NATURE NEUROSCIENCE VOLUME 8
MAY 2005 559
efforts to remove junk foods from dispensing
machines and cafeterias where they help to
seduce young people into obesity, just as read-
ily available cigarettes helped, until recently,
seduce them into addiction.
One unique challenge for the prevention
of obesity arises because food, unlike drugs,
is indispensable to survival. Thus, it will be
much harder for a society to implement regu-
lations to constrain the easy access to food that
can facilitate compulsive eating. What can be
hoped for, however, is more restricted access to
high-fat, high-calorie foods that are seductive
and unnecessary for good health, particularly
in public places such as schools.
As in the treatment of drug addiction, scientific
knowledge about the involvement of multiple
brain circuits (reward, motivation, learning,
cortical inhibitory control) would suggest
a multimodal approach to the treatment of
obesity. For obesity as well as for addiction,
promising pharmacological interventions
may be those that interfere with various pro-
cesses, including the reinforcing value of the
substance (food or drug); with conditioned
responses to these processes; and with stress-
induced relapse after temporary successes are
achieved. Indeed, in some instances the same
medications that are effective in interfer-
ing with (or reducing) food consumption in
animal models of obesity are also effective in
interfering with (or reducing) drug consump-
tion by self-administration in animal models
of drug abuse (for example, cannabinoid CB
In a similar fashion, some of the behav-
ioral interventions that are beneficial in the
treatment of addiction are also helpful in the
treatment of obesity. These include incentive
motivation, cognitive-behavioral therapy and
12-step programs. However, the interventions
for obesity are complicated by the impossibil-
ity of completely refraining from eating, as is
frequently recommended for drug addiction.
For example, we know that for relapse to drug-
seeking, the priming effects of the drug are very
; thus 12-step programs stress absolute
abstinence, a strategy that avoids the danger
of priming. Alcoholics note that it is easier to
draw a line between zero drinks and one drink
than between the first and second or the sixth
and seventh. In the case of food, a similar effect
is more difficult to achieve because food con-
sumption is essential and long periods of total
abstinence are not feasible. However, strategies
that avoid food rich in carbohydrates or fats,
or their combination, should help at-risk indi-
viduals to sidestep priming effects that trigger
Like addiction, obesity is a chronic condi-
tion with periods of protracted abstinence
(restriction of seductive foods) and periods of
relapse (compulsive eating). Thus, treatment
will in most cases require continuous care.
Large-scale prevention and treatment pro-
grams for obesity (like those for addiction)
will require the participation of the medical
community. The engagement of pediatricians
and family physicians might facilitate early
detection and treatment of obesity in child-
hood and adolescence. Unfortunately, as with
addiction, physicians, nurses and psycholo-
gists receive little training in the management
Obesity and addiction are special cases of the
consequences of ingestive behavior gone awry.
Each develops in some but not all individuals,
and each is subject to genetic predispositions
and the availability of a powerful reinforcer.
In each case, there appear to be periods of
developmental vulnerability. Although each
condition has its own interface with brain
mechanisms of motivation, the motivational
mechanisms themselves largely overlap. In
each case, neuroadaptations resulting from
excessive intake may make the ingestive behav-
ior more compulsive. The guidelines for pre-
vention and treatment of the two disorders
are remarkably similar, and some of the same
pharmacological interventions that are prom-
ising for the control of drug intake are also
promising for controlling the intake of food.
Few fields seem to offer as much potential for
cross-fertilization as the fields of addiction
and obesity research.
The authors thank C. Kassed for her assistance in
preparing the manuscript.
COMPETEING INTEREST STATEMENT
The authors declare that they have no competing
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