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.