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Food Addiction and“Addiction Transfer” AfterBariatric SurgeryKatie Boylan
Obesity in American Adults = 35.7%
Obesity in American Children = 16.9%
Food Addiction? Debate of the validity of “food  addiction” Is it based on the environment?  Strength of willpower? New...
Sugar Addiction One study done by Avena et al., 2008 deprived rats of all food  for 12 hours and then allowed them to hav...
Sugar Addiction Opiate-like “withdrawal” – when the rats were deprived  of sugar, they displayed similar signs of opiate ...
Sugar Addiction “Cross-sensitization” – rats showed different behaviors  when exposed to other drugs of abuse:    Hypera...
Neurobiological Changes The researchers also found significant changes within the brain  during and after intermittent su...
Fat Addiction? Similar studies have been done with high fat diets, which showed rats  bingeing on the food, but did NOT d...
Neurofunctional Imaging Studies PET studies have shown a  decrease in the number of  dopamine D2 receptors in  obese pati...
Gastric Banding Surgery Places an inflatable  band around the  stomach to restrict  food intake Size of stomach can be  ...
Roux en-Y gastric bypass A small pouch is  created from the  top portion of the  stomach, which is  then connected to  th...
Oprah Show Clip http://www.youtube.com/watch?v=oAo2VRr1cIY
Post-Surgery Findings Studies have found a change in alcohol metabolism after  bariatric surgery Patients get intoxicate...
Addiction Transfer Some professionals have started to coin this term  for when a person replaces one compulsive  behavior...
Addiction Transfer Patients have lost the weight, but still have not dealt with their  emotions that caused them to turn ...
Conclusion Significant neurobiological and behavioral changes occur  when given excessive, intermittent high fat and suga...
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Food Addiction and Addiction Transfer After Bariatric Surgery

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Final presentation for the Scaife Advanced Student Medical Seminar by Katie Boylan

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Transcript of "Food Addiction and Addiction Transfer After Bariatric Surgery"

