(The Week, posted on May 22, 2012 )

By Bill Frist, M.D.

The nation’s obesity epidemic is as much about brain chemistry as it is poor diet and laziness — a fact we must realize if we’re going to treat obesity effectively

In ancient history, eating was for survival. Food was tough to come by and we consumed what we needed. Food was a necessity. In today’s America, it is an addiction.

Much of the conventional wisdom about obesity, including what your doctor has probably told you, is wrong. My fellow doctors, for the past four decades, have preached a “calories in — calories out” approach, suggesting that weight loss must be achieved by restricting calories or expending more energy. That approach is failing… miserably.

Contemporary medical research, most of which has not yet made it to mainstream understanding, suggests we should focus on two other more promising areas: Food addiction and diet. Consider it an “it’s what you eat” approach that takes into account human biology and the response to certain food types.

According to the research of Nicole Avena of Princeton University, eating sugar triggers a dopamine-mediated response in the same part of the brain that is similarly targeted by cocaine, nicotine, and other highly addictive substances. Originally, this “reward center” evolved to reinforce behaviors, such as food and sex, that maximize species survival.

To combat this epidemic, we may have to start with the brain, not the stomach.

Sugar, however, seems to hijack the same neural and biochemical connections in the brain. The intense cravings for sugar may be explained by the intensity of dopamine secretion in the brain when we consume sugar and high-fructose corn syrup, both of which are staples of the common American diet. Consistent eating of sugary and processed food literally rewires our brain. In 2011, 28 studies, from animal investigations to clinical studies of compulsive eaters, all point toward unhealthy foods as being addictive.

So why do we get fat? It’s not a simple matter of calories consumed and calories expended. It’s probably wiser to think of obesity as a result of a hormonal imbalance, with the dominant obesity hormone being insulin.

Insulin secretion is stimulated by eating easily digestible, carbohydrate-rich foods: Refined carbohydrates (including flour and cereal grains, starchy vegetables such as potatoes, and sugars) and high-fructose corn syrup. Eating more of these makes us fat, hungrier, and even more sedentary.

Why does all this matter? First, your kids are going to live a life with more disease and will die younger than they should. This does not have to be the case, but we can only reverse course if we act. With a third of adolescents in the U.S. overweight, and adolescent diabetes and prediabetes skyrocketing from 9 percent in 2000 to 23 percent in 2008, we are on the path to an explosion in heart disease, high blood pressure, and cancer.

Second, healthcare spending is driving you and the country bankrupt. Obesity, a problem which didn’t really exist even 40 years ago, today accounts for almost a fifth of our nation’s health spending, which amounts to more than $150 billion every year. That is an annual tax of $1,400 on every household, and it continues to escalate.

The good news is that the obesity problem is solvable. It is reversible, if we act smartly, both individually by our own life choices and collectively through wiser, more active public policy.

What can we do?

1. Focus on the root causes of why people crave food, often hungering for the unhealthiest options, and not just deal with the aftereffects. Studies show that exercise alone does not lead to weight loss (but it is very healthy for you!), replacing lost calories with increased appetite. It’s what you eat that you should concentrate on. Weight loss regimens succeed long-term when they get rid of the fattening carbohydrates in your diet.

2. Think out of the box. If the increasingly strong hypothesis that sugar is addictive is correct, we need to treat it as such. An addiction demands attention to replacement foods, development of new classes of anti-craving and relapsing medicines, and possibly even more intense use of 12-step programs for therapy.

3. Public policy tools and tactics that affect advertising, availability, and cost (including taxation) have been effective in fighting alcohol and tobacco addiction. Our society instinctively rejects policy that suggests “food police.” In the future, however, expect these tools to be considered much more aggressively since obesity stands as an even greater public health threat than tobacco.

We cannot afford to ignore obesity. But let’s be open to changing our approach. To combat this epidemic, we may have to start with the brain, not the stomach.

This article was originally featured in The Week http://theweek.com/article/index/228248/how-to-wean-america-from-its-dangerous-food-addiction