Can Obesity Be an Addiction?

Bret S. Stetka, MD; Nora D. Volkow, MD

Disclosures

July 16, 2013

In This Article

Therapeutic Implications and Future Directions

Medscape: What does the improved understanding of addictive obesity mean for treatment? Are there therapies under investigation targeting the reward pathways in obesity?

Dr. Volkow: In animal models, there are medications that, for example, interfere with the consumption of high quantities of food. In many instances, these same drugs are useful in interfering with drug consumption. This is not surprising, as these drugs work by acting on the reward system. People are looking for drugs that can act on this system and decrease their addictive behaviors.

As the Director of NIDA, this is an area of great interest to me, because there has been very limited interest by the pharmaceutical industry in developing medications for drug addiction, whereas there is much more interest in developing obesity medication treatments.

Medscape: What antiaddiction medications have shown efficacy?

Dr. Volkow: One is naltrexone, a new opioid receptor antagonist that is very useful in treating heroin addiction and alcoholism. A combination of sustained-release bupropion/naltrexone therapy is currently being reviewed by the US Food and Drug Administration for obesity. There has also been a lot of interest in cannabinoid receptor antagonists.

Rimonabant -- a drug that was approved in Europe for the treatment of obesity, and then removed from the market because it caused suicidal thinking in some patients -- had been shown to interfere with the administration of drugs in animal models of addiction. It also showed potential benefits in treating marijuana abuse. Unfortunately, its side effects will preclude its clinical use.

More researchers are working on the neurobiological overlap between drug and food reward, and the adaptions that ensue with repeated use, as a strategy to help identify molecular targets for addiction medications.

Medscape: What are you and your group at NIDA currently working on?

Dr. Volkow: We are studying many facets of obesity. We are interested in understanding the mechanism by which glucose and other peripheral signals (including vagal stimulation) activate the reward system. We are also studying the neurocircuitry overlap between food and alcohol consumption; this has generated a lot of clinical interest, because bariatric surgery for the treatment of obesity is associated with a higher risk for developing an alcohol use disorder. Specifically, we are studying the mechanisms by which bariatric surgery modifies the rewarding effects of alcohol and other drugs.

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