Food Cravings

Introduction

  • Intense desire to eat specific foods that are highly palatable and energy-dense.

  • Conditioned response to food-related stimuli

Types

  • Cue-induced - Sight or smell

  • Tonic - Imagioning the food

  • State - Cravings at a particular time

  • Trait - General desire for a particular food with or without cues

Food addiction as a model

  • Explains failing to adhere to a particular diet

  • Lack of control

  • Lack of satisfaction after a meal

  • Lack of satiety

  • Similar traits of craving, withdrawal, and loss of control when compared to other addictions

Food intake

Homeostatic system

  • Regulate energy

  • Hormonal and neuronal feedback from the small intestine, pancreas, liver, adipose tissue, and brainstem

  • Regulates appetite and food-intake behaviour

  • Coordinates hunger, satiation (feeling of fullness), and satiety (duration of fullness)

  • Two antagonistic neuron sets

    • Orexigenic agouti-related peptide (AGRP/Neuropeptide Y)

    • Anorexigenic pro-opimelanocortin neurons (POMC)

  • Maintains a weight set point and defends our fat mass

Hedonic system

  • Mesocorticolimbic yststem

  • Mediates food via neural mechanisms

  • Includes learning, memory, reward, attention, decision-making, mood, and emotionality

  • Eating for pleasure

  • Eating that occurs in response to sight, smell, and taste

  • Mediated by dopamine (wanting) and opioid (liking) pathways

Interaction

  • Systems work together to focus on reward

  • Can cause weight gain

  • People have a weight trajectory, usually up

  • Stress, trauma, and relationship with food affect this

  • Particularly palatable foods that are high in fat, sugar, salt

Sustained weight loss

  • Hard to maintain without surgical or pharmacological intervention

  • A systemic review of lifestyle interventions for obesity found a mean weight loss of 7%

  • Once interventions ceased, participants returned to pre-treatment baselines

  • Mean time to regain all weight was 4 years

Obesogenic environment

  • Energy-dense, highly palatable foods are readily available

  • Food is available in large portions

  • Abundant food cues (advertising)

Weight loss and treatment strategies

  • When losing weight, the mechanisms of cravings will increase

  • Energy expenditure reduces, movement decreases, and fidgetting decreases

  • Best treatments help the patient with control

  • Ketogenic diets suppress appetite, helps with control

Drugs

  • Orlistat - Doesn’t help with control

  • Phentermine - Suppress appetite

  • Liraglutide - Suppress appetite

  • Contrave - Suppress appetite

Surgery

  • Helps sense of control, sense of eating less

  • Some evidence changes response to food cues

Lifestyle

  • Low Energy Diets - Short-term increase in cravings, longer-term suppression

  • Physical ACtivity - Does not increase food cravings, may decrease

Obesity Phenotypes

  • Abnormal satiation (feeling of fullness) - Consider Phentermine + Topiramate extended release

  • Abnormal hedonic eating - Contrave

  • Abnormal satiety (duration of fullness) - Liraglutide

  • Low predicted energy expenditure - Duromine

Tools

References