Obesity as Addiction

In this blog post I make the case that obesity is a result of addiction to the consumption of certain types of food, and as such, should be treated in the same way as other addictions.

A caveat is in order: I am not a medical professional and have no medical qualifications to be commenting on these matters. However, I have struggled with obesity for most of my adult life. I also have a long family history of addiction, which I have dealt with since childhood. So even though I am not medically qualified, I do have my own opinion based on my life experiences. I may add that my daughter is a social worker, and I have had many opportunities to discuss the nature of addiction with her.

What is addiction?

We all think of addiction in terms of hard drugs like cocaine and heroin. In my family history, the drug of choice has almost always been alcohol, so I will stick to that.  Once somebody is addicted to alcohol, drinking is beyond their control. They absolutely need to drink not only for the sensation of getting drunk, but also to prevent withdrawal. 

A big difference between food and alcohol is that we need food to survive, but we don’t need alcohol (nor do we need hard drugs like heroin or cocaine to survive). So it is natural to say that alcohol is addictive, but it is quite strange to say that food is addictive.

Nobody has a hard time regulating how much water they consume (unless they have some kind of pathological illness). You are thirsty and you drink. It is a natural well-regulated biological cycle. Similarly, we do not find it tricky to breathe in the right amount of air, in most cases (unless you are a professionally trained singer, perhaps). You just breathe in the air you need and exhale.

But with food, the situation is very different. Our bodies somehow do not always provide a perfect gauge for the amount of food we should take in. For the obese person, they take in too much food (a calorie surplus) and those calories are in many cases unhealthy calories (e.g., based on processed sugar).

The obese person eats to satisfy their hunger, and for the pleasure of eating the food. But their hormonal system does not accurately tell them how much food to consume, so they end up eating more than they need. The popular term now is “food noise”. Even after eating, a person is still subject to food noise, and so they want to eat more. Since the person is eating more food than they need, both for the pleasure of it and to avoid hunger and food noise, it is addictive behavior. 

The cycle of eating too much, when the body does not need it to survive, can continue for years, in some cases leading to extreme obesity. For example, in my case I weighed in at 350 pounds in September of 2025 (at the age of 62), which is morbidly obese.

Negative Consequences

The cycle of drinking, getting drunk, finding more to drink to avoid withdrawal can literally destroy somebody’s life: leading to loss of a job, loss of money, damaging or destroying close relationships, a very rapid decline in health, and in some cases, early death.

The consequences of obesity may not be as chaotic and debilitating as those of alcoholism, but they are just as destructive in the long run. Obesity can lead directly to type 2 diabetes, with various related problems such as heart disease and stroke. But there are many other problems too. The excess weight can cause stress on your feet and joints, leading to foot pain, and resulting in lower mobility. How do I know this? Because it happened to me. I had chronic foot pain for decades. But since losing 80 pounds, the pain has decreased quite a bit (except after I take a long walk).

American Culture

American culture promotes social drinking in all kinds of ways. Drinking is tightly integrated into the fabric of our society. It is seen as a socially acceptable activity, a form of entertainment, a way to have fun and blow off steam. Going out with friends usually involves having a few drinks. People become known as experts on various beverages. One person may be a wine expert, and another an expert on types of beer. It becomes a kind of intellectual hobby, in addition to a social activity. In NYC in some areas, you cannot walk down a single city block without seeing at least one and maybe more liquor stores.

Just as with drinking, American culture promotes all kinds of unhealthy foods in many different ways. Processed sugar and related substances like high-fructose corn syrup are perhaps the worst of these. Americans rejoice in these kinds of sugary treats. And the food industry aggressively pushes them in the name of profit. Just witness the fact of feeding our beloved children a great big bowl of sugary breakfast cereal before they go to school in the morning. That bowl of cereal wreaks havoc on their health, but they love it, so we give it to them. I know this, because I did this myself. I ate those cereals as a child, and fed them to my own children.

