Cited by 380Eating Disorders and BehaviorsNeurotransmitter Receptor Influence on BehaviorRegulation of Appetite and Obesity

The Addictive Dimensionality of Obesity

Open access
Volkow, Nora D., Wang, Gene-Jack, Tomasi, Dardo, Baler, Ruben D.·2013·Biological Psychiatry

Abstract

Our brains are hardwired to respond and seek immediate rewards. Thus, it is not surprising that many people overeat, which in some can result in obesity, whereas others take drugs, which in some can result in addiction. Though food intake and body weight are under homeostatic regulation, when highly palatable food is available, the ability to resist the urge to eat hinges on self-control. There is no homeostatic regulator to check the intake of drugs (including alcohol); thus, regulation of drug consumption is mostly driven by self-control or unwanted effects (i.e., sedation for alcohol). Disruption in both the neurobiological processes that underlie sensitivity to reward and those that underlie inhibitory control can lead to compulsive food intake in some individuals and compulsive drug intake in others. There is increasing evidence that disruption of energy homeostasis can affect the reward circuitry and that overconsumption of rewarding food can lead to changes in the reward circuitry that result in compulsive food intake akin to the phenotype seen with addiction. Addiction research has produced new evidence that hints at significant commonalities between the neural substrates underlying the disease of addiction and at least some forms of obesity. This recognition has spurred a healthy debate to try and ascertain the extent to which these complex and dimensional disorders overlap and whether or not a deeper understanding of the crosstalk between the homeostatic and reward systems will usher in unique opportunities for prevention and treatment of both obesity and drug addiction.

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that obesity and addiction share neurobiological substrates—especially dopamine pathways—while also involving unique processes, so food reward is best viewed as a dimensional component of obesity rather than proof that obesity is food addiction. It synthesizes genetic, molecular, neurocircuitry, and behavioral overlaps to suggest that addiction prevention and treatment strategies may inform obesity interventions.

Key findings

  • A genome-wide association study in 249,796 individuals of European descent identified 32 loci associated with BMI, but these explained only 1.5% of BMI variance. Candidate overlapping genes include DRD2 Taq I A1, CNR1, and the OPRM1 A118G polymorphism, linked to addiction, obesity risk, binge-eating, or alcoholism.
  • Homeostatic and reward systems interact: VTA/NAc neurons express receptors for GLP-1, ghrelin, leptin, insulin, orexin, and melanocortins; orexigenic signals increase VTA DA cell activity to food stimuli, while anorexigenic signals inhibit DA firing and decrease DA release. Human data cited include an inverse relationship between BMI and illicit drug use, lower risk for substance use disorders in obese individuals, and increased risk for alcohol abuse/alcoholism relapse after bariatric surgery.
  • Both addicted and obese subjects show blunted reward-circuit activation during consumption but sensitized responses to conditioned cues. Obese individuals viewing high-calorie food showed increased activation in NAc, dorsal striatum, OFC, ACC, amygdala, hippocampus, and insula; reduced striatal D2R availability is reported in addiction and obesity and is associated with decreased prefrontal activity.
  • The insula is implicated in food, cocaine, and cigarette cravings; gastric distention activates the posterior insula, but lean—not obese—subjects showed amygdala activation and anterior insula deactivation. The extended amygdala, corticotropin-releasing factor signaling, and habenula are proposed to contribute to stress reactivity and the “dark side” transition in addiction and possibly food addiction.

Methods

  • Narrative review and conceptual synthesis, not a systematic review or primary study. It integrates preclinical animal models and human genetic, imaging, and clinical evidence.
  • The main analysis argues that homeostatic and reward systems interact, with dopamine as a common substrate across mesoaccumbens/mesolimbic, mesostriatal, and mesocortical pathways. It proposes a “bowtie”/nested layered architecture model in which the DA system subserves hypothalamic internal signals.
  • Specific evidence cited includes a GWAS of 249,796 individuals, human PET/fMRI studies, rodent feeding and drug-reward experiments, and clinical observations such as bariatric surgery outcomes.

Limitations

  • The authors state they do not claim obesity is the result of food addiction, but rather that food reward plays a critical role in overeating and obesity, referring to it as the dimensional component of obesity. They also note that the extent of overlap remains debated, that it is unclear whether obesogenic diets decrease striatal D2R, and that the extent of similar direct/indirect pathway regulatory processes in obesity remains unclear.
  • Evident from the text: as a narrative review, it does not use a systematic search or quantitative synthesis, and many cited findings are correlational or from animal models, so causal direction and human generalizability are not fully established.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.biopsych.2012.12.020

Cites

114 of 114 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 120 cited sources checked · 0 supported · 0 flagged

  • Interpretationreasoning

    The explained BMI variance is unlikely to improve with larger samples due to complex biological-environmental interactions.

