“This book can change your life, if you allow it,” declares Biggest Loser contestant Tara Costa in the foreword to The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction, by Dr. Pamela Peeke. It isn't a rare claim to be made of a book. But Costa is far from the only person to be convinced that Peeke’s work will revolutionize how our society views overeating and food addiction: after The Hunger Fix launched on Katie Couric’s talk show in September, it took just five days to become a New York Times bestseller. “My team and I looked at each other and said, ‘Well, we must have hit a nerve,’” Peeke tells me.
While many scientists continue to debate whether or not overeating is a true "addiction"—the current DSM says not—Peeke has no such doubts. She's gathered an abundance of new studies and evidence, shedding light on the serious food problems from which so many Americans suffer. Peeke, MD, MPH, FACP, is a nationally renowned nutrition and fitness expert, a Pew Foundation Scholar in nutrition and metabolism, and a Fellow of the American College of Physicians. She also founded the Peeke Performance Center for Healthy Living, working to help thousands of men and women recover from food addiction.
"When you start a small child out with the “hyperpalatables,” and they have a Pop-Tart for breakfast instead of oatmeal, you’re just basically turning them into a science fair project."
In The Hunger Fix, she offers a unique perspective on eating disorders, and suggests simple lifestyle solutions to anyone struggling with them. (The first step is assessing just how serious your food obsession actually is: Peeke recommends taking the Yale Food Addiction Scale.) She speaks to me passionately about the science behind overeating, the obesity epidemic, and how kicking a food addiction can be even more difficult than a drug habit.
How does food addiction normally get started?
I’m going to make two cases. One is the case where you have absolutely no addictive genes in your body. As this person enters the world, they have an exposure environmentally to a truckload of sugary, fatty, salty substances. And you’re just surrounded by it. So now what’s happening is you’re conditioning that person and you’re causing organic changes in the brain and the prefrontal cortex, which is the rewards system and the “smartypants” part of your brain. Then over time, you become addicted.I always say, genetics load the gun but environment pulls the trigger.
Another kind of person does have some level of addiction in their genetics, depending on how many parents or relatives have dealt with addiction down the line. And that person is born with a genetic tendency toward developing one of those. They’re going to have a much quicker latching on to an addiction.
How important are the environmental factors that add to genetics?
The third piece that’s very, very important in the equation is that when you’re a child, you are at the mercy of whatever your parents give you. When you start a small child out with the “hyperpalatables,” and they have a Pop-Tart for breakfast instead of oatmeal, you’re just basically turning them into a science fair project. Some of those kids will become addicted much faster than others and some will not be effected whatsoever. And then there’s the issue of stress. People with addictive tendencies have difficulty adapting and adjusting to life’s stress without caving to the cravings. How it begins is you have a crock pot of assorted things here. You have your genetic background, you have the environment in which you live. This can happen at any point in time. You can have a completely clean childhood and then maybe a trauma happens later in life, and then you pick it up at that point in time.
Some people don’t believe that food addiction is real. What do you say to them?
What they’ve shown is that the prefrontal cortex actually shows organic damage to the orbital frontal part of the brain with someone who is just full-on addicted. They’ve done comparisons of brains in people who are cocaine abusers and those who are food addicted, according to the Yale Food Addiction Scale. What they found is that the brains are indistinguishable. You cannot tell the cocaine abusers from the food addicted because the damage is exactly the same. When people say “It’s psychology. For God’s sake, rein it in. It’s just one cupcake,” it demeans the entire experience of food addiction. That cookie triggers the entire domino effect in the rewards system. Your prefrontal cortex is so damaged that it can’t stand up to this hijacked rewards system and say “Wait a minute, what are we doing here?”
Would you say that kicking a food addiction is harder than kicking any other addiction?