Just as importantly, our lives nowadays are for the most part sedentary, as opposed to the more physically active lifestyles that most people had until the recent past (e.g., farming or hunting and gathering or pastoralism).  If we overeat, we simply do not burn it off. For example, I will arrive at the office at around 8:00am, and leave at 5:00pm, but engage in no strenuous physical activity the entire day. I mostly sit at my desk writing and reading. Once a day, I get up to go teach a course. That’s it.

Stigma

There is social stigma associated with addiction to alcohol. There is a culture of blaming the victim. We say why can’t that person just drink less? Are they so undisciplined that they cannot control themselves? They are being selfish for not thinking of how the members of their family are suffering. But one thing I have learned through many life experiences is that blaming the victim only gets in the way of solving the problem.

The stigma associated with obesity is in some ways as bad as the stigma associated with drinking. One can feel sorry for the drunk, but for the obese person, one feels nothing but disgust. You pity them because they cannot even manage how much they eat, and you find their appearance repulsive. It is still socially acceptable (witness the Bill Maher show) to make fun of fat people and to put them down mercilessly. Everybody loves a good joke! There are absolutely no social penalties that come with a fat joke, unlike severe social penalties that come with jokes associated with race or gender or disability. There are no such social penalties, because nobody is to blame but the obese person themselves.

Medication

The basic tenet of the harm reduction model of addiction treatment is to reduce the amount of harm that the person can do to themselves. One of the main strategies of this kind of treatment is to provide medications (such as naltrexone) which reduce cravings for alcohol. These medications are wonder drugs, allowing the addict some breathing room from constant cravings for alcohol and giving them the space needed to regain control of their lives.

The correlate of using medication to treat alcoholism is the use of GLP-1s (such as Wegovy) to treat obesity. These medications lower the background food noise (reducing cravings), and make it much easier for a person to regulate their eating. The success of these medications is direct proof that overeating is driven by hormones and neurochemical signaling, rather than just a lack of discipline and willpower.

A curious twist in this saga is that there is preliminary evidence that GLP-1s can help with drug addiction (not just weight loss). It is as if there is some general biological system having to do with craving in excess of what is needed, and GLP-1s take aim at that system.

I am not, however, saying that medication is the only way of approaching obesity. Any approach to obesity will involve many different angles, and should be discussed with your physician. Everybody has their own individual journey which may take them in completely different directions. But for some people, GLP-1s might be a lifesaver.

Heritability

Twin studies show that both alcoholism and obesity are heritable traits, both at roughly 40-50%. That means that nearly half of the variation between individuals is explained on the basis of genetics. Similar (although weaker) conclusions result from the calculation of polygenic risk scores, which aggregate thousands of genetic variants across the whole genome to estimate risk.

These two independent sources reinforce the basic conclusion that both alcoholism and obesity have their roots in biology, and are not just a matter of weakness of character or a failure of willpower.

Personal Responsibility

Baby boomers may remember the slogan “Just say no!” from the Reagan years. That was the socially acceptable response to drug use. This slogan puts the responsibility squarely on the drug user. But it is overly simplistic. At some point, for the addict, just saying “no” is a physical impossibility.

All this is not to say that I absolve the addict of personal responsibility. But the nature of that responsibility is in the realization that one is an addict and that something needs to be done about it. It can take years or even decades to admit that there is a problem. Without that fundamental realization, there is no way forward. No amount of treatment will do any good, if the addict themselves is not on board.

This turning point is just as important in the case of obesity as it is in alcoholism. I knew for decades that my weight was creeping up, just a few pounds every year. But I put it off, saying that I did not buy into cultural stereotypes of thinness and beauty, and thinking that after all I exercised every day and felt fine. But in the end, it crept up on me, and I discovered I was prediabetic, with some fairly serious health problems (described in other blog posts). That realization put me in crisis mode, and I changed my whole life, including diet and exercise. I also started taking Wegovy.