    “However, these 32 loci explained only 1.5% of the BMI variance (1,2), a situation that is unlikely to improve with larger samples because of the complex interactions between biological and environmental factors.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Naukkarinen, 2010, Use of genome-wide expression data to mine the “Gray Zone“ of GWA studies leads to novel candidate obesity genes, PLoS Genet source

      Not checked in the free run.

    • cites [2] Speliotes, 2010, Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index, Nat Genet source

      Not checked in the free run.

  • Interpretationreasoning

    The dopamine system, via mesoaccumbens/mesolimbic, mesostriatal, and mesocortical pathways, is a common substrate in the neurobiology of both addiction and obesity.

    “Thus, the dopamine (DA) system, through the mesoaccumbens/mesolimbic (reward and emotions), mesostriatal (habits, routines, and movement), and mesocortical (executive function) pathways, is a common substrate in the neurobiology of both disorders (Figure 1).”
    Quote in the paperSubstantial claim
  • Premisecitation

    Several hormones and neuropeptides involved in energy homeostasis influence the DA reward pathway.

    “Specifically, several hormones and neuropeptides involved in energy homeostasis influence the DA reward pathway (9).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Volkow, 2013, Obesity and addiction: Neurobiological overlaps, Obes Rev source

      Not checked in the free run.

  • Interpretationreasoning

    Addiction research has produced evidence of significant commonalities between neural substrates of addiction and at least some forms of obesity.

    “Addiction research has produced new evidence that hints at significant commonalities between the neural substrates underlying the disease of addiction and at least some forms of obesity.”
    Quote in the paperSubstantial claim
  • Premisecitation

    A GWAS of 249,796 individuals of European descent identified 32 loci associated with BMI.

    “Indeed, the most recent whole genome-wide association study conducted in 249,796 individuals of European descent identified 32 loci associated with body mass index (BMI).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Naukkarinen, 2010, Use of genome-wide expression data to mine the “Gray Zone“ of GWA studies leads to novel candidate obesity genes, PLoS Genet source

      Not checked in the free run.

    • cites [2] Speliotes, 2010, Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index, Nat Genet source

      Not checked in the free run.

  • May combine two claims. 55
  • Classified as probably not a substantial claim. 10
  • May combine two claims.

    Findingcitation

    Subjects with high genetic risk for alcoholism who were not alcoholic had higher than normal striatal D2R associated with normal prefrontal metabolism, which might have protected them.

    “Indeed, we showed that subjects who, despite having a high genetic risk for alcoholism (positive family history of alcoholism) were not alcoholics, had higher than normal striatal D2R, which was associated with normal prefrontal metabolism (81) that might have protected them from alcoholism.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [81] Volkow, 2006, High levels of dopamine D2 receptors in unaffected members of alcoholic families: Possible protective factors, Arch Gen Psychiatry source

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  • May combine two claims.

    Interpretationnone given

    Obesity can result from easy access to highly palatable food, and excessive consumption of such food can affect homeostatic signaling and disrupt food reward sensitivity.

    “However, obesity can also result from easy access to highly palatable food, excessive consumption of which can affect homeostatic signaling and disrupt the sensitivity to food reward.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationreasoning

    Food reward plays a critical role in overeating and obesity, which the authors call the dimensional component of obesity.

    “We present evidence of shared neurobiological substrates and do not claim that obesity is the result of food addiction but rather that food reward plays a critical role in overeating and obesity, referring to it as the dimensional component of obesity.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    VTA and/or NAc neurons express receptors for GLP-1, ghrelin, leptin, insulin, orexin, and melanocortin.

    “Moreover, neurons in VTA and/or nucleus accumbens (NAc) express glucagon-like peptide-1 (11,12), ghrelin (13,14), leptin (15,16), insulin (17), orexin (18), and melanocortin receptors (19).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [11] Alhadeff, 2012, GLP-1 neurons in the nucleus of the solitary tract project directly to the ventral tegmental area and nucleus accumbens to control for food intake, Endocrinology source

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    • cites [12] Rinaman, 2010, Ascending projections from the caudal visceral nucleus of the solitary tract to brain regions involved in food intake and energy expenditure, Brain Res source

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    • cites [13] Abizaid, 2006, Ghrelin modulates the activity and synaptic input organization of midbrain dopamine neurons while promoting appetite, J Clin Invest source

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    • cites [14] Jerlhag, 2007, Ghrelin administration into tegmental areas stimulates locomotor activity and increases extracellular concentration of dopamine in the nucleus accumbens, Addict Biol source

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    • cites [15] Figlewicz, 2003, Expression of receptors for insulin and leptin in the ventral tegmental area/substantia nigra (VTA/SN) of the rat, Brain Res source

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    • cites [16] Leshan, 2010, Ventral tegmental area leptin receptor neurons specifically project to and regulate cocaine- and amphetamine-regulated transcript neurons of the extended central amygdala, J Neurosci source

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  • May combine two claims.

