Tuesday, September 11, 2007

Obesity - maybe your stomach is depressed?

This has to be one of the most ridiculous comments I've read in a long time to describe obesity and it comes from Dr. Nora Volkow the director of the U.S. National Institute on Drug Abuse.

Dr. Volkow, in an editorial published in May in the American Journal of Psychiatry says 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"
She then goes on to compare obesity with drug addiction with food of course being the drug.

Yes, let's add one more stigma to obesity and label it a mental illness and compare the obese to drug addicts. Brilliant! Helpful! Oy!

You know what should be included in the Diagnostic and Statistical Manual V (the bible of psychiatric disorders) as a mental disorder? Quobesity.

Quobesity occurs when a person, just because they eat, believes that they are experts in all things obesity related. Side-effects include ridiculous editorials and quotations that often manifest as blog entries here.

The comparison of eating behaviours and drug addictions is certainly not a new one, but it does have a fatal flaw - how many folks do you know whose addictions only exist from 4pm onwards?

The vast majority of food addicts (chocoholics, carb-addicts etc) will report that their addictive behaviours and struggles with food only manifest from the mid to late afternoon onwards. It is an exceedingly small proportion of these folks who struggle all day long. The all day long folks, if they meet certain criteria, may indeed have a diagnosable psychiatric condition entitled binge eating disorder, however to reiterate, in my experience, the vast majority of bingers tend to only do so from the afternoon onward.

Those same folks, when taught to eat frequently, not skip meals or snacks and include foods helpful with hunger prevention tend to see their binging disappear, in many cases literally overnight.

If Dr. Volkow is keen to make changes for the up and coming new Diagnostic and Statistical Manual V (the bible of psychiatric disorders), might I suggest an exclusion criteria for binge eating disorder whereby the diagnosis cannot be given to an individual who skips any daytime meals or snacks.

For food addicts or binge eaters who might be reading this post - try this recipe to see if it helps minimize your addictive type behaviours. Worst case scenario you prove me wrong and you may indeed be a truly food addicted binge eater. Best case scenario, you regain control over what is most certainly a very frustrating and potentially demoralizing behaviour:

  • Breakfast within 30 minutes of waking, at least 350 calories with at least 15grams of protein
  • Eating every 2.5 hours with between meal snacks of 100-200 calories a piece with at least 8 grams of protein
  • Lunch of at least 300-400 calories with at least 15 grams of protein
  • Dinner of at least 400 calories with at least 15 grams of protein
  • For every hour of sustained exercise add an additional 100-150 calories that are primarily carbohydrate based.

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    1. - how many folks do you know whose addictions only exist from 4pm onwards?

      Um. Tons, actually. I have a family chock full of alcoholics, and the behaviour of having to have that after-work beer or post-dinner cocktail or repeating pattern of the the weekend drunk is extremely common. As are nicotine addicts who can quit smoking except for that one cigarette with coffee or those bummed smokes down at the pub when drinking with friends.

      Addictive behaviour that manifests in response to specific external cues is very common. I'm not necessarily arguing that food addiction is a real phenomenon, but if you want to refute it you are going to have to come up with a better argument than that.

    2. Anonymous5:46 pm

      Hi Doc,

      I've been following your guideline of small meals and snacks throughout the day. I've lost 10 pounds this year, and my boyfriend lost almost 25 pounds. It's really worked for us, and it wasn't even a difficult diet to follow. I made a big list of 100-200cal snacks (e.g. a cup of berries, an apple, yogurt) and made sure to buy these things when I did my groceries. Sometimes, I would even separate the portions right when I came home from the grocery store. I just wanted to say thank you for the great advice!

      I do have one question though. How do I encorporate more protein in my snacks?

    3. Glad to hear it!

      In terms of getting more protein in snacks there are two options - natural and supplements.

      Protein supplements (protein bars and such that you can buy in Supermarkets and health food stores) can be great. The ones I tend to eat are by a company called Bariatrix and they contain 150 calories and 15 grams of protein and are quite satiating.

      Going natural is often easy too - nuts are an easy option and studies on nuts show folks who consume nuts have dramatically decreased incidences of a number of chronic disease. Only thing about nuts is to ensure you don't go too high in calories or too high in sodium.

      Alternatively simply make sure you always combine your fruit with such options as yogurt and cheese.

      Legumes work too so things like hummus can be helpful as it's made with chick peas.

      Best regards and good luck,

    4. Anonymous6:47 am

      I agree that anyone who follows the eating pattern as described would enjoy healthy weight loss. I myself prescribe to the same pattern. The problem arises when despite fighting against it (all day from waking onward) the urge to eat cannot be controlled. I once used to smoke 2 packs of cigarettes a day and finally quit, I turned to drinking more and more until I realized I was losing control then got control, it turned to eating and this one, though I have had some success, is proving harder to beat. I am in fact quite physically active and feel very dedicated to living a healthier life - I do not eat artificial sweeteners, trans/hydrogenated fats, foods with nitrites, processed garbage foods or fast food. I don't make excuses that I am too busy to cook or prepare or plan. I am a member of the slow food movement. I eat organic... I simply struggle endlessly with the inability to stop myself from binging. Though this has improved with great effort, it still occasionally happens. I truely believe that I, and others I have encountered, have a deeply ingrained "addictive" personality. True, I don't believe this is the case with ALL people who want to lose weight, I see many people who fit your criteria of skipping meals and binging all evening, however, I cannot accept that addictive eating does not truely exsist at all.

    5. Just one real-world comment. Disclaimer first: I am not and have never been obese -- at my highest, my BMI was 27. Anyhow, here's the story: I have suffered with major depressive disorder all my life, and I have noticed a distinct difference in my eating habits when I am depressed and when I am not. When I'm depressed, I can't get enough sweets, particularly cake and ice cream. They actually DO make me feel better. Something to do with stimulation of dopamine in the brain? On the other hand, when I'm feeling well, I can eat small portions, and have found that eliminating grains and starchy vegetables and high-carb fruits has worked extremely well, and I have no problems maintaining my current weight, which is BMI 24.3. So for me, at least, there IS a connection between depression and unhealthy eating behaviors.