Addiction among the Morbidly Obese
Evaluating an Individual’s Treatment Needs
Those Struggling with Their Weight
It’s helpful to picture a simple Venn diagram when thinking about morbid obesity and drug addiction. Picture about 80 million American adults occupying the circle representing obesity in the US. Now picture about 20.8 million Americans, aged 12 and older, occupying a circle representing the estimated number of people who have experienced a substance use disorder. Put those two circles together and a shaded area would emerge to reveal the number of Americans who are experiencing co-occurring obesity and a substance use disorder. Research has not clearly revealed that number, but it is significant.
The co-occurrence of obesity and a substance abuse disorder is a complex matter. Research studies continue to consider the link between the two disorders while still trying to understand each. For this reason, a discussion of obesity and substance abuse must necessarily look at factors involved in each, then their interaction, and ultimately how to treat each and both at the same time. The good news is that recovery from both conditions is possible.
About Morbid Obesity
Morbid obesity can be measured scientifically, though it is an estimate at best. To measure the amount of fat, muscle, and water in the body, medical and other health professionals rely on taking a person’s body mass index (BMI). People who have a BMI higher than 35 are considered morbidly obese.
For individuals who are morbidly obese, their health is a main concern. The following is a list of some of the possible health risks:
- Type 2 diabetes
- Metabolic syndrome
- Reproductive problems
- Heart disease and blood lipid abnormalities
- Sleep apnea (periods during sleep when a person stops breathing
Obesity is a growing public health concern. The following obesity statistics reflect the extent of the issue:
- Of every three American adults, more than two are medically deemed overweight or obese.
- Of every three American adults, more than one is medically deemed obese.
- Of every 20 American adults, more than one is medically deemed to have extreme obesity.
- Approximately 33 percent of children and adolescents in the 6-19 age group are medically deemed to be overweight or obese.
According to the Obesity Society, obese individuals may be subjected to recurring negative social consequences solely based on their appearance. In recent years, some Americans have pushed back against weight stigma through the Fat Acceptance Movement and other efforts. The concept of “thin privilege” has also come to the fore and helped to point out that praising thinness is embedded in stigmatizing larger bodies. In view of these helpful social actions, perhaps the American psyche will shift from seeing bodies in terms of weight to seeing them more appropriately in terms of health.
In a paradoxical way, ending weight stigma may actually help people to achieve a more optimal weight. The stigma is a factor fueling in the obesity epidemic. Still, an even greater societal goal to achieve is to stop seeing people in terms of bodies. To that end, consider a quote from former Harvard Psychology Professor Richard Alpert: “Let’s trade in all our judging for appreciating. Let’s lay down our righteousness and just be together.”
The health concerns around morbid obesity compel the medical community, and society at large, to question the causes. The following are some of the many potential causes or factors involved in weight gain:
- Medications, including some antidepressants, can lead to weight gain.
- Certain medical conditions like hypothyroidism, if left untreated, can lead to obesity.
- Per research studies, the way individuals store fat relates to genetic factors.
- Behavioral factors are always relevant and include a person’s eating habit, level of daily physical activity, and meal planning.
- Lack of sleep, stress, and anxiety can cause weight gain.
- Overeating may itself be an addiction.
Obesity and Drug Addiction
A laboratory rat study discussed in Scientific American illuminates the potential link between obesity and addiction in the brain. Rats were provided with two food group options, one bland and the other rich in fats and sugars. The rats nearly exclusively opted for the food group rich in fats and sugars (akin to what Americans would call “junk food”). But there was an important twist. While the rats were eating the junk food, the researchers would ping one of their feet with an uncomfortable electric current. Despite the shock, the rats would continue to eat the junk food.
The research finding supports that the pleasure associated with eating junk foods outweighs the pain involved in doing so. From a neurological standpoint, the brain’s reward system won out. Perhaps this experiment explains, at least in part, why humans will continue to engage in unhealthy food behaviors despite full knowledge that they may experience pain or regret later. This same mental calculation – an acceptance of pleasure with full knowledge that there will be pain later – is also at play in substance abuse.
An informative TedMed talk further highlights how the process of becoming addicted to food may be similar to that of becoming addicted to drugs. When humans consume foods rich in fats and sugars, they experience a rush of dopamine in the brain’s reward system. A similar neurobiological process happens when people abuse drugs. The body also builds a tolerance to fatty and sugary foods like it does to drugs. In other words, a person will require more fats and sugars, over time, to get the familiar and desired pleasure from the food. In fact, one brain scan study showed that the brains of morbidly obese individuals were similar to the brains of people addicted to cocaine.
