She shared that while she was on her way to group she felt stressed and anxious; she had to tell the group that her relationship with food that week had been horrible. Her car seemed to automatically take her to the drive-thru of the nearest fast-food restaurant. Even though she had already eaten, she ordered food and said “we would like two orders of fries” so that the server would think she was ordering the large amount of food to share with someone else. After paying for the food, she pulled into a remote part of the parking lot to eat where no one would see her. She said she didn’t remember actually eating the food but remembers throwing out the wrappers, carefully removing any signs of her binge. Bloated and uncomfortable, the all-too-familiar collection of self-loathing comments began once again: “What’s the matter with you? You said you weren’t going to do this anymore! You’re pathetic. I don’t know why you even go to that group. You will never be anything but fat! You’re never going to get control of this.” As her thoughts grew louder, she reached into her purse for M&Ms to drown out the voice in her head.
The group nodded their heads in acknowledgment. They knew, all too well, the automatic nature of food addiction.
The addicted brain lives in impulsivity and compulsion. The person with a food addiction eats without conscious awareness of how much or even when they are eating. They reach for a cookie on the counter without knowing that they are doing it. They eat while watching TV and eat past satiety until the show is over, without realizing how much they have consumed. In treatment, one of the things we look for is the slowing of automaticity through comments like: “I was on my way to the pantry to get the potato chips and I said to myself ‘I shouldn’t be doing this, it’s not going to help me get what I want.’” Even though she may have eaten the chips anyway, the fact she was able to recognize what she was doing was new; her brain was starting to heal.
But how does this automatic response happen? And what can be done about it?
Compulsive eating and certain highly-palatable foods release a neurotransmitter called dopamine into the prefrontal cortex. This “feel-good” brain chemical opens the pleasure pathways in the brain that help us to numb out from the stress of life. While dopamine is essential, when we are stressed it hijacks the brain and we feel compelled to pursue “the cookies” even though we committed not to or even though we know it would not be good for us. Since willpower resides in the prefrontal cortex, when we flood it with dopamine the one thing we can NOT do is access willpower. Reaching for or seeking food when stressed has become automatic.
The addicted brain needs structure to decrease this automatic response and to heal from food addiction. In Lifestyle Transformation we have identified 8 categories of activities that, when performed, consistently aid in restoring the prefrontal cortex to its pre-addicted state and help the individual to live more intentionally. We call these categories the Cor-Conditions because of their positive effect on the dopamine-damaged prefrontal Cortex. With a healthier, better functioning brain, a person addicted to food can begin to access the will-power necessary to overcome food addiction.
People addicted to food can choose small, daily goals from the Cor-Conditions. They should be simple and attainable goals so that they do not become overwhelmed. An addicted person does not need to work within each of the categories every day but should strive to balance their participation with them throughout the week. We have seen optimal recovery when the addict completes 6-7 goals a day. Performing these daily goals consistently over time helps the brain heal from addiction and/or develop positive behaviors that increase intentional living.
The following are suggestions for daily goals in the eight “Cor-Conditions”:
Purposeful Activity: recovery reading, taking a walk, preparing a food plan for the day.
Mindfulness: techniques like staying present and aware of food during the meal instead of watching TV. Prayer, visualization, yoga and meditation are also very helpful.
A Healthy Relationship with Food: Working with a registered dietician to develop a healthy nutrition plan using a non-restrictive model is very beneficial.
Connection: Connection with others releases oxytocin, an important hormone that aids in recovery from addiction. Healthy relationships provide support. Learning to reach out to others for support is an important recovery principle.
Movement: Exercise can help return dopamine to normal levels. Individuals with obesity can work with a physical therapist to develop a safe program for increased activity.
Service: Long recognized in Twelve Steps as an important recovery principle, service has a positive effect on recovery from addiction.
Play: Many who struggle with food addiction have lost their ability to play because of weight imposed restrictions or self-consciousness about their body. Play and recreational activity is important for a well-balanced life.
Music: Studies have shown listening to music has a positive effect on the brain
 Blum, K., Chen, A., Giordano, J, Borestn, M., Chen, T. Hauser, M., Simpatico, T.,Femino, J., Braverman, E., Brah, D., (2012). The Addictive Brain: All Roads Lead to Dopamine, Journal of Psychoactive Drugs, 44 (2), 134–143.
 McGonigal, K. & Buczynski, R., (2015). The Neurobiology of willpower (it’s not what you expect). National Institute for Clinical Application of Behavioral Medicine. Webinar Session
 When working with a registered dietician, clients should request a non-restrictive approach as the addicted brain will register the restrictive nature of the diet as a compulsion. The Healthy at Any Size or Transtheoretical Model of Change are two dietetic models that work well alongside food addiction treatment.
 Wilkinson, L., Rowe, A., Bishop, R., Brunstrom, J., (2015). Attachment anxiety, disinhibited eating and body mass index in adulthood. International Journal of Obesity (2010) 34, 1442–1445
 Horn, S., (2015). Sweating it out. Exercise and addiction recovery. https://www.addictioncenter.com/community/sweating-it-out-exercise-and-addiction-recovery/
 Brown, S., & Vaughan, C. (2009). A Review of Play, How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul. Therapeutic Recreation Journal, 43.2, 57-59.
 Blum, K., Chen, T., Chen, A., Madigan, M., Downs, W., Waite, R., Braverman, E., Kerner, M., Bowirrat, A., Giordano, J., Henshaw, H., Gold, M. (2010) Do dopaminergic gene polymorphisms affect mesolimbic reward activation of music listening response? Therapeutic impact on Reward Deficiency Syndrome (RDS). Medical Hypotheses 74 (2010) 513-520.