Food Reward: a Dominant Factor in Obesity, Part VII

Now that I've explained the importance of food reward to obesity, and you're tired of reading about it, it's time to share my ideas on how to prevent and perhaps reverse fat gain.  First, I want to point out that although food reward is important, it's not the only factor.  Heritable factors (genetics and epigenetics), developmental factors (uterine environment, childhood diet), lifestyle factors (exercise, sleep, stress) and dietary factors besides reward also play a role.  That's why I called this series "a dominant factor in obesity", rather than "the dominant factor in obesity".
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Drug Cessation and Weight Gain

Commenter "mem", who has been practicing healthcare for 30+ years, made an interesting remark that I think is relevant to this discussion:

Recovering substance dependent people often put on lots of weight and it is not uncommon for them to become obese or morbidly obese.

This relates to the question that commenter "Gunther Gatherer" and I have been pondering in the comments: can stimulating reward pathways through non-food stimuli influence body fatness?  

It's clear that smoking cigarettes, taking cocaine and certain other pleasure drugs suppress appetite and can prevent weight gain.  These drugs all activate dopamine-dependent reward centers, which is why they're addictive.  Cocaine in particular directly inhibits dopamine clearance from the synapse (neuron-neuron junction), increasing its availability for signaling.
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"Friends Don't Let Friends Drive Drunk": How Soon is too Soon to Find the Teachable Moment in the Death of Ryan Dunn?

"Friends Don't Let Friends Drive Drunk". A memorable tag line from the 1990s, found in many drunk driving prevention public service announcements (PSAs).

Early Monday morning, June 20, 2011, Ryan Dunn and a passenger were killed in a car accident in Pennsylvania. Ryan appeared in all three seasons of "Jackass" on MTV, as well as their movies.

Shortly after the news of Ryan's death broke (along with preliminary reports of speeding and photos of him drinking at the bar hours before the accident), Roger Ebert tweeted "Friends Don't Let Jackasses Drink and Drive". Although Roger did not "intend to be cruel"- he "intended to be true", there was a lot of backlash to his play on the old PSA tagline. Ryan's friends and colleagues from "Jackass" tweeted their anger in response and popular celebrity blogger Perez Hilton posted that Roger responded insensitively to Ryan's death. All felt that it was too soon to hold Ryan up as an example of the dangers of drinking and driving.

So the question I pose is: How soon is too soon to capitalize on a "teachable moment"?

Teachable moments are important in public health. They let us identify a time when our audiences will be more open to prevention education/intervention because they will see its relevance to their lives. Often the identification and sustainability of teachable moments are supported by media reports on the health/lives of celebrities.

As this week has moved along, more information has been released about the accident that killed Ryan Dunn and his passenger. His alcohol level was approximately twice the legal limit in Pennsylvania (0.196%) and he was traveling at a very high rate of speed (estimated at 132-140 mph) at the time of collision. Therefore, there is clearly a lesson to be learned here- about speeding and about drinking and driving. But much of these lessons our audience already knows. If you drink and drive- you could die (and/or kill someone else). If you speed- you could die (and/or kill someone else).

So maybe the lessons have to be broader. Apparently Ryan had a history of speeding and driving under the influence. These factors put him at risk. What could he, his friends, his family, the courts, the bar done to prevent this tragedy? What about the bystanders? His friends at the bar...employees at the bar...his friend who ultimately got into the car...could someone have stopped him from driving? What are the lessons you find in this story and how/when should they be communicated?

Food Reward: a Dominant Factor in Obesity, Part VI

Reward Centers can Modify the Body Fat Setpoint

Dopamine is a neurotransmitter (chemical that signals between neurons) that is a central mediator of reward and motivation in the brain.  It has been known for decades that dopamine injections into the brain suppress food intake, and that this is due primarily to its action in the hypothalamus, which is the main region that regulates body fatness (1).  Dopamine-producing neurons from reward centers contact neurons in the hypothalamus that regulate body fatness (2).  I recently came across a paper by a researcher named Dr. Hanno Pijl, from Leiden University in the Netherlands (3).  The paper is a nice overview of the evidence linking dopamine signaling with body fatness via its effects on the hypothalamus, and I recommend it to any scientists out there who want to read more about the concept.
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Food Reward: a Dominant Factor in Obesity, Part V

Non-industrial diets from a food reward perspective

In 21st century affluent nations, we have unprecedented control over what food crosses our lips.  We can buy nearly any fruit or vegetable in any season, and a massive processed food industry has sprung up to satisfy (or manufacture) our every craving.  Most people can afford exotic spices and herbs from around the world-- consider that only a hundred years ago, black pepper was a luxury item.  But our degree of control goes even deeper: over the last century, kitchen technology such as electric/gas stoves, refrigerators, microwaves and a variety of other now-indispensable devices have changed the way we prepare food at home (Megan J. Elias.  Food in the United States, 1890-1945). 

To help calibrate our thinking about the role of food reward (and food palatability) in human evolutionary history, I offer a few brief descriptions of contemporary hunter-gatherer and non-industrial agriculturalist diets.  What did they eat, and how did they prepare it? 
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