Obesity is the largest health problem currently faced by the United States and many other countries around the world, no pun intended! In 2018, 42% of US residents were considered obese. This means their body mass index (weight in kilograms/height in meters2) was > 30. What’s worse is that those numbers are rising! Between 2000 and 2018 obesity rates rose from 30% of the population to 42%. The numbers continue to climb out of control and the COVID-19 pandemic appears to be accelerating things. Pretty soon, half of our country will be obese! Since 1975 the amount of obese people in the world has tripled according to the World Health Organization. Children are disproportionately becoming more obese than adults, highlighting the potential dismal future we are facing. Since obesity is now affecting much of the world, it is more appropriately described as a pandemic!
Obesity is a complicated medical issue. It is the underlying driver of many of our biggest health problems. Obesity causes both cancer and heart disease. The two leading causes of death in the United States and many other developed nations. Obesity also causes diabetes, sleep apnea, difficulty breathing, arthritis, inflammation, and a host of other health issues. Additionally, I have noticed in my clinical practice that obese patients tend to have much greater problems in combating COVID-19 infection. Obesity represents an inflammatory state that leads to numerous disease states, making us less fit to fight infection, and it is literally killing us. Remarkably, when obese patients lose weight, many of these health problems get a lot better or go away entirely. So why is it so hard for people to lose weight? I believe it is because they are actually addicted to high calorie foods as well as access to eating.
Bringing up obesity is not easy to do with patients. I find that many people are immediately defensive about their weight. When I ask people about food, many reply with “I starve myself”. When I ask about exercise, many reply “I am too busy, too tired, or it hurts too much”. When I ask about mental health, I typically uncover underlying triggers and stresses. I notice a lot of denial regarding food intake and behavior. The behavior and denial I have observed in so many obese individuals is remarkabley similar to the patterns I have observed in those addicted to drugs. For this reason, I have come to view obesity as an addiction to calorie rich food. This paradigm allows me to make sense of the difficulty patients face in combating their obesity. It has also allowed me better treat the complex and comorbid condition of being severely overweight or obese.
To highlight food's potential as an addictive substance, let's think about tobacco, and its principle ingredient, nicotine. Tobacco is both chemically addictive and habit-forming. After being exposed for a small period of time, we start to crave nicotine, which hijacks our brain's reward system and controls our actions. Many people also enjoy the routine of having a cigarette as well as having something in their hand. This represents the habitual component. Anything in life that brings joy and pleasure, or even things we are required to do everyday can be habit forming. When our habits negatively affect our life and health, and we are unable to readily quit them, I call this addiction. It's that simple for me.
High calorie foods essentially do the same thing that tobacco does. They hijack our brain's reward system and leave us always wanting more. That donut brings pleasure, we have all felt it! To me it is no different than that alcoholic beverage you crave at 5pm. What’s worse is that food intake is already habitual by necessity and we are blasted with cheap, high calorie, low nutrient foods, that our brains seem to love. Fifty years ago, smoking commercials were normal on television. However, as tobacco is so addictive and adverse to health, these advertisements have now been removed. Now what I see are fast food advertisements hammering us with commercials late into the night. Juicy 1,000 calorie cheese burgers, french fries, and ice cream shakes make so many want to jump in the car and swing through the local drive-through. Just like cigarette ads, these commercials prey on an addicted population. Just like cigarettes, they compel our addicted brains to take action now, against our better judgement.
Obesity along with polypharmacy, represent some of the most serious health concerns currently faced by the United States. Only environmental health factors, like clean air, and social factors, like education, represent public health issues of greater importance. Education is profoundly linked to obesity. The more education one has, the less likely they are to be obese. These public health crises all seem to be linked together into a complex web of unhealthiness. It is time for our society and the healthcare industry to take aggressive action against these problems. Sadly, drugs and obesity make the healthcare system tremendous amounts of money and incentives are not well aligned to combat these epidemic problems. What I can say is that if you are not bringing up obesity early and often as a provider, you are doing your patients a great dis-service and cognitively enabling patients to continue their destructive behavior. “My doctor didn’t mention my obesity but started a blood pressure medication.” This should be a never event!
Think about obesity rationally. This may help you understand why it is hard for me to attribute obesity to anything but addiction for the majority of obese individuals. Being obese sucks. People are unhappy, unhealthy, and cannot do the things they love. Anybody who is obese will tell you this. They will tell you that they desperately would like to lose weight. However, they simply cannot stop eating tremendous amounts of calories everyday. People develop horrible health issues like blindness, erectile dysfunction, heart disease, cancer, and loss of limbs. But yet they cannot stop. We put people on numerous drugs to help treat problems and reduce the risks that obesity has caused. We do surgery on people's stomachs to mechanically prevent them from over-eating. We literally spend hundreds of billions of dollars a year on obesity-related medical problems in the United States alone. We do all of this in spite of the fact that there are simple, free, and life improving strategies like diet and exercise readily available. When people actually cut out calories and exercise, they lose weight, and that is a fact! For some it may be harder than others, but still holds true.
It is hard to understand why people continue to destroy their bodies with tobacco, alcohol, methamphetamine, and other harmful substances unless one understands addiction and the powerful control it has over our rational minds. It is equally hard for me to understand why people continue to eat in spite of all the negative social and health related effects obesity brings. Under the lens of addiction, obesity starts to make a lot more sense to me.
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Author
William Brandenburg, MD, owner of Wonder Medicine clinic and full time rural hospitalist.
Editor
Karlee Brandenburg, RN-BSN, owner of Wonder Medicine.
Conflict of Interest
This article promotes Wonder Medicine clinic, which the author and editor own.
Disclaimer
This article was written for educational purposes only. It is not intended to serve as formal medical advice. Please talk with your healthcare provider if you are having a medical problem.
References
Adult Obesity Facts. CDC. Available at https://www.cdc.gov/obesity/data/adult.html
Obesity and Overweight. WHO. Available at https://www.who.int/news-room/fact-sheets/detail/obesity-andoverweight#:~:text=Worldwide%20obesity%20has%20nearly%20tripled,years%20and%20older%2C%20were%20overweight.&text=39%25%20of%20adults%20aged%2018,kills%20more%20people%20than%20underweight.
Numerous papers on Pubmed debate the idea of overeating being an addiction. Just type in “food and addiction” on pubmed.com.
Apovian AM. Obesity: definitions, comorbidities, causes, and burden. Am J Managed Care. 2016.
Many papers exist to support the statements in this blog it was hard to pick just a few.