That’s absolutely correct. I’m not at all minimizing the hell people go through in rehab, whether it’s from cocaine or from alcohol or whatever. It is a lot of work and you gotta do it. Let’s go to drugs for a moment. None of these things are necessary for survival. So I can see them as separate entities: I can push them out of my life. To detox and get on with my life, I have to change up the persons, places and things in my life that enable that type of addiction. You can change up your tribe, move somewhere else, and you don’t ever have to buy this stuff again because it’s not like you go to the grocery store and there’s alcohol in every aisle or cocaine hanging off the aisles.
Let’s flash forward to food. We need food to survive. Making this even more difficult, when I’m going down the street, I don’t see billboards with big syringes that say “Hey, do a hit today!” I don’t see pictures of people snorting cocaine. There are alcohol pictures, but they’re not that frequent. But food, are you kidding me? The cues are everywhere. Studies have shown that the cues and anticipation—not the consumption—for any addiction cause the greatest secretion of dopamine in the rewards system. They will start that whole obsession almost immediately.
What about Overeaters Anonymous and other programs for people with food addictions? Do you think tools like these are helpful?
I think whatever works out there in terms of well-established programs like Food Addicts Anonymous and Overeaters Anonymous is great. I think that all of these have great merit. What I say is, people end up choosing a combination of programs. For example, in Weight Watchers, they have group meetings. Some people hate group meetings, but they’ll use the e-tools and they’ll just do it that way. But there are other people who go to the group meetings and they write their little logs on a spiral bound notebook but they don’t like using the computer much. At the end of the day, if both of those people have made their goal in a healthy way, rock on. I say congratulations and kudos to [Overeaters Anonymous and Food Addicts Anonymous] for being so helpful.
How should people with cross-addictions to things like drugs or alcohol handle a food addiction?
I say in my book to be very careful, because cross-addiction can set you up for food addiction. In other words, if you’re an alcoholic or a drug abuser, many of those people go on to shift their addiction over to eating. That’s very, very common—especially in alcoholism and cigarette smoking. There’s some very early, compelling research that shows that those people who are cross-addicted have a more intense issue when it comes to all addictions, especially food addiction. So for people who are cross-addicted, whatever your food false fix is, once you’re off it, you’re off it. There’s no going back. You need to try to avoid that like the plague because that will cue you into a much more intense addiction if you go into relapse.
I’ll look at someone and I’ll say “Do you remember what it took for you to get off cocaine?” and they’ll go “Oh yeah, definitely.” And I’ll go “How do you feel about cocaine now?” and they’ll go “Oh no, no more.” And this is the way they have to treat their food false fixes. It’s the same mindset. When you look at that granulated sugar, you’ll see a line of coke. In addition, physical activity is absolutely imperative. Mediation, however you want to do it, via prayer, is imperative. Your mind, mouth and muscle all support your prefrontal cortex function and that is what you need. Sharpened and strengthened and powered up to maintain recovery for the rest of your life.
Would you say that the obesity epidemic in the US is due to food addiction above all else?
Obesity has many, many causes. We have an incredible need to look at everything from the lifestyle habits of parents to the decrease in total number of people cooking anymore. The physical activity issue, the types of food or lack thereof fed to everyone, the portion sizes, the fact that we don’t have food rituals anymore—it’s happening everywhere. Eating has become a 24-hour, seven-day-a-week gig. And people just give up after a while. So food addiction got thrown into all the rest of this. You cannot pin this on one thing. This is a very complex psychological, biological, sociocultural phenomenon.
How helpful do you think it would be if we as a society fully recognized food addiction?
Extremely! What you put in your mouth is causing organic changes in your brain which set you up for a vicious cycle that not only could potentially pack on pounds and lead into that whole arena of problems, but will condemn you to a life of disability and early death. What was most important about the book as a game-changer is that it gets people out of the standard operating procedure of just flapping the same 1,200-calorie “diet” on everyone. You have to ask whether or not they have the condition of food addiction and if they do, they need to be on a more customized detox and recovery plan so that they understand why after shedding 50 pounds they can’t just go back to “Oh, I can have a cookie again!” Maybe you can’t. And now we understand why. I think it is imperative that we take this new, exciting, compelling and revolutionary science from all over the world, and integrate this new knowledge into our current repertoire.