Lifestyle Modification is Very Similar to Addiction Recovery; Treat it That Way!
My recent experience with heart disease has rekindled an interest I have in the genetic aspects that cause predispositions to disease. I discovered early on in my 2003 research into obesity that there was a then postulated tie between the A1 allele on the number two dopamine receptor (DRD2-A1) and other forms of addiction such as gambling, shopping and other drugs. Kenneth Blum originally identified DRD2-A1 as the “alcoholic gene” in a landmark 1990 study article published in the Journal of the American Medical Association. He followed this up with too many studies to mention. One that was written for the general public published in the American Scientist in 1996 is an excellent and easily understandable article that even has pictures! It is entitled Reward Deficiency Syndrome and you can find it easily with a Google search if you are interested in such things. Since my last searches for studies of the DRD2 gene, research has expanded greatly and the postulations that Kenneth Blum made in the 90s that the DRD2 gene would have implications for other addictions is gaining traction in the scientific community.
The basic concept is that people with the A1 allele don’t receive the same level of dopamine reward in their brain that other people do when participating in actions such as drinking or smoking or eating something sweet and therefore need to engage in that activity over and over again until they becoming addicted. Blum coined the phrase reward deficiency syndrome for this. As research and understanding grew the thinking on the DRD2-A1 moved from alcoholism to a predisposed to all forms of addiction based on the dopamine reward deficiency that may also be tied to all reward systems in the brain. Genetic research has uncovered that some people are predisposed to addiction, but not to a specific type of addictive activity. Howard Schaffer as the lead author of a Harvard publication entitled Overcoming Addiction states that “several scientific advances have shaped our understanding of addiction. For example, new brain imaging technologies have revealed that our brains respond similarly to different pleasurable experiences, whether derived from drugs or behaviors.”
Obviously, research has just started and the scientific community is far from consensus on this, but there is plenty here for us common folk to apply to our own lives right now in terms of weight loss and lifestyle modification. The lesson is to take all of the research and lessons learned from addiction recovery and apply it to our weight loss and lifestyle modification efforts. The same reward deficiency that is at the root of addiction problems with alcohol and drugs may be at least one of the culprits involved with continuing to eat calorically dense foods that work on the same dopamine reward system.
As identified by that Harvard publication the hallmarks of addiction are craving for the object of addiction, which can be mild to intense, loss of control over the use of the object of addiction and continued engagement with the object of addiction despite adverse consequences. Many of us that have tried to reduce or quit snacking on high fat or high sugar foods can recognize these three hallmarks. When was the last time you had a slice of pizza even though you know it was something you shouldn’t be eating?
Here are some things that can be applied to all addictive behaviors.
Learn the “triggers” that lead to poor eating habits and ways to avoid them.
In every Healthy Cooking Live cooking demonstration that I have done at Hometown Café there has been a question about how to deal with being at parties and events where high-fat highly processed foods are eaten. We can just call this “dealing with temptation.” I mentioned in one of my answers to this question that we all need to be aware of the people, places, and things that are “triggers” for us and that it would be setting yourself up for inevitable failure to not think about what to do when faced with one of your triggers well ahead of time.
There are many similarities between addiction treatment and weight loss. Dealing with temptation is something that all 12-step programs have a lot to say about. In 12-step programs, you will hear the phrase “beware of people, places and things” mentioned often. This means that you need to identify, avoid and cope with “triggers” that are associated with the behavior that you are trying to change. In our case that behavior is indulging in foods that we want to eliminate from our diet in order to lose weight and improve health.
Always be aware of where you are. Places can be very strong behavior triggers. I have talked about my own love affair with apple fritters warm out of the fryer that I used to buy on the way back from the nightly mail drop at the 24-hour airmail facility in Columbus Ohio. My solution was to choose not to drive down East Broad Street where the donut shop was located when returning from the airport. Just being on East Broad Street at the wrong time of day placed me at risk. During the first few months of my lifestyle modification while I was still learning to deal with temptations, being at the stoplight in front of my favorite donut shop was dangerous so I took it one step further and didn’t even drive on East Broad at that time I used to stop and get those apple fritters every morning. You have to think ahead about the places that will be triggers for you.
About a year before I experienced the heart event that started my lifestyle modification journey, I also quit a very heavy smoking habit. Being aware of triggers was an especially important aspect of my recovery from nicotine addiction. Anybody that has ever smoked knows that coffee, the time just following a meal and even places where you used to smoke can all be triggers that lead you to crave a cigarette. Even geographic locations can place you at greater risk. When I was in Dubai and Qatar working in the early-90s everybody smoked. It was part of the culture and was socially acceptable so I found myself smoking more often. Here in Smith Center, we all need to be aware that we are in a geographic location that places us at greater risk of being heavy.
A survey study published in the December 2019 issue of The New England Journal of Medicine using data compiled by the well-known and reliable National Health and Nutrition Examination Survey (NHANES) shows that the State of Kansas may join the heaviest states in the union, at number seven, by the year 2030. This 2019 study extends accurate projections of body mass index (BMI) that were reported in 2012 in the American Journal of Preventive Medicine.
