“My War With Food Addiction”

  “Some people fight battles with guns and

Eating Disorders tanks, others use spoons and kitchen utensils.
June 22, 2010 I remember the Battle of the Bulge. The
Ponderosa Salad Bar suffered a six-plate
Carl Christensen, MD PhD defeat. I remember a war with a chocolate
Easter bunny. In the middle of the night, I bit
Pain Recovery Solutions, Ann Arbor Mi
its head off. I admit it. I was a food addict.
Depts of OB Gyn & Psychiatry, WSU My life was controlled by food. Moderation
[email protected] was never my strong point.
EATING DISORDERS 06 22 10 2

“My War With Food Addiction” Step Two: Overeater’s Anonymous

  When it came to ice cream, one scoop was never   “We have driven miles in the dead of night to
enough. I once ate a two-and-a-half gallon tub of satisfy a craving for food. We have eaten
maple walnut ice cream. It almost froze my stomach. food that was frozen, burnt, stale, or even
To make matters worse, it was my roommate’s ice
cream! I felt so badly afterwards that I put a 12-foot
dangerously spoiled. We have eaten food off
chain through the handles of the refrigerator and of other people’s plates, off the floor, off the
cupboards and told my roommate, "here's the key to ground. We have dug food out of the garbage
your food." He wasn't impressed.” and eaten it.”
  Tom McGregor, “Eating in Freedom”

EATING DISORDERS 06 22 10 3 EATING DISORDERS 06 22 10 4

Step Two: Overeater’s Anonymous Anorexia

  “We have frequently lied about what we have   “I don’t see what they tell me they see in the
eaten-lied to others because we didn’t want to mirror. My cheeks are too full, my hips and
face the truth ourselves. We have stolen food thighs are too wide and round, my arms carry
from our friends, ….we have also stolen too much fat and my stomach bulges.
money to buy food. We have eaten beyond
the point of being full, beyond the point of Looking in the mirror is a daily torture that I
being sick of eating. We have continued to allow myself, because who can resist the
overeat, knowing all the while we were temptation of that reflective sheet of glass?
disfiguring and maiming our bodies.” Of glimpsing who they think they are?
EATING DISORDERS 06 22 10 5 EATING DISORDERS 06 22 10 6

EATING DISORDERS 6 22 10 1
 Anorexia Tonight’s talk
  I am afraid. Someone please tell me there is a   What is an eating disorder?
  Are eating disorders addictions?
better way, because I just don’t know where   What is addiction?
to turn or what to do. I am fifteen, and I will   What parts of the brain are involved?
join the ranks of those who call themselves   What is obesity?
anorexic.”   What are the consequences of eating disorders?
  How are eating disorders treated? What about medication?
  Brain scans: the lights are bright, but nobody’s home……
-Anonymous   Where can I get help?

EATING DISORDERS 06 22 10 7 EATING DISORDERS 06 22 10 8

Eating Disorders ≠ weight disorder

  Anorexia Nervosa
  Bulimia
  Binge eating disorder
“…..he’s very depressing” (2007)

EATING DISORDERS 06 22 10 9 EATING DISORDERS 06 22 10 10

Anorexia Nervosa Bulimia Nervosa

  Refuses to maintain a “normal” weight or   Episodes of binge eating with a sense of loss of
control
>15% below IBW
  followed by compensatory behavior of the purging
  Fear of weight gain type (self-induced vomiting, laxative abuse, diuretic
  Severe body image disturbance abuse) or nonpurging type (excessive exercise,
fasting, or strict diets).
  Absence of menstrual cycles (if post-   Binges and the resulting compensatory behavior
menstrual female) must occur a minimum of two times per week for
  2 types: restrictive and binging/purging* three months
  Dissatisfaction with body shape and weight
EATING DISORDERS 06 22 10 11 EATING DISORDERS 06 22 10 12

EATING DISORDERS 6 22 10 2
 Binge Eating Disorder
  Eating much more rapidly than normal
  Eating until uncomfortably full
  Eating large amounts of food when not feeling
physically hungry Eating Disorders: are they Addictions?
  Eating alone because of embarrassment
  Feeling disgusted, depressed, or very guilty
after overeating

EATING DISORDERS 06 22 10 13 EATING DISORDERS 06 22 10 14

Physiologic Dependence: Tolerance

What is Addiction? and Withdrawal
  Physiologic Dependence?   Tolerance: requiring increasing amounts of
  Lack of willpower? drug to get the same effect
  An “amoral” condition?
  Withdrawal: the opposite effect of the drug
  A brain disease? when it is removed

  NEITHER of these imply chemical

dependency (addiction)
EATING DISORDERS 06 22 10 15 EATING DISORDERS 06 22 10 16

Lack of Willpower? An “amoral” condition?

