(More) notes on food addiction

Quite appropriately, stories have been cascading out of the media since April 4, when researcher Ashley Gearhardt, a post-doc at Yale, and her colleagues released a study that correlates people who scored high on a food-addiction questionaire they developed with increased brain activity when given food cues.

"It's the first study to ask whether a paper-and-pencil checklist for food addiction correlates with brain regions known for drug reinforcement," said Mark Gold, University of Florida chairman of psychiatry and a prominent addiction researcher who wasn't involved in the study.

That quote is courtesy of Kevin Helliker, writing in the Wall Street Journal. Going to Mark Gold for comment on addiction is evidence that Helliker knows what he's doing. I admire Gold's work and accomplishments greatly.


Gold's next comment illustrates very well why I wrote "Fat Boy Thin Man," and why it's a-scientific approach adds to general understanding of food addiction.

Dr. Gold said such a checklist could be valuable for individuals considering gastric bypass.

My inference from Gold's comment is that people who score high on the checklist are less-appropriate candidates for surgery because they have deeper causes for their obesity than "regular" overeaters. But if he is, I think he has it wrong.

From my perspective, any sort of weight-loss surgery is only a physical solution. It has the potential to dramatically reduce the physical threats — Type 2 diabetes, heart disease, cardiovascular stress, joint pain, etc. — attributed to obesity. But the surgery cannot touch the reasons why a patient got to be so large, whether it is food addiction or some other driver. In addition to the physical intervention, patients need to change their behavior if they want to avoid returning to where surgery airlifted them from.

Meanwhile, surgery isn't the only way to reduce body size. It may be the best option for patients at high immediate risk of obesity's ills, but I know many people like me who have reduced weight and kept it off without having the surgery. So my conclusion is that whether one is a food addict, and whether one would benefit from surgical intervention for obesity, are not related.

But even Mark Gold, possibly the most accomplished addiction authority alive, seems to think they are. That illustrates how far we are from public understanding of the very complex thicket of obesity, addiction, and their remedies.

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