    Premisenone given

    Drug intake lacks a homeostatic regulator, so drug consumption is mostly regulated by self-control or unwanted effects.

    “There is no homeostatic regulator to check the intake of drugs (including alcohol); thus, regulation of drug consumption is mostly driven by self-control or unwanted effects (i.e., sedation for alcohol).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    Obesity is associated with genes involved in DA neurotransmission, such as DRD2 Taq I A1 allele, which is also associated with addiction.

    “This could explain the association of obesity with genes involved with DA neurotransmission, such as the DRD2 Taq I A1 allele, which has been associated with addiction (4).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Blum, 1996, Increased prevalence of the Taq I A1 allele of the dopamine receptor gene (DRD2) in obesity with comorbid substance use disorder: A preliminary report, Pharmacogenetics source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Repeated drug consumption can directly disrupt the reward circuit, its main pharmacological target.

    “Repeated consumption of a drug, on the other hand, can directly disrupt the reward circuit, its main pharmacologic target.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    CNR1 gene variations have been associated with BMI and obesity risk by most studies, and with addiction.

    “Similarly, there are genes at the intersection between reward and homeostatic pathways, like the cannabinoid receptor 1 (CNR1) gene, variations in which have been associated with BMI and obesity risk by most studies (5), as well as with addiction (6).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Schleinitz, 2010, Role of genetic variation in the cannabinoid type 1 receptor gene (CNR1) in the pathophysiology of human obesity, Pharmacogenomics source

      Not checked in the free run.

    • cites [6] Benyamina, 2010, CNR1 gene polymorphisms in addictive disorders: A systematic review and a meta-analysis, Addict Biol source

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  • May combine two claims.

    Premisereasoning

    Food intake and body weight are homeostatically regulated, but when highly palatable food is available, resisting eating depends on self-control.

    “Though food intake and body weight are under homeostatic regulation, when highly palatable food is available, the ability to resist the urge to eat hinges on self-control.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    Orexigenic signals increase VTA DA cell activity in response to food stimuli, while anorexigenic signals inhibit DA firing and decrease DA release.

    “Overall, homeostatic orexigenic signals increase the activity of ventral tegmental area (VTA) DA cells when exposed to food stimuli, whereas anorexigenic ones inhibit DA firing and decrease DA release (10).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Opland, 2011, Modulation of the mesolimbic dopamine system by leptin, Brain Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Endogenous opioids are involved in hedonic responses to food and drugs, and the OPRM1 A118G polymorphism is associated with vulnerability to binge-eating disorders and alcoholism.

    “And, let us also remember in this context that endogenous opioids are involved in hedonic responses to food and to drugs and that the functional A118G polymorphism in the μ-opioid receptor gene (OPRM1) has been associated with vulnerability for binge-eating disorders (7) and alcoholism (8).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Davis, 2009, Dopamine for “wanting“ and opioids for “liking“: A comparison of obese adults with and without binge eating, Obesity (Silver Spring) source

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    • cites [8] Ray, 2011, The role of the Asn40Asp polymorphism of the mu opioid receptor gene (OPRM1) on alcoholism etiology and treatment: A critical review, Alcohol Clin Exp Res source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Disruption of energy homeostasis can affect reward circuitry, and overconsumption of rewarding food can change reward circuitry to produce compulsive food intake similar to addiction.

    “There is increasing evidence that disruption of energy homeostasis can affect the reward circuitry and that overconsumption of rewarding food can lead to changes in the reward circuitry that result in compulsive food intake akin to the phenotype seen with addiction.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    The authors propose that addiction and obesity share neurobiological processes that when disrupted can cause compulsive consumption, while also having unique processes.

    “We propose that these two diseases share neurobiological processes that, when disrupted, can result in compulsive consumption, while also involving unique neurobiological processes.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    High-calorie food is widely available not only as nutrition but also as a strong reward that promotes eating.