EATING DISORDERS 06 22 10 17 EATING DISORDERS 06 22 10 18

EATING DISORDERS 6 22 10 3
 VTA: supplies DA to the N Acc
A Brain Disease? The NA: GO!!!
Frontal Cortex: STOP!!!!

EATING DISORDERS 06 22 10 20 EATING DISORDERS 06 22 10 21

“I feel like I don’t belong in my

own skin….” anonymous alcoholic

  Decreased Dopamine receptors =decreased

Dopamine =

  Decreased Hedonic
Tone

  Salsitz 2006

EATING DISORDERS 06 22 10 22 EATING DISORDERS 06 22 10 23

Chemical Dependence: DSM IV

Can you find the (alleged) future
definition
alcoholic?
  Tolerance   Great deal of time
  Withdrawal spent in obtaining/
  Take more/take longer using /recovering
than intended   Important social/occ/
  Can’t cut down or recreation given up 2º
control use to use
  Use despite physical/
psych problem

EATING DISORDERS 06 22 10 24 EATING DISORDERS 06 22 10 25

EATING DISORDERS 6 22 10 4
 Addiction/chemical dependence:
working definition RELAPSE: the problem with addiction
  Drug triggered: “I thought I could (eat/
  A chronic progressive disease characterized by the following physical and
psychological symptoms (the four (five) C’s):
smoke/drink) just one….”

  Craving
  Stress triggered: “I’m going through too much
  Compulsion
right now. Gimme that!”
  Loss of Control
  Continued use despite consequences, and
  Chronic use   Cue triggered: “Wet faces and wet places”

EATING DISORDERS 06 22 10 26 EATING DISORDERS 06 22 10 27

Drug Triggered Relapse: Gardner Stress Triggered Relapse: Gardner

2006 2006

EATING DISORDERS 06 22 10 28 EATING DISORDERS 06 22 10 29

Cue Triggered Relapse: Gardner 2006 Other parts of the Brain

  Dorsal Striatum (Craving)
  Amygdala (Memory/Danger/emergency)
  Hippocampus (memory)
  Frontal cortex (? Inhibition)
  Hypothalamus (Appetite/satiety)

EATING DISORDERS 06 22 10 30 EATING DISORDERS 06 22 10 31

EATING DISORDERS 6 22 10 5
 Other Neurochemicals in the Brain FA/OA AA/NA
  Norepinephrine (stimulates/satiates)   “We ask that during   “Don’t let yourself
your share you not become Hungry,
  Serotonin (calms)
mention specific food Angry, Lonely, or
  Endocannabinoids (super size that, please!) groups by name” Tired!”
  Endorphins (increased feeding)
  Leptin (antagonist of EC)
  Ghrelin (stimulates appetite)

EATING DISORDERS 06 22 10 32 EATING DISORDERS 06 22 10 33

“Hi…I’m Joe. I’m cross addicted” Food Addiction????

  FA: “Hi, I’m Joe. I’m a food addict”.
  OA: “Hi, I’m Joe. I’m a compulsive
overeater.”

  Both are describing the same thing: an

abnormal relationship with food.

EATING DISORDERS 06 22 10 34 EATING DISORDERS 06 22 10 35

How many of these are

addicitons?

EATING DISORDERS 06 22 10 36 EATING DISORDERS 06 22 10 37

EATING DISORDERS 6 22 10 6
 EATING DISORDERS 06 22 10 38 EATING DISORDERS 06 22 10 39

EATING DISORDERS 06 22 10 40 EATING DISORDERS 06 22 10 41

Are Eating Disorders Addictions?

Mark Gold, “Eating Disorders, Overeating, and Pathological Attachment to
Food”.

