Obesity as a brain disorder

As the new year has begun and many people have vowed to lose weight as their resolution, the topic of weight loss and obesity are up there. But then again, do they ever go away? I can't count how many ads I've heard on the television and radio about joining this gym or that gym, trying this weight loss plan, etc. However, on a completely different slant, I came across an interesting editorial in The American Journal of Psychiatry, entitled "Should obesity be included as a brain disorder" by Drs. Nora Volkow and Charles O'Brien. They were addressing this question as an inclusion into the new DSM-V proposed to be published in 2011.

Drs. Volkow and O'Brien propose "that some forms of obesity are driven by an excessive motivational drive for food and should be included as a mental disorder in DSM-V. DSM-IV recognizes eating disorders such as anorexia and bulimia as mental disorders with severe impairments and serious adverse outcomes but does not recognize obesity despite its devastating medical and psychological consequences. Obesity is characterized by compulsive consumption of food and the inability to restrain from eating despite the desire to do so. These symptoms are remarkably parallel to those described in DSM-IV for substance abuse and drug dependence (Table 1), which has led some to suggest that obesity may be considered a "food addiction" (5).

They go on to talk about the similarities of the brain regions of those with obesity and substance abuse dependency which is essentially the drive for rewarding properties. That in effect affects dopamine, though in different ways from the substance abuser. They also point out how the medications used for both substance and obesity often overlap.

In their conclusion, they do point out that this classification is a component at looking at obesity as a mental health disorder which is not completely inclusive to everyone.

I think this is an interesting take on obesity and could be true for some people. Dr. Volkow is likely to take this approach since she is an addictions specialist. She was featured in the excellent HBO documentary "Addiction." I thought her explanation about how addiction works was very educational. If you haven't seen this, I highly recommend it.

This editorial was written last May, and in the current issue a psychologist rebutted her thoughts. She also had some interesting things to say, including how from her experience the "health at every size approach" has worked in her practice. This approach is about not dieting, tuning in to your hunger signals, and accepting your size. Drs. Volkow's and O'Brien's also addressed the psychologist and defended their editorial in this issue.

Personally, I think it is an interesting way to look at obesity. I do not think all people who are obese would fall into this category as Dr. Volkow suggests, but it does give explanations into the "drive to eat" just as those with anorexia nervosa have a drive to restrict their food intake or not to find food as pleasurable as some recent studies have proposed. I think with addiction, there is a lot of overlap whether it is to food to illegal substances to an eating disorder if you believe an eating disorder can also be classified as an addiction, etc.

My only issue with so much studying of the brain going on and different illnesses is that people will just blame their brain and forget accountability and responsibility. Don't get me wrong, science is really in its infancy of studying the brain and how it works, but there has to be balance. But the more information we have, the more society can be helped educationally.

Just to point out, there is also an article about binge eating disorder and treatment as well in this current issue.