Diet diary: The increasingly despairing battle against the bulge
The whopping increase in the number of obese and overweight people, from 857 million in 1980 to 2.1 billion in 2013, despite an information overload, unprecedented interest in this field and increased body consciousness is a paradox indeed. Even as the number of diets and weight-loss tools multiply, the battle of the bulge is nowhere near being won. Sadly, even co-morbidities associated with obesity are increasing rapidly and what is worse, are happening at lower BMIs (Body Mass Index) and even in people who are not overweight. Non-alcoholic fatty liver, polycystic ovaries (irregular menstruation) and impaired glucose tolerance are some of the common problems these days. Along with the rapid rise in auto-immune diseases and malignancies, it seems that the lifestyle disease burden is staring us in the face more than ever before. It seems logical to infer that the more we are trying to cap it, the bigger obesity is growing. Are we really eating that much more and getting so lazy that we are acquiring proportions that we have never known? It seems likely that there is more to it and we may be missing some key links. One, there may be a problem in understanding the nature of food we are consuming. Secondly, the growing epidemic may be due to what has been called “food addiction”, which is arising from the food we are eating. Food addiction, although controversial, has recently gained attention in scientific literature and falls into the realm of atypical eating disorders. It has been implicated in craving, binging and obesity. Its recognition may be useful in management of complications like diabetes, heart disease and other chronic conditions. Food addiction implies that there is a biochemical condition in the body that creates a physiological craving for specific food. This craving, and its underlying biochemistry, is comparable to alcoholism. Just as alcohol is the substance that drives alcoholism, there are substances that trigger a food addict’s out-of-control eating. It suggests that specific foods, especially those rich in fat and/sugar and/ salt are capable of promoting addiction — like behaviour and neural changes under certain conditions, the so called physical dependence. More recently even gluten (a protein in wheat and other grains) is being recognised to be among them. These foods seem to affect the same addictive brain pathways that are influenced by alcohol and drugs. Perhaps, eating carelessly, loading up on high fat, high carbohydrate and salt can also trigger hormonal imbalance, mood swings and lethargy, ultimately leading to chronic food addiction and piled up pounds. These foods although highly palatable are not addictive per se but become addictive following prolonged restriction or binge eating. These could be as diverse as refined carbohydrates, processed foods, cheese, chocolates, sugars and milk proteins. Such eating behaviour has been associated with increased risk of obesity, early weight gain, depression, anxiety, and substance abuse as well as with relapses in treatment. The relevance of food addiction may be path-breaking in the treatment of overeating and obesity, which so-far have been associated with eating disorders caused from emotional problems that could be treated by psychotherapy or counselling. While this may be true for many individuals who have used food to manage their emotions or deal with stress, the problem is more complex for the true food addict. The key feature of any addiction is loss of control. In food addiction, loss of control is manifested by either more frequent and or larger meals. Although anecodotal reports abound, few studies have been able to document addictive properties of foods meeting rigorous scientific criteria. However, recent findings suggest that it may also be the way in which foods are consumed (eg alternating access and restriction) rather than their sensory (taste, smell etc) properties that leads to addictive eating. In other words, palatable foods are alone not responsible, because even non-palatable ones can come to be desired and potentially overeaten. In animal studies, withdrawal from high-fat diets leads to neuro-chemical changes like those induced by withdrawal from drugs. There is also convincing evidence that bingeing on sugar induces behaviour and neural changes similar to those induced by drugs. Studies have further revealed that external stimuli such as cues, good or great smelling, looking, tasting, and reinforcing food stimulate seeking that food and modifying intake similar to that of drugs of abuse. Recognising and identifying food addiction may help treatment modalities for chronic food cravings, compulsive overeating, and binge eating that may represent a phenotype of obesity. Screening for food addiction has the potential to identify people with eating difficulties that seriously compromise weight management efforts.
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