    “This is particularly true whenever high-calorie content food is widely available, not just as a source of nutrition, but also as a strong reward that, by itself, promotes eating.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    The magnitude of DA increases in addicted subjects predicts intensity of cue-induced cravings, and in animals predicts effort to get drug.

    “The magnitude of these DA increases in addicted subjects predicts the intensity of cue-induced cravings (48), and in animals, they predict the effort that an animal is willing to exert to get the drug (49).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [48] Volkow, 2006, Cocaine cues and dopamine in dorsal striatum: Mechanism of craving in cocaine addiction, J Neurosci source

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    • cites [49] Vanderschuren, 2005, Involvement of the dorsal striatum in cue-controlled cocaine seeking, J Neurosci source

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    Premisecitation

    Human studies found an inverse relationship between BMI and illicit drug use and lower risk for substance use disorders in obese individuals, including lower rates of nicotine and marijuana abuse.

    “Similarly, human studies found an inverse relationship between BMI and illicit drug use (21) and a lower risk for substance use disorders in obese individuals (22), including lower rates of nicotine (23) and marijuana (24) abuse.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [21] Bluml, 2012, Relationship between substance use and body mass index in young males, Am J Addict source

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    • cites [22] Simon, 2006, Association between obesity and psychiatric disorders in the US adult population, Arch Gen Psychiatry source

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    • cites [23] Blendy, 2005, Reduced nicotine reward in obesity: Cross-comparison in human and mouse, Psychopharmacology (Berl) source

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  • May combine two claims.

    Interpretationreasoning

    Drugs activate brain reward pathways more potently than food, which helps explain their greater ability to induce loss of control and compulsive consumption.

    “Since drugs activate brain reward pathways more potently than food, this helps explain (together with homeostatic satiety mechanisms) the greater ability of drugs to induce loss of control and compulsive consummatory behavior.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    On first exposure to food reward, VTA DA neuron firing increases and DA release in NAc increases.

    “For example, upon first exposure to a food reward, the firing of DA neurons in the VTA increases with a resulting increase in DA release in the NAc (32).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Norgren, 2006, Gustatory reward and the nucleus accumbens, Physiol Behav source

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    Premisecitation

    A D1-like antagonist blocked and a D2-like antagonist increased reinstatement of food-seeking behavior.

    “This possibility is consistent with a recent report in which a D1-like antagonist blocked and a D2-like antagonist increased the reinstatement of food-seeking behavior (37).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Ball, 2011, Opposing roles for dopamine D1- and D2-like receptors in discrete cue-induced reinstatement of food seeking, Behav Brain Res source

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  • May combine two claims.

    Premisecitation

    Both addicted and obese subjects show less activation of reward circuits when given the drug or palatable food, respectively.

    “Surprisingly, both addicted and obese subjects exhibit less activation of reward circuits when given the drug or the palatable food, respectively (45).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] Stice, 2008, Relation of reward from food intake and anticipated food intake to obesity: A functional magnetic resonance imaging study, J Abnorm Psychol source

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  • May combine two claims.

    Interpretationreasoning

    Increases in DA induced by a conditioned stimulus predict the behavioral price an animal will pay to receive it, ensuring motivational drive occurs before eating.

    “Moreover, since the increases in DA induced by the conditioned stimulus predict the behavioral price the animal is willing to pay to receive it, this will ensure that the motivational drive (fueled by DA signaling) occurs before the animal is eating the food itself.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    DA-deficient mice die of starvation likely due to decreased motivation to consume food, and replenishing dorsal striatum DA restores feeding and rescues them.

    “Indeed, DA-deficient mice die of starvation, likely as a result of a decreased motivation to consume the food, and replenishing the dorsal striatum with DA restores feeding and rescues them (28).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Palmiter, 2008, Dopamine signaling in the dorsal striatum is essential for motivated behaviors: Lessons from dopamine-deficient mice, Ann N Y Acad Sci source

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  • May combine two claims.

    Premisecitation

    Anorexigenic peptides decrease brain reward system sensitivity to food reward, while orexigenic peptides increase it.

    “Consistent with preclinical studies, imaging studies have also shown that anorexigenic peptides (e.g., insulin, leptin, peptide YY) decrease the sensitivity of the brain reward system to food reward, whereas orexigenic ones (e.g., ghrelin,) increase it [see review (44)].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Volkow, 2011, Reward, dopamine and the control of food intake: Implications for obesity, Trends Cogn Sci source

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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Drugs of abuse activate the DA reward circuit, which if chronic in vulnerable individuals can result in addiction.

