SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
The under-recognised addiction - food addiction (Jun 2009)

I was beginning to wonder what was in the air when a fourth person came in to surgery on the same day wanting to talk about their eating. They were all very different but with one thing in common - varying degrees of food addiction.

The first patient was Isha, a 39 year old Asian woman who had come for her monthly weigh-in. She had attended OA (Overeaters Anonymous) for many years and found it helpful but her weight had remained high. For the past four months she had moved to OA H.O.W. (Honest Open-minded and Willing to listen) which offers compulsive overeater 12-steppers a programme of recovery with a disciplined and structured approach. Now four stone down, fitter and more content than she had ever been, it certainly seemed to be the right approach for her.

Second in was Tom, a 45 year old single parent receiving drug treatment from us, who was celebrating the loss of his third stone. We had been trying to get him to address his enormous increase in weight since stopping street drugs and taking over the care of his daughter, but he hadn't been able to change until he began a new relationship. Before this his diet had consisted mainly of packets of biscuits and fizzy drinks. I explained about sugar addiction and cross-addiction and advised him to stop all sugar and fizzy drinks, and get exercising. He was amazed how much better he felt and how the weight fell off.

Next there was Fred for a BP check and a chat about his progress. He was excited having reached his target Body Mass Index (BMI) of 23. He had been morbidly obese (BMI of 45) when I had first seen him for knee pain about twelve months previously. As a builder, his knees were greatly interfering with his work. X-rays showed signs of wear and tear and I advised him that losing weight was the best way forward. He agreed, but had tried endless diets and experienced the frustration of weight loss and then weight gain. We discussed options and he decided to try a medically approved very low carbohydrate diet and a group therapy programme. These programmes recognise that losing weight is not enough, that it is essential to attend groups to work on the origins of your obesity and continue to attend and address the causes of your eating.

Lastly on that day came Alice who had realised through counseling that the origins of her overweight were about protection from family issues- she had been using her weight as a defense from the world. With this realisation the weight began to fall off. She felt "groups" were not for her and used counseling and several websites which provided calorie and nutritional advice.

Food addiction is an under-recognised condition resulting in the compulsive, excessive craving for and consumption of food. It is not only manifested by the abnormal intake of food, but the intake and craving for foods that are, in themselves, harmful to the individual. People become physiologically and mentally dependent upon food. Overcoming an addiction to food can be very frustrating and disheartening - because unlike addiction to alcohol or drugs, you can't abstain. "Food addicts" come from all age, race, and gender groups. The four above were overweight, but food addicts can be underweight or normal weight. There is no single or easy way to combat food addiction and it requires intense discipline in modifying eating patterns and lifestyle, along with an exercise program. Diets alone rarely have long-term success and people need to find the solution for them and we need to support people to find their way.

All these patients had a similar problem - food addiction - but all had come up with individual solutions and will need to continue to work on their problems.

- Dr Chris Ford