  “The 1960s were known as the decade of sex, drugs, and rock
and roll. Food seems to be an afterthought and it may be that
it is suppressed by drug-taking.
  …the heavier the patient, the less alcohol and illegal drugs
they use. It is almost as if they are competing for the same
reward sites in the brain.
  Treatment of addicts appears to result in weight gain….all
supervised drug abstinence treatment causes weight gain.
  …loss of control over eating and obesity produces changes in
the brain, which are similar to those produced by drugs of
abuse.”

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EATING DISORDERS 6 22 10 7
 Are Eating Disorders Addictions? Why Healthy Fast Food May Not
Nora Volkow Work…..
  Many obesity researchers focus on how the
body's fuel and fat levels control appetite. But
as binge eaters know, habits and desire often
override metabolic need, which share some of
the characteristics of drug using behavior in
drug-addicted subjects.

EATING DISORDERS 06 22 10 44 EATING DISORDERS 06 22 10 45

Obesity: use despite consequences BMI Graph

  How do you define it?
  How has it changed in the U.S.?
  What are the known causes ASSOCIATIONS
not causes)?

EATING DISORDERS 06 22 10 46 EATING DISORDERS 06 22 10 47

Obesity Trends* Among U.S. Adults

Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1995, 2005
(*BMI ≥30, or about 30 lbs overweight for 5’4” person) BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
1990 1995

2005

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% No Data <10% 10%–14%
EATING DISORDERS 06 22 10 48 EATING DISORDERS 06 22 10 49

EATING DISORDERS 6 22 10 8
 Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% No Data <10% 10%–14%

EATING DISORDERS 06 22 10 50 EATING DISORDERS 06 22 10 51

Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% No Data <10% 10%–14%

EATING DISORDERS 06 22 10 52 EATING DISORDERS 06 22 10 53

Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% No Data <10% 10%–14% 15%–19%

EATING DISORDERS 06 22 10 54 EATING DISORDERS 06 22 10 55

EATING DISORDERS 6 22 10 9
 Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% No Data <10% 10%–14% 15%–19%

EATING DISORDERS 06 22 10 56 EATING DISORDERS 06 22 10 57

Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% No Data <10% 10%–14% 15%–19%

EATING DISORDERS 06 22 10 58 EATING DISORDERS 06 22 10 59

Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% No Data <10% 10%–14% 15%–19% ≥20%

EATING DISORDERS 06 22 10 60 EATING DISORDERS 06 22 10 61

EATING DISORDERS 6 22 10 10
 Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20% No Data <10% 10%–14% 15%–19% ≥20%
EATING DISORDERS 06 22 10 62 EATING DISORDERS 06 22 10 63

Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20% No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
EATING DISORDERS 06 22 10 64 EATING DISORDERS 06 22 10 65

Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 2002 BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25% No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
EATING DISORDERS 06 22 10 66 EATING DISORDERS 06 22 10 67

EATING DISORDERS 6 22 10 11
 Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults
BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25% No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
EATING DISORDERS 06 22 10 68 EATING DISORDERS 06 22 10 69

Obesity: known Associations Obesity: known Associations

  Prenatal: mom’s caloric intake; maternal DM   Sleep deprivation (Spiegel 2004): causes
  Breastfeeding: protective decrease in leptin and increase in ghrelin
  FH: one or both parents   Eating!
  Energy expenditure: more important than   “Fast food”: incr weight and insulin resistance
(Pereira 2005)
food intake?
  EATING DISORDERS: nighttime eating; binge
  TV: every 2 hours incr obesity 23% and DM eating disorders
14%

EATING DISORDERS 06 22 10 70 EATING DISORDERS 06 22 10 71

Supersize Me Eating Disorders: Physical Problems

  Effects of caloric restriction
  Effects of purging
  Effects of overeating

EATING DISORDERS 06 22 10 72 EATING DISORDERS 06 22 10 73

EATING DISORDERS 6 22 10 12
 Effects of Caloric Restriction
(Anorexia) Effects of Caloric Restriction
  Osteoporosis/osteopenia   Constipation (vs distorted body image)
  Cardiac disease/sudden death   Refeeding syndrome: cardiac collapse when
  Cognitive problems food intake resumes; death due to low
  GI dysfunction phosphate concentration
  Endocrine changes
  Electrolyte abnormalities
  Infertility
EATING DISORDERS 06 22 10 74 EATING DISORDERS 06 22 10 75

Effects of Purging (Bulimia)