According to the Obesity Action Coalition, alcohol use disorder and obesity may be more intertwined than previously thought. Alcohol breaks down to ethanol in the human body. Research shows that ethanol is active in the brain’s reward system in a way similar to how salt, fat, and sugar operate. In 2011, a Washington University School of Medicine in St. Louis study found that people who have a family history of alcohol use disorders face an increased risk of developing obesity. A possible explanation is that family members may share genetic factors involved in addiction but one will abuse alcohol whereas another one will abuse food. The addictive behavior is intact; it’s just the subject matter of the addiction that is different.
It is important to bear in mind that even if a person has genetic factors involved in addictive behavior, the environment exerts a considerable influence. Unfortunately, Americans have extensive access to fatty, sugary, salty foods, alcohol, and illicit drugs. In view of the enormous power and wealth of the institutions that profit from the sale of these items (legal market and black market), access will most likely remain. The key then is for individuals to self-moderate.
Learning about how to overcome the genetic and environmental factors involved in food and drug abuse is a first step. Again, research makes clear that once a person has consumed a fatty or sugary food, or continually taken a psychoactive drug, the brain will send prompts to consume more of the food or drug. Abusing drugs and/or foods is like being on a rollercoaster, and trying to stop might feel like jumping out of one’s seat mid-air. Treatment can stop the rollercoaster and help a person make an empowered exit.
Treatment for Addiction among the Morbidly Obese
A research essay on obesity and drug addiction treatment published in the Journal of Addiction Medicine found that several of the same treatment methodologies (with some tailoring) could work for both obesity and drug addiction recovery. Those therapies include but are not limited to:
- Behavioral therapies
- Cognitive therapies
- Self-help groups (e.g. Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery, and Overeater’s Anonymous)
According to the researchers, it is no surprise that similar therapies work because of the similarity in behaviors underlying both types of abuses, such as:
- Acting compulsively
- Continuing to abuse food, alcohol, or another drug with knowledge of the impending, adverse consequences
- Experiencing diminished control over oneself vis-à-vis food, alcohol, or other drugs
- Having an appetitive urge for food, alcohol, or other drugs
- Feeling stressed
- Attempting to cope with stress by abusing food, alcohol, or other drugs
Individuals who are experiencing co-occurring obesity and a substance use disorder require treatment for both disorders. An addiction recovery program can provide a diagnosis at or shortly after admission. It is imperative that a professional, such as a doctor or addiction specialist, assess an incoming client to determine the type of substance abuse and eating disorder that is at issue. There may be different treatment tracks available, depending on the types of abuse present. For instance, pharmacological therapies (i.e., medications) are used for recovery from some types of drugs of abuse and not others. Therapy, a main staple of recovery programs, can address all types of substance use disorders and eating disorders.
A recovery program will tailor the therapy type and sessions to the specific needs of the individual client. In some instances, a recovery program will have the expertise to provide treatment for the co-occurring disorders in one facility. In other instances, the center may need to coordinate with a local obesity specialist, clinic, or hospital to provide the specific type and level of care that is needed to treat the obesity.
- Mutual aid groups or fellowships: These include resources like Overeaters Anonymous, Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery.
- Obesity Action Coalition: This organization provides online resources to help individuals dealing with obesity to find support groups and to network.
- SAMHSA helpline: The Substance Abuse and Mental Health Services Administration has a national helpline that operates for free 24/7. An agent can provide a referral to a treatment center and other helpful information. The number is 1-800-662-HELP (4357).
- Legal aid societies: Most states have a legal aid society that will provide free or low-cost assistance to individuals who are facing discrimination in violation of the law due to their status (e.g., as an obese person or a person in recovery from substance abuse).
- COAST: The Center for Obesity, Assessment, Study and Treatment (COAST) at the esteemed University of California, San Francisco, often has information on cutting-edge treatment options for obesity. COAST may also have recent information on current or recent studies that evaluated both obesity and drug addiction.
- Yoga: As The New York Times discusses in an article about yoga and obesity, yoga studios across the nation are offering classes tailored to this demographic. Numerous studios across the nation offer specialized yoga classes – for all body types – for individuals in recovery from substance abuse.