The latest 2019 article identifies the following eight states as having a population over 50 percent with a body mass index greater than 30: Oklahoma 58.4 percent, Mississippi 58.2 percent, Alabama 58.2 percent, Arkansas 58.2 percent, West Virginia 57.5 percent, Louisiana 57.2 percent, Tennessee 55.8 percent, and Kansas with 55.6 percent of the population projected to have a BMI over 30 in 2030. BMI categories are normal weight (18.5 to 25), overweight (25 to 30) and obese (over 30).
There are many contributing factors involved here, but you can’t get around the fact that the place we live in has a culture that promotes being not just overweight, but obese! We need to be conscious of the ways that the place we live encourages us to participate in behaviors that promote being overweight.
In practical terms, if you fill-up with gas at Casey’s and when you go in to pay you always get a slice of pizza and a Coke you can call stopping at Casey’s a trigger for poor eating habits. A solution may be to get gas at another location. Paying at the pump so you don’t have to go inside near the smell of the pizza might be enough too, but not planning on dealing with what you know is a trigger is just irresponsible and may lead to a dietary set-back.
Being conscious of triggers associated with people, places and things is another asset in your toolbox that can help you be successful with your lifestyle modification!
Change your environment.
Remove any reminders of your addiction from your home and workplace. For example, separate from those who would encourage you to be involved with the object of your addiction (drug, alcohol or behavior). If you are trying to quit drinking, get rid of any alcohol, bottle openers, wine glasses and corkscrews. If you’re trying to quit gambling, remove any playing cards, scratch tickets or poker chips. Also, don’t let other people use or bring reminders of the addiction-related substance or behavior into your home.
I have been in a lot of homes of people that are attempting lifestyle modification and you all would be amazed at how many people have not removed the foods they are trying to eliminate from their diet from their kitchen and house. You are not going to reduce your ice cream consumption if there is a pint of Cherry Garcia staring you in the face every time you open the freezer door! The question is always “what do you want me to do, throw all that stuff away?” My answer is always abso-darn-lutely! (I use another word there!) If you are not willing to walk around your house with a garbage can then you are not committed and you will fail. The act of throwing away all of that is also an extremely powerful physical manifestation of your desire to change and heal! Participating in exercise has the same effect. One thing I learned from quitting smoking is that it’s not enough to just throw your smokes away, you have to completely destroy them. If you don’t think that in one hour, you’ll become a dumpster diver then you ain’t thinkin’ right!
If you aren’t willing to throw anything away try the next suggestion.
Set a start date.
Sometimes we need to count to three before we start. So, eat all the stuff in your house, have that last pizza or trip to Mickey Dee’s and then be done with it. This is a very common thing for addicted people to do before changing their ways. Enjoy the last few times and make sure that they are good ones! Getting good and sick wouldn’t be a bad thing for any activity you are trying to change!
Create a support network.
Our tendency is to keep our weight loss or lifestyle modification effort a secret. One reason is to save face in case we fail. Sun Tzu the ancient Chinese general, military strategist, writer and philosopher said to have written the Art of War is quoted writing; “throw your soldiers into positions whence there is no escape, and they will prefer death to flight.” By letting everybody know about your weight loss or lifestyle modification goals you are leaving yourself no way out but to face public defeat and embarrassment if you fail. AA and all 12-step programs advise members that if they are really serious about changing to tell everyone, especially family and close friends because they can help you stay clean. Even casual acquaintances can become part of your support network! The alcoholic serious about quitting tells their bartender first! There’s nothing like a little shame to motivate change.
Talk to your family and friends and ask for their encouragement and support. Let them know you are changing; trust me they will be happy. If they use your object of addiction, ask them not to do so in front of you and not to talk about it.
Weight loss and lifestyle modification aren’t easy and it’s going to take everything you have at your disposal. To be successful you need to use every single tool in your box!
Here are the references for today’s Healthy Eating Tip:
Blum K, Noble EP, Sheridan PJ, et al. Allelic Association of Human Dopamine D2 Receptor Gene in Alcoholism. Journal of the American Medical Association. 1990;263(15):2055–2060.
Blum, Kenneth G.; Cull, John R.; Braverman, Eric E.; Comings, David. Reward Deficiency Syndrome. American Scientist. 1996;84 (2):132.
Howard J. Shaffer and Julie Corliss. Overcoming Addiction: Finding an Effective Path Toward Recovery. Harvard Health Publishing. Harvard Medical School. Boston, MA, 2020,
Finkelstein EA, et al. Obesity and Severe Obesity Forecasts Through 2030. Am J Prev Med 2012;42(6):563–570.
Ward ZJ, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med 2019;381;(25):2440-2450.
About the National Health and Nutrition Examination Survey. National Center for Health Statistics (NCHS). Centers for Disease Control and Prevention (CDC). . Accessed 2/19/2021.