Addiction is a dependence on a substance that the affected individual feels powerless to stop. Millions of Americans have addictions, and food addiction is among one of the most common. Studies, in collaboration with bariatric psychologists, Drs. Moorehead and Ardelt, found that nearly 80% of gastric bypass pre-surgical patients suffer from food addiction. These studies, along with those of other investigators, also found that the behavioral biochemical causes and effects underlying food addiction are nearly identical to those of other self-destructive addictions.

Turning to Food to Cope with Feelings of Low Self Worth

One of the most common behavioral characteristic of individuals suffering from self-destructive addictions is a feeling of not being good enough. Feelings of low self worth, in turn, may cause a poor self image, low self esteem, depression, anxiety, a need to overachieve and an intense and chronic fear of failure. Professionals who study addictions believe that society contributes to the development of addictions by establishing unreasonable or unreachable criteria for worthiness. The "addict" not only has negative feelings regarding self but also has failed to develop appropriate stress coping. Instead of confronting life stressors directly or finding healthier ways to manage emotions such as through exercise, journaling, relaxation, spiritual care, therapy etc., the "addict" seeks to avoid unpleasant feelings by eating, drinking alcohol, smoking, using drugs, gambling and various other ways of escaping from reality.

One collaborative study found that more than 90% of pre-surgical morbidly obese patients use avoidance stress coping behavior to handle emotions, seeking comfort from negative feelings and stressful situations through the use and sometimes the abuse of food. There are strong associations between avoidance coping behavior, food addiction and lack of control over eating. Most food addicts feel that they have no control over their addiction in spite of having complete knowledge of its negative social and health consequences. They recognize the adverse effects the addiction has on friends, family, and self, but feel powerless over such behavior. This generates feelings of guilt and remorse thereby worsening the addictions and setting in motion a vicious cycle of avoidance and abuse. Negative feelings toward self, remorse, guilt and inappropriate stress coping behavior may cause neurochemical changes within the brain that adversely influence mood and cause a physical dependency for the addictive substance. These neurochemical defects occur in the limbic system of the brain, the area of the brain that controls mood and basic functions such as eating.

The Body's Stress Response

When individuals are confronted with stressful situations, specific hormones are produced, which help the body to cope with the situation. One of the body's stress response pathways, known as the limbic-hypothalamic-pituitary-adrenal (LHPA) axis, generates a series of brain hormones that eventually lead to production of cortisol by the adrenal gland. Cortisol helps to make available more sugar to the brain and other parts of the body to help cope with the stressful event. Individuals who are under chronic stress (including those who have constant negative feelings of self) have an overactive LHPA axis. Hyperactivity of this axis has been reported in individuals who are obese as well as alcoholics, drug users, smokers and victims of early abuse or trauma. Elevated cortisol levels on an ongoing basis are not only harmful to health, but also harmful to mood. It can cause depression. It also affects mood by interfering with the actions of one of the brain’s major messengers, serotonin. Serotonin defects cause depression and anxiety. Many alcoholics, smokers, drug addicts and obese individuals suffer from depression and anxiety. Nicotine, alcohol and certain drugs increase serotonin activities and temporarily improve mood. These addictions are a means of self medication.

Food as "Medication"

Carbohydrates also raise serotonin levels and enhance mood temporarily. Studies have found that the majority of individuals who are obese crave carbohydrates. Low serotonin and stress induced activation of the LHPA axis are also known to increase the risk for substance abuse and food addiction through another feel good pathway, the dopamine reward system. The pleasure derived from substances such as alcohol, nicotine and certain drugs are, in part, due to the stimulation of dopamine. Eating foods high in sugar, fat or even the smell or taste of an individual’s favorite food activates the dopamine reward system, producing pleasure and satisfaction. Frequent use of addictive substances, such as nicotine, alcohol and food, reduces the pleasurable effects of the dopamine reward system so that more and more of the substance is required to derive satisfaction.

Recent studies found that obesity can be associated with defects in dopaminergic responses to the smell and taste of food. It may be possible that some obese individuals may eat more and more food to increase dopamine activities and improve mood. Abstinence from the abused substance helps to reverse or improve many neurochemical defects associated with addictions. Bariatric surgery, by reducing the amount of food intake, and enhancing mood through weight loss, is effective in improving neurochemical defects contributing to the addictive behavior. However, such improvements can be short-lived. Food cravings as well as depression may reoccur over time, along with weight regain. The behaviors responsible for initiating the cascade of events leading to such defects are not resolved by the surgery. Low self worth and poor stress coping skills must be addressed for these issues to resolve.