  Dental erosion
  Enlarged salivary glands
  “finger sign”
  Esophageal damage

EATING DISORDERS 06 22 10 76 EATING DISORDERS 06 22 10 77

Effects of Overeating: Metabolic

Syndrome Causes of Eating Disorders?
  Elevated waist circumference:   Sexual abuse? (environment)
Men — Equal to or greater than 40 inches (102 cm)
Women — Equal to or greater than 35 inches (88 cm)   Family history (genetics)
  Elevated triglycerides:   6-10X increase if 1st degree relative affected
Equal to or greater than 150 mg/dL
  Reduced HDL (“good”) cholesterol:   More common in identical than fraternal twins
Men — Less than 40 mg/dL   More common if relatives have alcoholism
Women — Less than 50 mg/dL
  Elevated blood pressure:   Associated with other psychiatric disorders
Equal to or greater than 130/85 mm Hg   Associated with other chemical dependency (B>AN)
  Elevated fasting glucose:
Equal to or greater than 100 mg/dL   ADDICTION?

EATING DISORDERS 06 22 10 78 EATING DISORDERS 06 22 10 79

EATING DISORDERS 6 22 10 13
 Eating Disorder & Chemical
Dependency ED + CD
  A 19 year old was admitted to residential   During the interview, however, she requests
treatment for cocaine dependency. permission for:
  She has been treated in the past for “eating   “extra laxatives”
problems” but it “is over now”.   Lettuce only for meals
  Permission to “jog” without supervision
  Extra vitamin allowance.
  Records review: previous admission to ICU
for severe malnutrition.
EATING DISORDERS 06 22 10 80 EATING DISORDERS 06 22 10 81

Do You Have an Eating Disorder? Are You a Food Addict? 20 Questions

20 Questions from FAIR
1.  Have you ever wanted to stop eating and found you
just couldn’t?
2.  Do you think about food or your weight constantly?
3.  Do you find yourself attempting one diet or food
plan after another, with no lasting success?
4.  Do you binge and then “get rid of the binge”?
5.  Do you eat differently in private than you do in
front of other people?

EATING DISORDERS 06 22 10 82 EATING DISORDERS 06 22 10 83

Are You a Food Addict? 20 Questions Are You a Food Addict? 20 Questions
from FAIR from FAIR
11.  Have you ever discarded food, only to
6.  Has a doctor or family member every approached retrieve and eat it later?
you with concerns about your eating/weight? 12.  Do you eat in secret?
7.  Do you eat large quantities of food at one time
(binge)? 13.  Do you fast or severely restrict your food
8.  Is your weight problem due to your “nibbling” all
intake?
day long? 14.  Have you ever stolen other people’s food?
9.  Do you eat to escape from your feelings? 15.  Have you ever hidden food to make sure you
10.  Do you eat when you’re not hungry? have “enough”?
EATING DISORDERS 06 22 10 84 EATING DISORDERS 06 22 10 85

EATING DISORDERS 6 22 10 14
 Are You a Food Addict? 20 Questions
from FAIR Treatment for ED/Obesity
16.  Do you feel driven to exercise excessively to   Caloric Restriction
control your weight?
17.  Do you obsessively calculate the calories you’ve
  Psychotherapy
burned against the calories you’ve eaten?   Spiritual
18.  Do you frequently feel guilty or ashamed about   Medical
what you’ve eaten?
19.  Are you waiting for your life to begin “when you   Surgical
lose the weight?”
20.  Do you feel hopeless about your relationship with
food?
EATING DISORDERS 06 22 10 86 EATING DISORDERS 06 22 10 87

Treatment for ED/Obesity Treatment for ED/Obesity

  Caloric Restriction: if diets worked, the   Psychotherapy: CBT, WW, EDEN
auditorium would be empty tonight.   Spiritual
  Psychotherapy   Medical
  Spiritual   Surgical
  Medical
  Surgical

EATING DISORDERS 06 22 10 88 EATING DISORDERS 06 22 10 89

Treatment for ED/Obesity Treatment for ED/Obesity

  Psychotherapy   Psychotherapy
  Spiritual: FA, OA, FAA   Spiritual
  Medical   Medical: Stimulants, AD, AED, CB1I, DAI
  Surgical   Surgical