    “Drugs of abuse work by activating the DA reward circuit, which, if chronic, in vulnerable individuals, can result in addiction.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisereasoning

    High-calorie foods can promote overeating uncoupled from energetic needs and trigger learned stimulus-reward associations.

    “Indeed, high-calorie foods can promote overeating (i.e., eating that is uncoupled from energetic needs) and trigger learned associations between the stimulus and the reward (conditioning).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Interventions that decrease BMI and reduce plasma insulin and leptin enhance sensitivity to psychostimulant drugs.

    “Moreover, interventions that decrease BMI and reduce plasma levels of insulin and leptin enhance the sensitivity to psychostimulant drugs (25),”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Davis, 2010, Insulin, leptin and reward, Trends Endocrinol Metab source

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  • Classified as probably not a substantial claim.

    Interpretationcitation

    Blunted DA activation by consumption of drug or food could trigger overconsumption to compensate for the blunted reward circuit response.

    “Since this is not what is seen in the clinic, it was suggested that blunted DA activation by consumption (of drug or food) could trigger overconsumption to compensate for the blunted response of the reward circuit (46).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] Stice, 2008, Relation between obesity and blunted striatal response to food is moderated by TaqIA A1 allele, Science source

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  • May combine two claims.

    Premisecitation

    In humans, ingestion of palatable food releases DA in striatum in proportion to meal pleasantness ratings and activates reward circuitry.

    “In humans, the ingestion of palatable food releases DA in the striatum in proportion to the ratings of meal pleasantness (42) and activates reward circuitry (43).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [42] Small, 2003, Feeding-induced dopamine release in dorsal striatum correlates with meal pleasantness ratings in healthy human volunteers, Neuroimage source

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    • cites [43] Volkow, 2008, Overlapping neuronal circuits in addiction and obesity: Evidence of systems pathology, Philos Trans R Soc Lond B Biol Sci source

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    Premisecitation

    Certain foods, especially those rich in sugars and fat, are potently rewarding and can trigger addictive-like behaviors in laboratory animals and humans.

    “Certain foods, particularly those rich in sugars and fat, are also potently rewarding (40) and can trigger addictive like behaviors in laboratory animals (41) and humans (27).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [40] Lenoir, 2007, Intense sweetness surpasses cocaine reward, PLoS One source

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    • cites [41] Avena, 2008, Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake, Neurosci Biobehav Rev source

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    • cites [27] Volkow, 2007, Issues for DSM-V: Should obesity be included as a brain disorder?, Am J Psychiatry source

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  • May combine two claims.

    Premisereasoning

    Brain DA pathways play central roles in obesity and addiction.

    “Brain DA pathways, which modulate the behavioral responses to environmental stimuli, play central roles in obesity (also in addiction).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    In striatum, D2 receptors mediate indirect pathway signaling to frontocortical regions; down-regulation enhances drug sensitization, while upregulation interferes with drug consumption.

    “In the striatum, D2 receptors mediate signaling through the indirect pathway that modulates frontocortical regions, and its down-regulation enhances drug sensitization in animal models (74), whereas its upregulation interferes with drug consumption (75).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [74] Ferguson, 2011, Transient neuronal inhibition reveals opposing roles of indirect and direct pathways in sensitization, Nat Neurosci source

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    • cites [75] Thanos, 2008, D2R DNA transfer into the nucleus accumbens attenuates cocaine self-administration in rats, Synapse source

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  • May combine two claims.

    Premisecitation

    Stress is associated with increased consumption of palatable foods, weight gain, and potentiated OFC activation to food rewards.

    “Still, stress is associated with increased consumption of palatable foods and weight gain and a potentiated OFC activation to food rewards (57).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Rudenga, 2012, Acute stress potentiates brain response to milkshake as a function of body weight and chronic stress [published online ahead of print March 20], Int J Obes (Lond)

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  • May combine two claims.

    Premisecitation

    Cocaine-addicted subjects who successfully inhibited craving during drug cues decreased metabolism in medial OFC and NAc, consistent with OFC, ACC, and striatum involvement in enhanced motivation to procure drug.

    “Also, when cocaine-addicted subjects purposefully inhibited craving when exposed to drug cues, those who were successful decreased metabolism in medial OFC (processes motivational value of a reinforcer) and NAc (predicts reward) (55), consistent with the involvement of OFC, ACC, and striatum in the enhanced motivation to procure the drug seen in addiction.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] Volkow, 2009, Cognitive control of drug craving inhibits brain reward regions in cocaine abusers, Neuroimage source

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  • May combine two claims.

    Premisecitation

    DA modulates motivation and persistence.

