It is in the brain that our distorted relationship with food is born. This is what emerges from studies that increasingly focus on the brain mechanisms underlying overweight and obesity. Like a recent Spanish research published in the journal Cerebral Cortex, which allegedly identified alterations in the brains of obese children similar to those found in those suffering from OCD.
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A hypothesis yet to be confirmed, but which signals a change taking place in the research. “Also thanks to the progress of neuroimaging, in the last twenty years the attention has shifted from the hormones that regulate appetite in the brain, in particular to the processes of inhibition of satiety”, explains the psychologist. Francantonio Devoto, first author of a research on studies that evaluate the activation of the brain in relation to appetite and the perception of food in obese individuals, carried out thanks to a software developed at the University of Milan Bicocca. Research that highlights reactions in obese subjects – such as increased response in brain regions related to reward, even when faced with purely visual stimuli and in conditions of satiety – similar to those of those suffering from addiction.
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“Obviously, there is a difference between food and other addictive substances – underlines Devoto – but the basic idea is that the thought of food automatically triggers the desire to eat, regardless of appetite, as if the obese were insensitive , or less sensitive, to the state of satiety than the average “.
A mechanism, however, different from that hypothesized by Spanish researchers: “Obsessive compulsive disorder has characteristics that are not found in these patients”, comments the psychologist: “Obesity is a complex phenomenon, a spectrum of disorders with different nuances that we are studying to identify the most suitable treatments “.
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And today the research focuses on the nervous system, despite the difficulty of subjecting large obese people to magnetic resonance imaging: “It is in the brain that our relationship with food finds a balance”, he adds. Eraldo Paulesu, professor of physiological psychology at the University of Milano-Bicocca. “On the other hand, hormones, which for years have been considered the central node of the obesity problem, also act on the brain”.
And if at the beginning only some forms of obesity were assimilated to addictions, such as those related to binge eating, now things are changing, “also thanks to neuroimaging studies that allow to cross metabolic data with brain activity”, he explains. Livio Luzi, full professor of Endocrinology at the University of Milan and director of the Department of Endocrinology, Nutrition and Metabolic Diseases of the Multimedia Group.
Today we know that in the brains of obese subjects there is a lack of dopamine, “in absolute terms, of the presence of the neurotransmitter, or of the response of dopaminergic receptors”, explains Luzi. In any case, to feel well these subjects need a greater dose of positive stimuli: “The brain of the obese is similar to that of the smoker, where dopamine regulates the neurotransmitters that come into play in the activity of the circuits of the smoker. reward “, observes the endocrinologist.
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On the fact that food is closely related to pleasure we all agree, “the problem arises when this is released from physiological necessity, and in the end also from the mechanisms of pleasure”, observes Paulesu: “In the behavior of the obese there is it is a spasmodic desire for food, defined craving, which occurs regardless of whether this experience gives satisfaction or not, exactly as it happens for someone with an addiction “.
However, it is a phenomenon in which the environment plays an important role: “Our brain has evolved in a situation of food scarcity, it is not predisposed to manage the superabundance of calories with which we live”, observes Devoto: “We know that many obese people who lose weight tend to regain it quickly, which is also why it is important to validate treatments that combine various elements “.
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In the past, a lot of focus has been placed on bariatric surgery which, however, in addition to presenting risks, does not intervene on the mechanisms that cause obesity: “The problem is that many patients would like quick solutions, while the ones that work best are also the most demanding ones”, remembers Paulesu. “Today the most interesting approach focuses on an association between cognitive behavioral therapy and neuromodulation techniques”.
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The new frontier for obesity therapies, in fact, is transcranial magnetic stimulation (Tms), a non-invasive method already used to treat addictions and other disorders, which acts on the dopaminergic system through paths linked to the perception of pleasure and the mechanisms of addiction and that is giving interesting results.
“The idea was born in 2011, when at a medical congress I heard about a possible application of this method for the treatment of addictions”, recalls Luzi. Thus began the first researches, and also a patent, in the process of definitive publication in the United States, a country where it is possible to patent a new application of a therapeutic procedure: in this case, the use of TMS to treat food addiction in patients. obese. The endocrinologist continues: “We have seen that five weeks of treatment determine an activation of the prefrontal cortex in areas that regulate the will, the ability to block acceptable behavior, the same ones that come into play in addiction”.
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The first studies show interesting results: a 9% weight loss – almost double the 5% that international guidelines consider a success – and an increase in physical activity: “Probably the brain mechanism is the same,” he explains. Luzi: “It increases the release of dopamine which acts on the reward circuit, and which is also the precursor of catecholamines, hormones that activate the musculoskeletal system, prompting the patient to eat less and move more”.
Patients also continue to lose weight for up to twelve months without the need for other treatments. One result the researchers are trying to interpret: “One possible hypothesis is that the treatment promotes neuroplasticity by modifying the brain areas that serve to keep the brain in a state of well-being,” explains Luzi.
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Tms has also been shown to have an inhibitory effect on the visual cortex, helping patients not to lose control when faced with the image of their favorite dish. A recent study by the same group also shows that the treatment helps normalize the intestinal microbiota, which in the obese is altered and contributes to systemic inflammation: “We know that between the intestine and the brain there is a bidirectional correlation, and it is conceivable that these signals come from the brain to the intestine “, recalls Luzi, who adds:” Then there is a third hypothesis, for which we have preliminary results: measuring with an infrared camera the heat loss of the body of patients treated with TMS it seems that the treatment tends to normalize thermoregulation, which is altered in the obese “.
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All data in favor of a therapy that has relatively low costs and side effects considered acceptable: a slight headache in a small percentage of subjects after the first sessions. “There are no particular contraindications, indeed the treatment should begin as soon as possible”, explains Luzi. Which, however, considers educating children in schools to prevent obesity as a priority.
The relationship with food is a complex phenomenon, in which genes and the environment come into play: “We are all exposed to alcohol, but not all of us become alcoholics”, recalls Devoto: “We know that normal weight adolescents children of obese parents have an increased response to stimuli related to food, a phenomenon also found in the children of drug addicted and alcoholic parents: perhaps genes could be one of the elements at the basis of these behaviors “.
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There are quite rare forms of obesity of genetic origin, but in this case, explains Paulesu: “There could be a genetic correlation linked to the activity of dopaminergic receptors that could make some people more predisposed to food gratification”. In the meantime it is being evaluated, and the first results are encouraging, whether the treatment of Tsm can also help patients with type 2 diabetes. For now it is only a hypothesis based on preliminary data.
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Women over 30: diet and gymnastics put you in a good mood
Diet and mental health go hand in hand, especially for women over thirty: this is what emerges from a study carried out at Binghamton University in New York. For years the researcher Lina Begdache studies the relationships between diet and mood. In this case, the idea was to check whether certain characteristics of the diet positively influenced mood and physical activity.
“In general, there is a positive correlation between healthy diet, physical activity and psychological well-being, but the data show that this is especially true for women, who also suffer the most damage from an unbalanced diet,” says Begdache.
Carried out by investigating the eating habits of 1200 subjects, men and women through anonymous questionnaires, the study shows that among the foods associated with well-being there are fruits and vegetables, especially dark green ones: “Foods that provide the body with amino acids that act as neurotransmitters and have a positive role on energy and mood, “says Begdache.
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Mental distress is instead linked especially to the constant consumption of caffeine and high glycemic index foods such as fast food foods, as well as the habit of skipping breakfast: “We have however seen – emphasizes the researcher – that these negative correlations they are greatly reduced in women who exercise “.
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