EATING DISORDERS 06 22 10 90 EATING DISORDERS 06 22 10 91

EATING DISORDERS 6 22 10 15
 Treatment for ED/Obesity Spirituality ≠ Religion
  Psychotherapy   Belief in a power greater than yourself
  Spiritual   “Turn your will over”
  Medical   Accept direction
  Surgical: bypass, banding   Live according to principles

EATING DISORDERS 06 22 10 92 EATING DISORDERS 06 22 10 93

Spirituality ≠ Religion Twelve Step Programs

  Food Addicts in
Recovery Anonymous

  Overeater’s
Anonymous

EATING DISORDERS 06 22 10 94 EATING DISORDERS 06 22 10 95

Twelve Steps of FA/OA Twelve Steps of FA/OA

http://foodaddicts.org; http://oa.org http://foodaddicts.org; http://oa.org
1. We admitted we were powerless over
food — that our lives had become
unmanageable.
7. Humbly asked Him to remove our
shortcomings.
1.  We admitted we were powerless
2. Came to believe that a Power greater
than ourselves could restore us to sanity.
8. Made a list of all persons we had harmed and
became willing to make amends to them all. over food — that our lives had
become unmanageable.
9. Made direct amends to such people wherever
3. Made a decision to turn our will and our possible, except when to do so would injure
lives over to the care of God as we them or others.
understood Him. 10. Continued to take personal inventory and when
4. Made a searching and fearless moral we were wrong, promptly admitted it.
inventory of ourselves. 11. Sought through prayer and meditation to
5. Admitted to God, to ourselves and to improve our conscious contact with God as we
understood Him, praying only for knowledge
another human being the exact nature of of His will for us and the power to carry that
our wrongs. out.
6. Were entirely ready to have God remove 12. Having had a spiritual awakening as the result
all these defects of character. of these Steps, we tried to carry this message to
compulsive overeaters and to practice these
principles in all our affairs.

EATING DISORDERS 06 22 10 96 EATING DISORDERS 06 22 10 97

EATING DISORDERS 6 22 10 16
 Twelve Steps of FA/OA Twelve Steps of FA/OA
http://foodaddicts.org; http://oa.org http://foodaddicts.org; http://oa.org

3. Made a decision to turn our will and

2. Came to believe that a Power greater our lives over to the care of God as
than ourselves could restore us to we understood Him.
sanity.

EATING DISORDERS 06 22 10 98 EATING DISORDERS 06 22 10 99

Twelve Steps of FA/OA

Twelve Steps of FA/OA http://foodaddicts.org; http://oa.org
http://foodaddicts.org; http://oa.org

4. Made a searching and fearless moral 5. Admitted to God, to ourselves and to another
inventory of ourselves. human being the exact nature of our wrongs.

EATING DISORDERS 06 22 10 100 EATING DISORDERS 06 22 10 101

Twelve Steps of FA/OA Twelve Steps of FA/OA

http://foodaddicts.org; http://oa.org http://foodaddicts.org; http://oa.org
  6. Were entirely ready to have God remove
all these defects of character.   7. Humbly asked Him to remove our
shortcomings.

EATING DISORDERS 06 22 10 102 EATING DISORDERS 06 22 10 103

EATING DISORDERS 6 22 10 17
 Twelve Steps of FA/OA Twelve Steps of FA/OA
http://foodaddicts.org; http://oa.org http://foodaddicts.org; http://oa.org

  9. Made direct amends to such people

  8. Made a list of all persons we had harmed wherever possible, except when to do so
and became willing to make amends to them would injure them or others.
all.

EATING DISORDERS 06 22 10 104 EATING DISORDERS 06 22 10 105

Twelve Steps of FA/OA Twelve Steps of FA/OA

http://foodaddicts.org; http://oa.org http://foodaddicts.org; http://oa.org

  10. Continued to take personal inventory and   11. Sought through prayer and meditation to
when we were wrong, promptly admitted it. improve our conscious contact with God as
we understood Him, praying only for
knowledge of His will for us and the power to
carry that out.

EATING DISORDERS 06 22 10 106 EATING DISORDERS 06 22 10 107

Twelve Steps of FA/OA

http://foodaddicts.org; http://oa.org Do men get eating disorders?

12. Having had a spiritual awakening as the

result of these Steps, we tried to carry this
message to compulsive overeaters and to
practice these principles in all our affairs.

