“Why We Should Start Talking About Morbid Obesity as an Addictive Disorder”

Jason Kirby, DO
Jun 20
3 min read

Hint: It’s Not Just About Willpower

Let’s get one thing out of the way: Morbid obesity is not a character flaw.

It’s not laziness, a lack of discipline, or a failure of morals. And it’s definitely not fixed by shame. But here’s the kicker—despite overwhelming evidence, we still don’t officially recognize morbid obesity as an addictive disorder, even though it behaves just like one in real life.

Let’s talk about why it’s time to rethink that—and how doing so could change the way we treat, support, and respect people struggling with it.

🍰 Obesity and Addiction: More Alike Than Different

If you’ve worked in addiction medicine or lived in recovery, the parallels between food and drug compulsions are undeniable.

Here’s what they share:

Cravings that override logic (“I know I’ll feel like crap after this, but I’m doing it anyway.”)
Loss of control (“Just one bite” turns into the whole pizza.)
Emotional dysregulation (“I eat when I’m sad, bored, anxious, or happy—especially when I’m happy.”)
Tolerance and escalation (What used to satisfy no longer does. You need more. Often.)
Withdrawal-like discomfort when trying to stop (irritability, depression, anxiety, headaches)
Rituals and secrecy (“Don’t let anyone see me eat this. I’ll just eat in the car…”)

Swap out “food” with “alcohol,” “opioids,” or “porn,” and the story reads the same.

😔 Where It Starts: Trauma, Shame, and Survival

Many people living with morbid obesity didn’t just “let themselves go.” They’ve been trying to cope—often since childhood.

There’s solid evidence linking compulsive eating to:

Adverse Childhood Experiences (ACEs)
Sexual and physical abuse
Emotional neglect
Complex trauma or prolonged toxic stress
Co-occurring disorders like anxiety, depression, and PTSD

Food becomes medicine. It soothes, numbs, and helps a person feel something—or nothing—just like any other drug.

And society? Society punishes these folks twice: once for what happened to them, and again for how they tried to survive it.

🧠 The Brain Doesn’t Care if It’s Cake or Cocaine

Neurologically, the brain doesn’t discriminate between substances and behaviors. Dopamine is dopamine.

Ultraprocessed foods, especially those loaded with sugar, fat, and salt, light up reward centers in the brain like fireworks—activating the same circuitry as drugs of abuse.

MRI studies show:

Reduced activity in the prefrontal cortex (responsible for decision-making and impulse control)
Overactive reward pathways
Deficient dopamine receptor sensitivity

Sound familiar? It should—it mirrors the brain scans of people with substance use disorders.

🔄 It’s Not Just About the Food

Like all addictions, morbid obesity isn’t simply about the behavior. It’s about the underlying pain, the maladaptive coping, and the loop that keeps people stuck in the same cycle:

Trigger → Craving → Ritual → Binge → Shame → Repeat

You can’t shame someone out of that loop. You treat it like you would any addiction:

Compassion
Therapy (trauma-informed and behavioral)
Structured support
Medical options (like GLP-1s, which act on cravings)
Community and connection
Behavioral replacement—not just restriction

❤️ Why It Matters: Destigmatize to Heal

Here’s the heart of it: When we start to see obesity as an addictive disorder, we stop blaming the person and start treating the condition.

We create space for:

Real conversations
Medical interventions without judgment
Long-term recovery, not quick fixes
Hope.

Not every case of obesity is rooted in addiction. But for those that are, it’s time we call it what it is—and treat it with the same respect, science, and seriousness that we do for substance use disorders.