Food Addiction and Hedonic Eating: A New Approach to Obesity Research and TreatmentNicole M. Avena, Ph.D. New York Obesity Research Center, Columbia University, NY

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Food reward

(hedonics)

Food reward

(hedonics)

People sometimes eat because they want to eat, not because they have to eat (people may eat because of boredom, stress, etc.)

Foods that are rich in fats and sugars, and consequently calories, taste good.

Palatable food is ubiquitous for most people in our society.

Food is a part of our social lives.

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Drugs that are abused act on brain systems that evolved to reinforce natural behaviors (e.g., sex, feeding).

There are overlaps in the brain pathways activated by palatable foods and drugs of abuse.

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Rats prone to overeat are more likely to cross a shock grid to get access to palatable food (Oswald et al., 2011).

Rats with a history of sugar-bingeing show an increase in intake following a period of abstinence (Avena et al, 2005). During abstinence, rats with a history of sugar access will also work harder over time to get access to sugar-associated cues (Grimm et al., 2005).

Sugar-bingeing rats show signs of anxiety when given the opioid antagonist, naloxone, or when fasted from all food for 36 hrs (Colantuoni et al., 2002; Avena et al., 2008).

Rats with 18-23 h/day access to a cafeteria diet do not decrease their intake of palatable food when shown a stimulus associated with a foot shock, unlike rats with 1 h/day access or chow only controls (Johnson & Kenny, 2010).

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Increases in dopamine (DA) release wane with repeated exposure to chow; however, these increases continue in response to sugar.

This effect is only seen in sugar-bingeing rats, not control rats.

This effect is also seen in response to fat (Liang, Hajnal, & Norgren, 2006).

Rats are not overweight.

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In a sample of 79 women with BED, 92.4% met the DSM-IV criteria for substance dependence when questions substituted “substance” with “binge eating” (Cassin and von Ranson, 2007).

A recent study found that participants with BED had addictive personality scores similar to what has been reported for individuals with substance dependence disorder (Lent & Swencionis, 2012).

In 2009, the Yale Food Addiction Scale (YFAS) was created to study food addiction by applying the DSM-IV criteria for substance dependence to eating behaviors.

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Our laboratory has recently collected pilot data the first study assessing addiction-like behaviors with respect to particular types of food.

55%, 35%, and 15% of female participants (AN=7, BN=8, EDNOS=5) met the criteria for addictions to fat, sugar, and fruits and vegetables, respectively.

Sugar and fat addiction symptom counts were higher in the BN compared to the AN group (p=.002; p=.001). Fat addiction symptom counts were also higher in the BN compared to the EDNOS group (p=.02).

These preliminary results suggest:1) Foods high in fat may be more likely to elicit behaviors resembling substance dependence.2) Difficulty with high fat foods appears to be most likely among individuals with BN.

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Pharmacological agents known to target brain systems associated with reward (i.e., the dopaminergic and opioidergic systems) are currently being studied in order to identify drug treatments that may suppress overeating, particularly of highly palatable foods. Candidate pharmacological compounds include…

– The GABA-B agonist, Baclofen, has been shown to reduce binge eating in both preclinical and clinical studies (Buda-Levin et al., 2005; Broft et al., 2007; Berner et al., 2009; Corwin et al., 2012). It’s effects are stronger with fat than with sugar.

– The opioid antagonist, Naltrexone, has also been shown to reduce binge eating in several preclinical studies (Rao et al., 2008; Corwin & Wojnicki, 2009; Wong, Wojnicki, & Corwin, 2009; Giuliano et al., 2012; Blasio et al., 2013). Clinical studies of naltrexone have produced mixed findings thus far, though most studies do indicate a positive effect (Mitchell et al., 1989; Alger et al., 1991; Chatoor et al., 1994; Marrazzi et al., 1995).

– We have recently found that the combination of baclofen and naltrexone is successful in attenuating hedonic eating (but not intake of standard chow) in preclinical models (Avena, Gold et al., under review).

– Our laboratory has recently shown an ALDH-2 inhibitor, which has also been found to reduce alcohol intake and cocaine seeking in rats, to reduce binge consumption of sugar (Bocarsly et al., 2014).

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