As research into the food-addiction model continues to gain credence, an author who strongly asserts he is a food addict offers several enlightening perspectives to the discussion.Michael Prager, a writer and former Boston Globe journalist, has recently released an honest, vivid, and thought-provoking memoir, “Fat Boy, Thin Man” on his lifelong struggle with weight. At a young age, Michael’s eating spiraled out of control and his weight grew to 365 pounds. Michael struggled to manage his weight by dieting and exercising, but regardless of what efforts he employed, he was unable to attain control over his eating. At one of his darkest hours, Michael entered a psychiatric hospital and began to recognize that he felt addicted to food. This realization led to participation in support groups that focused on food addiction and resulted in the loss of approximately 155 pounds. Although challenges remain, Michael has maintained his weight loss for almost 20 years and demonstrated a sane pattern of eating by following a food plan that includes abstinence from his personal trigger foods, which includes anything containing refined sugar or flour.
In addition to writing a poignant and heartfelt book, Michael touches on many highly debated scientific topics in “Fat Boy, Thin Man.” First, Michael’s book centers on his experience of food addiction. Although still a highly controversial topic, scientific evidence is building that supports the validity of Michael’s conclusion of being addicted to food. One major factor is the rapidly evolving nature of food in the current environment. Food is a necessary substance for survival, but the majority of foods in the Western diet are pumped full of added sugar, fat, salt, food additives, caffeine, and flavor enhancers. This process results in foods that are exponentially more rewarding than the foods the human body and brain evolved to handle. For example, humans exposed to highly palatable food cues exhibit brain activation that is akin to the brain response of drug users exposed to drug cues. Similarly, administration of sugar, fat, and processed foods to animals can result in brain changes and behavioral changes, such as withdrawal, that mirror the effects of substances like alcohol, heroin, and cocaine.
In some instances, sugar appears to be more rewarding to animals than addictive drugs. Dr. Serge Ahmed’s group designed an experiment where rats had to choose between drinking sugar water or receiving intravenous cocaine. Surprisingly, the rats overwhelming chose the sugar over the addictive substance. To follow up these unexpected findings, Dr. Ahmed and his colleagues addicted rats to cocaine and then had the cocaine-addicted rats complete the same task. Again, the rats continued to choose the sugar over the cocaine even though they were addicted to cocaine. Finally, Dr. Ahmed’s group repeated the task by replacing cocaine with heroin and found that the rats still preferred drinking the sugar water to the drug. Michael’s experience adds credence to these findings. Although, food was Michael’s first “drug” he also shares his history of other drug use in “Fat Boy, Thin Man.” During his life, Michael had periods where he used nicotine, alcohol, marijuana, and cocaine on a regular basis. Strikingly, these substances were not able to compete with his desire for food and Michael would alter his drug use to avoid impacting his excess food consumption. For example, Michael would limit his cocaine use so it would not cause him to lose his appetite and reduce the pleasurable effect of his food binges.
Michael’s memoir also speaks to one of the critiques of the food-addiction hypothesis, that drug addiction has more severe consequences than excess food consumption, which suggests food addiction is not a valid concept. A similar argument was once applied to tobacco products because cigarettes and chewing tobacco do not cause a strong intoxication syndrome and are legal to purchase and consume. Thus, people were not getting arrested for using cigarettes and they were not crashing cars or becoming physically violent because they were under the influence of nicotine. This made nicotine appear less problematic than other addictive drugs, but when the health consequences of nicotine use became apparent and people still could not quit, nicotine’s addictive nature became clearer. Public health and treatment efforts have reduced nicotine use in recent decades, but tobacco use is the still the number one cause of preventable death in America. Although diseases related to excess food consumption are the number two cause of preventable death and millions of people are unable to alter their food consumption, the severity of food-related problems relative to drug-related problems is still called into question. Michael provides evidence to the severity of problems associated with out of control food consumption. In addition to the health consequences of his eating behavior, Michael avoided social engagements to spend more time binging on food, becoming socially isolated. While a youth, he stole food and money from his family and his employer to fund his binge eating. Food had such a strong pull that he risked legal consequences, in addition to social and health consequences, to continue his habit.
Through hard emotional and psychological work, Michael Prager is at peace with his eating habits. He continues to follow the methods and practices he picked up in rehab, therapy, and support groups, and, in addition to recently publishing a book, he also became a father. The recent scientific findings, coupled with the experiences of Michael and others like him, suggest that the topic of food addiction deserves further attention.