  1. 1. Food Addiction and“Addiction Transfer” AfterBariatric SurgeryKatie Boylan
  2. 2. Obesity in American Adults = 35.7%
  3. 3. Obesity in American Children = 16.9%
  4. 4. Food Addiction? Debate of the validity of “food addiction” Is it based on the environment? Strength of willpower? New research has started to show evidence for a biological basis of addictions to high fat and sugary foods Similar neurological changes occurred in rats that were addicted to substances of abuse, such as opiates and cocaine
  5. 5. Sugar Addiction One study done by Avena et al., 2008 deprived rats of all food for 12 hours and then allowed them to have access to both regular chow food and a sugar solution for 12 hours This created an intermittent availability of sugar intake and it was continued for 1 month The rats started to show similar signs of addiction and withdrawal during periods of sugar abstinence:  “Bingeing” – the rats started to drink excessive amounts of the sugar solution, especially when it first became available during the day  Similar to drug addiction when users build and tolerance and escalate their use to continue feeling the same euphoric effects  When compared to rats who had 24 hour access to sugar, the rats with intermittent access ate the same amount of sugar within a shorter timeframe, consisting of larger, but fewer meals
  6. 6. Sugar Addiction Opiate-like “withdrawal” – when the rats were deprived of sugar, they displayed similar signs of opiate withdrawal, such as:  Somatic signs – teeth chattering, forepaw tremor, head shakes  Behavioral anxiety – spending less time than control rats in an open and exposed arm of a maze  Behavioral depression – decreased escape efforts and more passive floating in a forced-swim test “Craving” – the rats showed an enhanced motivation to obtain the sugar by:  Pressing a lever 23% more after a 2 week period of sugar abstinence compared to when the experiment was first over  Suggests that the motivational impact of sugar persists and enhances even during periods of abstinence
  7. 7. Sugar Addiction “Cross-sensitization” – rats showed different behaviors when exposed to other drugs of abuse:  Hyperactivity – when given low doses of amphetamine (0.5 mg/kg that have no effect on naïve rats), the rats that were fed intermittent sugar showed hyperactive behaviors and locomotor cross-sensitization  Similar effect s when given cocaine, suggesting similar pathways in the mesolimbic dopaminergic neurotransmission and could be an explanation for poly-substance abuse  Increased intake of another drug – rats that were fed intermittent sugar and then forced to abstain showed a 9% increase intake of alcohol  Similar results have been found with an increase in self- administration of cocaine compared to control groups and could be an explanation for the “gateway effect”
  8. 8. Neurobiological Changes The researchers also found significant changes within the brain during and after intermittent sugar intake:  Increase in release of dopamine in the nucleus accumbens during sugar intake  After continued use, increase in D1 receptor binding and decrease in D2 receptor binding  similar to results found in cocaine abuse  Changes within the opioid system, showing a decrease in enkephalin mRNA expression in the nucleus accumbens (thought to lead to a decrease in the release of dopamine through mu and delta receptors)  similar results in human subjects that were cocaine- dependent  During abstinence, there was a decrease in extracellular dopamine, followed by release of acetylcholine  mimics the response that occurs during morphine, nicotine, and alcohol withdrawal  Impact on dopaminergic, cholinergic and opioid systems, with similarities to other drugs of abuse
  9. 9. Fat Addiction? Similar studies have been done with high fat diets, which showed rats bingeing on the food, but did NOT display the same signs of opiate-like “withdrawal” that were seen with sugar In addition, rats on the high sugar diet tended to compensate for their bingeing by decreasing their intake of normal chow food, and had normal weights Rats placed on high fat, or high sugar and fat combination diets tended to gain weight Could this explain our obesity epidemic? Much of the American diet is a combination of fat and sugar, such as fried doughnuts and cupcakes Could the sugar be accounting for the addiction and fat be accounting for the weight gain?
  10. 10. Neurofunctional Imaging Studies PET studies have shown a decrease in the number of dopamine D2 receptors in obese patients as well as those addicted to cocaine, methamphetamine, alcohol, and heroine Inverse relationship between obese BMI (42- 60) and the amount of dopamine D2 receptors, but not in control group  plays a larger role in obese subjects
  11. 11. Gastric Banding Surgery Places an inflatable band around the stomach to restrict food intake Size of stomach can be adjusted easily Lowest mortality rate Least invasive Weight loss does not come as fast and is not as permanent as other options
  12. 12. Roux en-Y gastric bypass A small pouch is created from the top portion of the stomach, which is then connected to the jejunum A majority of the stomach and duodenum are bypassed Faster and longer lasting weight loss More complications such as ulcers, internal hernias, and malabsorption
  13. 13. Oprah Show Clip http://www.youtube.com/watch?v=oAo2VRr1cIY
  14. 14. Post-Surgery Findings Studies have found a change in alcohol metabolism after bariatric surgery Patients get intoxicated faster and take longer to become sober Another study found an increased percent in alcoholism in bariatric surgery patients 6-10 years after the surgery Possibly because food and drugs compete for the same reinforcement sites in the brain through the mesolimbic dopaminergic pathway If a patient undergoes bariatric surgery and can no longer satisfy their cravings by bingeing on high fat and sugary foods, they may turn to other substances to activate the same pathway  addiction transfer?
  15. 15. Addiction Transfer Some professionals have started to coin this term for when a person replaces one compulsive behavior for another We see the concept occurring after bariatric surgery, as substance abuse is not commonly found in the obese population, but there is an increase after bariatric surgery Also seen in some recovering alcoholics who develop a dependence on nicotine or caffeine – same phenomenon? Not an accepted clinical or scientific term Not a common outcome of bariatric surgery, but increased risk of problematic substance abuse
  16. 16. Addiction Transfer Patients have lost the weight, but still have not dealt with their emotions that caused them to turn to food for comfort in the first place Feel a “void”, so turn to another substance for the comfort that food used to provide “The weight loss surgery didn’t cause me to be an alcoholic. I’m born an addict” – bariatric patient One study found that cognitive-behavioral group therapy was helpful for patients post-surgery, but they also thought that individualized therapy would be helpful as well More studies need to be conducted on the most effective therapy for bariatric patients
  17. 17. Conclusion Significant neurobiological and behavioral changes occur when given excessive, intermittent high fat and sugar diets These parallel the changes found in those with drug addictions, such as cocaine, amphetamines, and heroine Patients who undergo bariatric surgery may have an increased risk of developing another addiction or compulsive behavior “Addiction transfer” is not a clinical term, but the theory is supported by many clinicians and can be seen across different groups of people

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