    “Indeed, DA also modulates motivation and persistence (58).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] Salamone, 2007, Effort-related functions of nucleus accumbens dopamine and associated forebrain circuits, Psychopharmacology (Berl) source

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    Premisecitation

    Research supports a functional link between OFC impairment and disordered eating, including an association between disinhibited eating in obese adolescents and reduced OFC volume.

    “Indeed, several lines of research support a functional link between OFC impairment and disordered eating, including the reported association between disinhibited eating in obese adolescents and reduced OFC volume (66).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [66] Maayan, 2011, Disinhibited eating in obese adolescents is associated with orbitofrontal volume reductions and executive dysfunction, Obesity (Silver Spring) source

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  • May combine two claims.

    Premisenone given

    DA activation of striatum by cues is involved in desire (wanting) and triggers behaviors toward consuming the desired reward.

    “It appears as if DA activation of the striatum by cues (including drug-related contexts) is involved with the desire (wanting), as the trigger of behaviors geared toward consuming the desired reward.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Evidence indicates the OFC supports conditioned cue-elicited feeding and contributes to overeating irrespective of hunger signals.

    “There is evidence that the OFC also supports conditioned cue-elicited feeding (64) and that it contributes to overeating, irrespective of hunger signals (65).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [64] Holland, 2005, A neural systems analysis of the potentiation of feeding by conditioned stimuli, Physiol Behav source

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    • cites [65] Ogden, 1990, Cognitive restraint and sensitivity to cues for hunger and satiety, Physiol Behav source

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  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    Pre-existing prefrontal dysfunction could underlie vulnerability to excessive drug or food consumption, exacerbated by decreases in striatal D2R.

    “Similarly, a pre-existing dysfunction of prefrontal regions could also underlie the vulnerability for excessive drug or food consumption, which would be further exacerbated by decreases in striatal D2R (either drug- or stress-induced; it is unclear whether obesogenic diets decrease striatal D2R).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Inhibition of striatal D2R or activation of D1 receptor-expressing striatal neurons enhances sensitivity to drug rewards.

    “Moreover, inhibition of striatal D2R or activation of D1 receptor-expressing striatal neurons (mediate signaling in the striatal direct pathway) enhances the sensitivity to drug rewards (74).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Ferguson, 2011, Transient neuronal inhibition reveals opposing roles of indirect and direct pathways in sensitization, Nat Neurosci source

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  • May combine two claims.

    Premisecitation

    Dysregulation of striatal D2R signaling has been implicated in obesity and compulsive food intake in obese rodents.

    “Dysregulation of striatal D2R signaling has also been implicated in obesity (76,77) and in compulsive food intake in obese rodents (78).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [76] de Weijer, 2011, Lower striatal dopamine D2/3 receptor availability in obese compared with non-obese subjects, EJNMMI Res source

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    • cites [77] Geiger, 2009, Deficits of mesolimbic dopamine neurotransmission in rat dietary obesity, Neuroscience source

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    • cites [78] Johnson, 2010, Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats, Nat Neurosci source

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  • May combine two claims.

    Premisecitation

    When nonobese male subjects inhibited food craving during food cues, they decreased activity in amygdala, OFC, hippocampus, insula, and striatum; OFC decreases were associated with reduced food craving.

    “Indeed, imaging studies showed that when nonobese male subjects were asked to inhibit their craving for food when exposed to food cues, they decreased activity in amygdala, OFC, hippocampus, insula, and striatum; and OFC decreases were associated with reductions in food craving (54).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Wang, 2009, Evidence of gender differences in the ability to inhibit brain activation elicited by food stimulation, Proc Natl Acad Sci U S A source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Because OFC and ACC impairments are associated with compulsive behaviors and impulsivity, impaired dopamine modulation in these regions likely contributes to compulsive and impulsive drug or food intake.

    “In addition, because impairments in OFC and ACC are associated with compulsive behaviors and impulsivity, impaired modulation of dopamine in these regions is likely to contribute to the compulsive and impulsive patterns of drug (addiction) or food (obesity) intake.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Ventral and medial prefrontal regions including OFC and ventral ACC become activated with exposure to craving-inducing drug stimuli or cues, in contrast to decreases in prefrontal activity in detoxified cocaine abusers not stimulated by drug cues.

    “In contrast to the decreases in prefrontal activity reported in detoxified cocaine abusers when not stimulated with drug or drug cues [see review (59)], ventral and medial prefrontal regions (including OFC and ventral ACC) become activated with exposure to craving-inducing stimuli (either drugs or cues) (60,61).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [59] Volkow, 2009, Imaging dopamine's role in drug abuse and addiction, Neuropharmacology source

      Not checked in the free run.

