Is severe obesity a form of addiction? Rationale, clinical approach, and controlled clinical trial.
For many, obesity is just a problem of energy input and expenditure: more energy input than expenditure. However, the clinical practice and epidemiological data clearly show that weight control is more complex than expected by this simple equation. This is particularly true in morbid obesity, a form of severe obesity in which a person's Body Mass Index (BMI, kg/m(2)) is over 40. If we compare the definitions and diagnostic criteria for "dependence" and "addiction" with the situation of many severe obese subjects, it is apparent that they match very well. Further, different neurological studies confirm this similarity: both addiction and obesity patients have a deficiency of dopamine receptors. Nevertheless, when we compare many of the actual obesity treatments with the ones used in the area of addictions it is possible to find relevant differences: obesity treatments neither consider different levels of type and intensity of care, nor a multidimensional approach. To overcome these limitations, in this paper we propose a bio-psychosocial approach in which the genetic influence (lack of dopamine receptors) is matched by psychosocial issues (pressure for thinness and diet as main body image dissatisfaction treatment). Further, the paper outlines how this approach may influence the treatment options, by focusing both on the lessons coming from actual addiction treatment and the opportunities offered by virtual reality. Finally, the paper presents and discusses the outcome of a controlled trial, based on the proposed approach, including a 6-month follow-up (211 morbid obese females with a BMI of >40 and a documented history of failures.
Riva
Giuseppe
G
Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano, Milan, Italy. auxo.psylab@auxologico.it
Bacchetta
Monica
M
Cesa
Gianluca
G
Conti
Sara
S
Castelnuovo
Gianluca
G
Mantovani
Fabrizia
F
Molinari
Enrico
E
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016739:Behavior, Addictive / Q000150:complications / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D001828:Body Image; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003198:Computer Simulation; D004035:Diet Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D020377:Self Efficacy; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface