“What do you want for dinner?” I’m asked.
“I don’t care,” I respond.
It’s a cliche, but I honestly don’t care anymore. I eat, enjoy it mildly or not at all, and don’t think about it again once I’m done. My relationship with food hasn’t always been this bland.
For about six months, I’ve been taking a combination of medications — bupropion and naltrexone — prescribed by my doctor for weight loss.
According to the common narrative, I am meant to feel imprisoned by this body. I am assumed to be oppressed by my appetite. I am burdened with the responsibility of type 2 diabetes because I weigh more than the charts say I’m supposed to. I have not yet fully adopted these beliefs for myself but I am aware that the rest of the world has, including my medical providers.
The combination of bupropion (an antidepressant and smoking cessation aid) and naltrexone (a medication intended to help with alcohol and opioid dependence) is marketed as a weight-loss drug under the brand name Contrave. The whole situation is curious and baffling to me. Why is a drug that helps people stay off opioids and alcohol prescribed to help me stay off food?
Not even the manufacturer of Contrave can explain how it works to induce a modest average weight loss of 12 pounds over a year’s time. The drug’s website says it is “believed to work on two areas of your brain — the hunger center and the reward system — to reduce hunger and help control cravings. The exact neurochemical effects of Contrave leading to weight loss are not fully understood.”
Why is a drug that helps people stay off opioids and alcohol prescribed to help me stay off food?
I dug into academic studies to come up with my own theory of how the medication has tamped down my previously intense craving and love for food. A 2007 paper used rat research to show that sugar is “addictive” because it induces the release of opioids and dopamines in the brain. Naltrexone blocks the pleasurable and sedative effects of opioids and blocks opioid receptors to reduce cravings. It seems straight-forward — food doesn’t feel good anymore, so I don’t care as much if I eat it.
But do I have an addiction?
I have asked the question before. Dozens of times, I’ve been sucked into a diet protocol and tried to quit sugar (or carbs or cheese or processed foods). I would have sworn I was experiencing withdrawal — anxiety, anger, depression, headaches, uncontrollable cravings, and malaise.
Theories on food addiction are fairly new and at times contentious. The standard tool to assess food addiction (based on accepted criteria for other substance dependence) is the Yale Food Addiction Scale. I was not surprised that, according to the assessment, I have 5 of 7 symptoms of food addiction, including one important criterion — clinically significant impairment or distress.
The clinical significance criterion for mental illness is subjective by design. How do food and eating cause me distress or impair daily functioning? I have not spoken to a psychiatric professional about this topic, and it’s hard to quantify on my own. What I know is I live with the constant hum of fear, doubt, and shame that my food choices are wrong— or that I am not in control of them at all. When, where, what, and why I eat (or don’t eat) is a source of daily distress. The fact that I also manage type 2 diabetes, raises the stakes for all of that uncertainty. My food decisions are heavy with potential health consequences, and I carry that mental burden with me everywhere.
My choice to continue this treatment pivots on whether I accept the “addiction” label. If I balk at calling my appetite an addiction, why would I take a (potentially harmful) medication to control it?
Not all medical professionals accept the theory that food can be addictive. For instance, one confounding factor in the rat research that “proves” sugar is addictive is that restriction is built into the study. It is perhaps not simply the neurochemical response to sugar that indicates a problem but that the response is exaggerated by prolonged periods of deprivation from the substance.
What is the human version of restricted access to food? A diet. Like any one of the dozens of diets I’ve been on in the last three decades.
“Deprivation drives compulsive binge behavior,” Evans wrote. “Restriction further fuels feelings of loss of control and a lessened ability to self-regulate.”
Maybe I do exhibit clinically significant dependence on food but maybe this “addiction” is the product of years of deprivation and disordered thinking about food. It’s a part of my story I’ve only begun to examine.
“Deprivation drives compulsive binge behavior,” wrote Marci Evans, a registered dietician specializing in disordered eating. “Restriction further fuels feelings of loss of control and a lessened ability to self-regulate.”
Diving deeper into conflicting theories on food addiction, I saw a forked path. One road led to continued dieting and restriction while the other pointed to intuitive eating. But which one would take me to the ultimate destination, blood sugar control and better diabetes management?
Being prescribed a medication intended to treat addiction ignited my curiosity about whether my own appetite could indeed be labeled an addiction. But what was I looking for in that label? An explanation for my chronic inability to control what I eat? Maybe if my relationship with food was a diagnosable addiction, I would feel more comfortable with taking this medication to treat it — and with the deletion of all that pleasure that I used to get from eating.
Do I follow all doctor recommendations, take the drugs, control the pleasure chemicals in my brain, lose weight, and have better blood sugar control? Or do I decline this treatment, stay the same weight, crave/enjoy/possibly regret food, and pursue other treatments for blood sugar control? And there are unlimited other scenarios with the variables for treatment, weight, and diabetes outcomes combining in infinite permutations.
Uncertainty and fear are interwoven all through this body. Uncertainty about the feasibility of weight loss; fear of long term diabetes complications. Uncertainty about what and how much to eat; fear that it is entirely out of my control.
For now, this deep examination of myself and the subject of food addiction has no neat conclusion. Tonight I took the pills, but I also Googled how to safely taper off of them. I do not know what I will choose tomorrow.