I sat in on a session that addressed the question “Can people get addicted to palatable food?”. It was led by Gene-Jack Wang, MD and Karen Beerbower, MS, RD, LD, CEDRD. Dr. Wang presented a series of research findings associating reduced dopamine receptor levels/activity and food addiction, and Karen gave a clinical perspective on the research and how it impacts RDs. Just more evidence that weight issues are extremely complex and treatment requires: a thorough assessment, a complete care team, and a lot of hard work on the part of the patient/client and dietitian.
Here are the highlights of the session:
What Does the Research Say?
- Dopamine is a neurotransmitter that helps regulate our feelings of reward (in terms of food this might mean receiving pleasure from eating)
- The studies he shared showed evidence that people with higher BMIs to have lower levels of dopamine receptors (holds true for rodents and monkeys too, not just humans).
- Having more receptors would mean you feel a “high” feeling, so without those receptors you need more stimulation to feel “reward”
- Drug users and compulsive overeaters have both been shown to have lower levels of these receptors — this keeps them going back for more drugs/food
- This gives evidence that it’s more difficult to fight impulse when you have fewer dopamine receptors
What Does it Mean for RDs?
Karen made so many great points — this is just further evidence that weight/eating issues aren’t simple, and treating them doesn’t take a simple answer. And she was absolutely right in saying there’s a reason why the diet industry is thriving and has a 97% failure rate.
Diets don’t work, and change takes time and hard work, there is no magic pill. Therapists are given leeway in their counseling to take weeks and weeks to get to know a patient, but dietitians are sometimes expected to give the diagnosis and treatment in 1 session. We need to work to set the expectation that addressing issues like binge eating disorder takes a complete care team, including a therapist, and requires a time commitment of months or years (consistently), not 1 time per month (occasionally).
My opinion: As RDs working in “weight management” capacity, even if you don’t work with people with eating disorders, it is important to understand how to identify/screen for possible eating disorders and refer out if you do not work with that population. As someone who does, please do not “fly solo” and try working with them until you have sharpened your training and experience. Remember “do no harm”.
Jessica Setnick’s Eating Disorder Bootcamp Home Study is a good place to start. I also encourage you to attend the 2013 Binge Eating Disorder Conference in Bethesda, MD. I’m speaking along with a list of fabulous RDs for an entire day dedicated to the RD role in treating binge eating and compulsive overeating.
Filed under: nutrition Tagged: | eating disorders, fnce, food addiction
Glad you enjoyed the conference. For many years, it was difficult to understand the relationship between food and addiction. The great news is that there are new research tools to study the impact of substances like food products on the brains reward center as well as the main impulse control center, the prefrontal cortex PFC. Through the use of PET and fMRI scans, you can indeed note the decrease in dopamine receptors as well as damage and impairment of function in the PFC. What does this mean in practical terms? It means that food addiction is real and that there is a validated quiz created by Yale U researchers to help consumers determine if they have an issue. http://www.drpeeke.com/PopQuiz.htm This new science is a game changer. You’re right when you say long gone is the traditional diet mentality and therapy. Instead, now there is need for science-based detox and recovery like any addiction. There’s a new textbook for professionals called Food and Addiction edited by Gold and Brownell. To complement this, I have authored a consumer book THE HUNGER FIX, which was launched on Katie Couric’s new show Sept 21st, then featured on Good Morning America and Nightline. Men and women are relieved and becoming enlightened about what has happened to their reward systems and applying the science-based tools to resolve their condition. Thanks for your blog and educating your peers about this exciting and promising new science field.
Pam Peeke MD, MPH, FACP