I often get questions from my patients: Is my obesity due to food or hormones? It is a great question, and the answer isn’t always clear. Obesity is a complex, multifactorial condition. To truly understand it, we need to examine both the brain and body, specifically how food impacts our reward system and how hormones regulate hunger and metabolism.
Let us begin with food addiction. Certain foods, especially ultra-processed items high in sugar, fat, and salt, can hijack our brain’s dopaminergic reward system, particularly in the nucleus accumbens, similar to addictive drugs.
These hyperpalatable foods stimulate the release of dopamine, a neurotransmitter associated with pleasure and reward, leading to a cycle of craving and overconsumption.
Over time, just like with substance use, the brain may develop tolerance, meaning you need more of that food to get the same reward. You might also experience cravings and even withdrawal-like symptoms when you try to cut back.
This is not about a lack of willpower. Brain imaging studies have shown that in people with obesity, the same areas activated by drugs in people with substance use disorders light up in response to hyperpalatable foods. This kind of compulsive eating behaviour fits the clinical criteria for addiction in some individuals.
Research indicates that approximately 14% of adults globally may be addicted to such ultra-processed foods.
This addiction is not merely about a lack of self-control. It is a neurochemical response where the brain’s reward pathways are altered, similar to substance addiction. Individuals may experience Intense cravings, withdrawal symptoms, and a loss of control over their eating behaviours.
On the other hand, hormonal dysregulation plays a significant role in obesity. Hormones like leptin, ghrelin, insulin and cortisol regulate hunger and energy balance.
Leptin is released by the fat cells and normally tells your brain, Hey, we have got enough energy, you can stop eating. But in many people with obesity, we see leptin resistance, the brain doesn’t respond to that signal properly, so appetite stays high even when energy stores are full.
Ghrelin, on the other hand, is the hunger hormone produced in the stomach. In people with chronic dieting or poor sleep, ghrelin levels can stay elevated, making you feel hungry even when you are not physically in need of food.
And let’s not forget insulin and cortisol. Insulin resistance leads to higher circulating insulin, which promotes fat storage. And chronic stress, which raises cortisol, can increase cravings, especially for sugary, high-fat foods and promote abdominal fat storage.
Understanding obesity requires acknowledging both food addiction and hormonal dysregulation. Some people may be more vulnerable to addictive eating patterns due to brain chemistry, while others may struggle with hormonal imbalances that drive persistent hunger and fat storage. In many cases, both are happening at the same time.
That’s why treating obesity requires more than just eating less, moving more. It requires a comprehensive, addressing both the psychological aspects of food addiction and the physiological components of hormonal dysregulation. This may include nutritional counselling, behavioural therapy, stress management, and medical interventions targeting hormonal imbalances.