    • cites [60] Grant, 1996, Activation of memory circuits during cue-elicited cocaine craving, Proc Natl Acad Sci U S A source

      Not checked in the free run.

    • cites [61] Wang, 1999, Regional brain metabolic activation during craving elicited by recall of previous drug experiences, Life Sci source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    In addiction, drug taking becomes the main motivational drive, so addicted subjects are aroused by obtaining drug but withdrawn and apathetic to non-drug activities.

    “Because drug taking becomes the main motivational drive in addiction, addicted subjects are aroused and motivated by the process of obtaining the drug but withdrawn and apathetic when exposed to non–drug-related activities.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Greater medial OFC volumes are seen in bulimia nervosa and binge-eating disorder patients, and OFC damage in rhesus monkeys results in hyperphagia.

    “In contrast, greater volumes of the medial OFC were seen in both bulimia nervosa and binge-eating disorder patients (67), and damage to the OFC in rhesus monkeys has been reported to result in hyperphagia (68).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [67] Schafer, 2010, Regional grey matter volume abnormalities in bulimia nervosa and binge-eating disorder, Neuroimage source

      Not checked in the free run.

    • cites [68] Machado, 2007, Measuring reward assessment in a semi-naturalistic context: The effects of selective amygdala, orbital frontal or hippocampal lesions, Neuroscience source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The OFC is involved in attributing salience value to food and assessing expected pleasantness and palatability based on context.

    “The OFC is similarly involved in attributing salience value to food (62), helping to assess its expected pleasantness and palatability as a function of its context.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [62] Grabenhorst, 2008, How cognition modulates affective responses to taste and flavor: Top-down influences on the orbitofrontal and pregenual cingulate cortices, Cereb Cortex source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Reduced availability of striatal D2R receptors is a consistent abnormality across many drug addictions and can persist months after detoxification.

    “Imaging studies revealed that reduced availability of striatal D2R receptors is a consistent abnormality across a wide variety of drug addictions and one that can persist months after detoxification [reviewed in (59)].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] Volkow, 2009, Imaging dopamine's role in drug abuse and addiction, Neuropharmacology source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The insula is a primary gustatory area participating in eating behaviors such as taste.

    “The insula is also a primary gustatory area, which participates in many aspects of eating behaviors, such as taste.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Subjects recovered from anorexia nervosa show less insular activation when tasting sucrose and no association of pleasantness with insular activation as controls do.

    “In contrast, subjects who have recovered from anorexia nervosa show less insular activation when tasting sucrose and no association of feelings of pleasantness with insular activation as observed in control subjects (104).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [104] Wagner, 2008, Altered insula response to taste stimuli in individuals recovered from restricting-type anorexia nervosa, Neuropsychopharmacology source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The insula, especially anterior regions, is reciprocally connected to limbic regions and supports interoceptive functions, integrating autonomic/visceral information with emotion and motivation and providing conscious awareness of urges.

    “The insula, particularly its more anterior regions, is reciprocally connected to several limbic regions and supports interoceptive functions, integrating the autonomic and visceral information with emotion and motivation and providing conscious awareness of these urges (95).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [95] Naqvi, 2009, The hidden island of addiction: The insula, Trends Neurosci source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A similar transition from pleasurable to compulsive eating may occur in food addiction after exposure to obesogenic foods.

    “More recently, Parylak et al. (106) have proposed that a similar transition may occur in food addiction with exposure to obesogenic foods.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [106] Parylak, 2011, The dark side of food addiction, Physiol Behav source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other studies found significant decreases in prefrontal cortex blood flow associated with higher weight in healthy controls, and an fMRI study reported impaired executive function in obese women.

    “Other studies found significant decreases in blood flow in the prefrontal cortex associated with higher weight in healthy control subjects (84,85), and a functional magnetic resonance imaging study reported impaired executive function in obese women (86).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [84] Willeumier, 2012, Elevated body mass in National Football League players linked to cognitive impairment and decreased prefrontal cortex and temporal pole activity, Transl Psychiatry source

      Not checked in the free run.

    • cites [85] Willeumier, 2011, Elevated BMI is associated with decreased blood flow in the prefrontal cortex using SPECT imaging in healthy adults, Obesity (Silver Spring) source

      Not checked in the free run.

    • cites [86] Kishinevsky, 2012, fMRI reactivity on a delay discounting task predicts weight gain in obese women, Appetite source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An MRI study of elderly women found negative correlation between BMI and gray matter volumes including frontal regions, which in OFC correlated with impaired executive function.