EATING DISORDERS 06 22 10 108 EATING DISORDERS 06 22 10 110

EATING DISORDERS 6 22 10 18
 From “Food Addiction: Stories of
Men in Recovery” Treatment of AN/BN
  Being a man, I learned I was not supposed to worry   Cognitive Behavioral Therapy (Lewandowski
about my weight. When I stopped drinking
alcohol…my weight began to rise, and no matter 1997)
what I tried, I could not control it. Food had become   Interpersonal therapy
my alternative to alcohol.
  In FA, I was able to recognize that certain foods are
  Medications:
addictive substances for me. I learned how to weigh   For AN: little data, ? Olanzapine
and measure my food, putting boundaries around my   BN: fluoxetine, ? Ondansetron
meals. I have been able to return to the athletic
activities that had become too painful…In FA, I am   Hospitalization
learning how to face life without using food as a   OA (Malenbaum 1988)
drug.”
EATING DISORDERS 06 22 10 111 EATING DISORDERS 06 22 10 112

Medications for Obesity:

Medications for Obesity: Stimulants Antidepressants
  Phentermine (Adipex)   Act on serotonin:
  Diethylproprion (Tenuate)   Sertraline (Zoloft)
  Sibutramine (Meridia) (also serotonin)   Fluoxetine (Prozac)
  Ephedra/ Ma Huang   Act on norepi/dopamine:
  Buproprion

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Medications for Obesity: Medications for Obesity: EC

Antiepileptics antagonists (Rimonabant, Acomplia)
  Topiramate (Topomax)   CB1 receptor blocker
  Commonly used for
migraine prophylaxis
  Compared to placebo:
  Produces “topomax   5% BW loss: 51 vs 19%
brain”   10% BW loss: 27 vs 7%
  DEPRESSION: did not get FDA approval

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 Medications for Obesity: mu
antagonists (naltrexone, Vivitrol) Bariatric Surgery
  May block the “reward” of eating through the   Indications
mu opioid receptor  DA release   Contraindications
  Used to block the reward of alcohol, tobacco?   Complications
  ? Blocks natural endorphins
  Blocks the ability of anyone in the ER to give
you pain meds when you break your leg!

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Bariatric Surgery Bariatric Surgery

  Indications:   Contraindications
  BMI > 40 or 35 with complications   Binge eating disorder
  Have failed medical therapy   Current drug and alcohol use
  Surgical candidates   Untreated MDD or psychosis

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Bariatric Surgery Gastric Banding

  Complications
  Mortality: 1 – 20? %
  Malabsorption
  Post-surgical complications
  ? Addictive disorders

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 Roux en Y (gastric bypass) Laparascopic Roux en Y

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Laparascopic Roux en Y Laparascopic Roux en Y

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Laparascopic Roux en Y Laparascopic Roux en Y

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 Laparascopic Roux en Y Laparascopic Roux en Y

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Laparascopic Roux en Y Laparascopic Roux en Y

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Laparascopic Roux en Y SOS Study: Swedish Obese Subjects

  Randomized to either bariatric surgery or
“conventional” treatment
  “conventional” treatment gained 2% over 10
years
  Surgery group lost 16 % over 10 years

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 BRAIN SCANS
apologies to PETA Dopamine

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Obese subjects have decreased DA

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Dopamine Receptors: Normal vs.

Dopamine: Normal vs. Overweight Obese

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 Effect of Cocaine Cues on Dopamine
  A cocaine addict is
shown a picture of
Bambi in the forest.
  The large amount of
“red” indicates that
dopamine hasn’t been
released.

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Effect of Cocaine Cues on Dopamine Volkow: Placebo Ritalin Food

  The picture on the right   The sight of food
shows less “red” = caused a release of
  Dopamine has been dopamine, just like
released.
cocaine!
  THE CUE OF SEEING
COCAINE CAUSED   In this “addict”, the
DOPAMINE RELEASE drug is FOOD
  = RISK OF RELAPSE

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Abnormal response to Ritalin is due to

abnormal brain chemistry

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 DAKOTA
1995-2007

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Contact info
  Carl Christensen MD PhD
  Pain Recovery Solutions, Ypsi MI (734 434
6600)
  Voice/fax: 734 448 0226
  Email:
  [email protected]

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