Lobbying against corn-in-every-food will be even trickier than lobbying against smoking...

Look at this webpage.. page 5... corn in everything.

http://www.wendys.com/food/pdf/us/nutrition.pdf

 

[worriedwell]

Personally I think that the idea of stigmatizing the overweight, worriedwell, although it has some logic to it on a first grade level, hasn't seemed to be working so far. They are already looked down upon by almost every media production. Furthermore, we know it doesn't work for other eating disorders, if that the way you wnat to look at them.

I'm think their is a difference between a concerted health information campaign by society at large that is embraced by media outlets (and awareness of disinformation) vs. "stigmatizing the overweight". The point I'm trying to make is that publically moving away from stigma on a "first grade level" and moving into a more adult, more intellectual, academic arena. Sure it may hurt overweight people's feelings if they are categorized as unhealthy, but in the grand scheme of things, that is a neccessary consequence of a campaign that is driven by focusing on decisions made by individuals and you have to paint those decisions as inherently wrong (because being overweight is without question medically unhealthy). Kids need to grow up thinking that overeating is bad and have it thrown at them from all directions. The same way nicotine is bad (well not really the same way, I know the analogy is flawed, but if your goal is really to stop overeating, for the greater good of your society, raising the stakes of overeating is a neccessary evil).

Of course, psychologists and psychiatrists will remain neccessary to help people cope with their feelings about how society views their obesity, etc, but its a different lense you look through when you are talking about policy and sociological phenomena vs. individual psychological health.

Just my opinion, and still thinking out loud, rather than having totally thought it through.

 

[Psyclops]

My bad, I thought you meant stigmatized, as opposed to PSA type campaign. sorry

 

[Milo]

But I agree, it's a big problem.

 

[Triathlon]

I am afraid our society is NOT going to get better, but worse. As many of you are aware being in the mental health field or even just in medicine, PEOPLE DO NOT CHANGE! They may modify their surroundings to facilitate an external force that causes a change, ie taking an antidepressant vs. solving the problems within your personal life/family, work, whatever. Or instead of exercising and controlling your diet, take a lipid lowering medication, or relying on the government or a family support group to care for you because you are "disabled". Now don't freak out I am not saying that nobody changes but for the most part this is the way it is. Now the angle I want to expose is the environment, people are moulded by the support system around them and they go about their day in the same way responding to the stimuli presented to them. I am hungry there is a fast food joint, problem solved. I am in a room with a super comfy couch I better sit in it. oh there is a TV with a bazillion channels I can sit here adequately stimulated for hours, I am hungry NOW I will microwave a hotdog or better yet just open a bag of chips, these are salty i better balance this out I need some sugar SODA mmmmm. Well I better have an entire meal "Look sitting within in arms reach is a telephone I can punch in some numbers tell the person my cc numbers and ding dong dinner." Or there is the working parents that don't "have time" for the kids so they buy the Fast and Easy meals marketed to kids. They call them on their cell phones kids when you're done chatting online make yourself some microwave mac and cheese.
This is the same scenario we all have heard it is quite cliche but also not innaccurate.
We are becoming busier because communication has become easier, as the technologies improve we get lazier why work when something will do it for you. When is the last time you rolled up a window with one of those spinny roundy handle things? basically we have eliminated almost all natural effort in our world.
The next time you are at the gym look around at how silly it all is. What would our ancestors think? you actually lift things that you don't have to? Why on earth would you walk on a conveyer belt? And you mean to tell me you spent 1500 dollars on a mattress? And the regular cotton sheets are just too uncomfortable so we had to get the high thread count.
Now this is an undeniable rant and rave session. I am very pleased with the comforts of our society and I enjoy not having to sleep on hay or having to go outside to pee. but seriously we need to take control of this Ease and break out of the mould we have to take initiative and create effort to build character. As psychiatrists I think we have a great opportunity to help people in this aspect. Will it do any good? For some maybe, but we are fighting an uphill battle. Obesity is an epidemic supported by the evolution of society and it will not get better until the infrastructure of american collapses and we hit hard times again. NECESSITY IS THE ULTIMATE MOTIVATOR!
Will it happen? Probably, Every great world power in the history of civilization fell.

Now are'nt I positive.

 

[Psyclops]

I am afraid our society is NOT going to get better, but worse.

Trizzle, this point I am not willing to cede. There are certain aspects that have gotten worse, but on the whole I think we are progressing. One aspect taht has gotten worse is our rampant consumerism. One area is food. As for can food be considered an addiction? I don't know, they have OA. And there are times when, using my N=1 sample here, I can't resist gourging myself on Thai food. I really feel that I can't resist it. It isn't all of the time, but sometimes. Know if I felt that way all the time it might be a real problem. I would think it might even be an addiction. The question then is, how does this develop? Does it develop? Is it purely biological? Or will eating certain foods trigger it? Or certain life experiences? Diathesis Stress anyone? Or the ever popular, blame resistant "chemical inbalance"?