    “For example, a magnetic resonance imaging study of elderly women found a negative correlation between BMI and gray matter volumes (including frontal regions), which, in the OFC, correlated with impaired executive function (83).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Walther, 2010, Structural brain differences and cognitive functioning related to body mass index in older females, Hum Brain Mapp source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    When normal weight women tasted sucrose, both insula and DA midbrain areas activated, whereas sucralose only activated the insula.

    “For example, when normal weight women tasted a sweetener with calories (sucrose), both the insula and DA midbrain areas became activated, whereas tasting a calorie-free sweetener (sucralose) only activated the insula (103).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [103] Frank, 2008, Sucrose activates human taste pathways differently from artificial sweetener, Neuroimage source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The dark side of addiction is a transition from initial pleasurable drug use to compulsive drug consumption aimed at relieving negative emotional states.

    “The dark side of addiction was initially proposed by Koob and Le Moal (105) to describe the transition that drug-addicted individuals experience between the initial, pleasurable use of drugs to the one that, with repeated use, results in drug consumption to relieve negative emotional states.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [105] Koob, 2005, Plasticity of reward neurocircuitry and the 'dark side' of drug addiction, Nat Neurosci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Neurons in the rostromedial tegmental nucleus receive major input from the lateral habenula, project to VTA dopamine neurons, and are activated after food deprivation.

    “The habenula is also implicated in food reward: neurons in the rostromedial tegmental nucleus, which receive a major input from the lateral habenula, project to VTA DA neurons and are activated after food deprivation (110).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [110] Jhou, 2009, The rostromedial tegmental nucleus (RMTg), a GABAergic afferent to midbrain dopamine neurons, encodes aversive stimuli and inhibits motor responses, Neuron source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Central to that model is enhanced sensitivity of the extended amygdala and increased signaling through corticotropin-releasing factor and related peptides, which mediate stress responses.

    “Central to their model is an enhanced sensitivity of the extended amygdala and increased signaling through corticotropin-releasing factor and corticotropin-releasing factor related peptides, which mediate responses to stress.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [106] Parylak, 2011, The dark side of food addiction, Physiol Behav source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    This model helps explain the many contact points between obesity and addiction.

    “This model helps explain the proliferating examples of contact points between obesity and addiction, some of which were highlighted in this review.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Smoking and obesity, the two largest preventable threats to public health, involve the reward circuit that drives individuals to consume rewards despite their harm to health.

    “It is telling that the two largest preventable threats to public health (smoking and obesity) involve the reward circuit that drives the motivation of individuals to consume rewards despite the fact that they are harmful to their health.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationreasoning

    Enhanced habenula sensitivity resulting from chronic drug exposure could cause greater reactivity to drug cues and contribute to dysphoric states during withdrawal.

    “Thus, an enhanced sensitivity of the habenula, as a result of chronic drug exposure, could underlie a greater reactivity to drug cues and also contribute to dysphoric states during withdrawal.”
    Quote in the paperSubstantial claim
60 of 60

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Cited study does not match the described preclinical finding

    Minor

    The text cites reference 47 for a preclinical finding about decreased VTA dopamine activity and increased food consumption. Reference 47 is titled as a study of reward-system activation in obese women viewing food pictures, not a preclinical study of dopamine activity or consumption.

1 of 1

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Authors
Volkow, N. D., Wang, G.-J., Tomasi, D., & Baler, R. D.
Affiliations
  • National Institutes of Health (US)
  • Brookhaven National Laboratory (US)
Corresponding author
Volkow, Nora D.
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2013-05
Volume
73
Issue
9
Pages
811-818
ISSN
0006-3223 (ISSN-L)
OpenAlex
W1981784954
Cited by
380
References
114
Citations by year
2026: 19 · 2025: 23 · 2024: 17 · 2023: 21 · 2022: 18 · 2021: 25 · 2020: 23 · 2019: 21 · 2018: 37 · 2017: 35 · 2016: 41 · 2015: 50 · 2014: 36 · 2013: 14
FWCI
6.94
Type
journal article
Language
en
Open access
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Institute on Alcohol Abuse and Alcoholism (ZIAAA000550)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
Keywords
obesity, addiction, compulsive eating, reward systems, energy homeostasis, self-control, inhibitory control, palatable food, drug addiction, neural correlates
MeSH terms
Compulsive Behavior, Dopamine, Eating, Homeostasis, Humans, Obesity, Reward, Behavior, Addictive, Prefrontal Cortex

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

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