Disorder is a more fitting concept for many ailments and afflictions, because it encompasses the relationship—often intermittent, transitional, or shifting—between normality and abnormality. They are related and recognized in terms of each other and the prevailing dominance of order or disorder. The difference between order and disorder is the degree and consistency of the organization and stabilization of our internal default states. A default state (also called default network mode) is the pattern of neural network firing our brain does internally when it reverts to its familiar resting mode. Default states can be normal in the sense of flexible and healthy or familiar but dysregulated in the sense that due to habit the brain acts as if that is the normal default mode. Order deteriorates into disorder when our default states are disorganized and lack coherent feedback and integration, thereby inducing or maintain dysfunctional patterns. For example, a mood disorder reflects the brain’s difficulty and instability with regulating mood flows, variations in arousal, and resilience. Similarly, a sleep disorder occurs when one cannot routinely transition among necessary states of arousal to enter and maintain sleep stages.

Why Does This Matter?

The medical establishment has classified alcoholism and obesity as diseases. Why not just accept it and let it be judged as such? Because it matters for the characteristics described above: namely, if it’s a disease, it must be treated with the conventional tools of medicine. Not doing so would deny and deprive patients of “necessary” treatments to eradicate physical causes and abnormalities, making symptoms persist and health decline.

If obesity is a disease, then those afflicted may tend to deny responsibility for its origin and continuation. With the disease model, obese people may feel exonerated from behaviors and health practices that contributed to the condition. Their health and fate are in the hands and plans of physicians who attempt to eliminate the disease through drugs or surgery, perhaps “relieving” them of their own duties regarding their “cure” except for compliance with the medical regimen.

Even with a disease model for alcoholism and drug addiction, doctors and treatment facilities recommend or include collateral interventions aimed at reforming patient lifestyles and behaviors. Such interventions may be very helpful. But the bottom line is that “therapies” and meetings cannot substitute for treating the afflicted organ. Cancer support groups may be useful, but they don’t treat the cancer. Collateral treatments that improve attitude may assist the healing process, but the afflicted organs still require biological treatment. The issues of etiology and persistence of conditions such as obesity, addictions, and mental illnesses are complicated by murky crossovers between scientific evidence and theories about the cause-and-effect relationships between behaviors and organic health. An example of contradictory belief and practice is easily demonstrated in the conventional approach to anxiety and depression. For these conditions, mainstream medicine will typically recommend medication.

Mood disorders are assumed to be due to neurotransmitter deficiencies, so the appropriate solution is deemed chemical. However, physicians may also recommend psychotherapy (talking about it). In my view, this is hypocritical lip service. Here’s why: if the problem is only neurochemical, then why would talking about it about it address the physiological problem? In what way is that a solution? Conversely, if some form of talk therapy solves or reverses anxiety or depression, then why flood the body with harsh chemicals having known adverse side effects and dependencies?

Pediatricians often prescribe medications (particularly dangerous stimulants) to children with attention-deficit disorder based upon an assumption that without medicinally straightening out their neurotransmitters, they cannot learn or behave properly. Yet there is also a parallel thrust for parenting skills, behavioral interventions, and academic and lifestyle modifications. In theory, these interventions would complement and augment each other. Confusion derives from what you believe is the actual cause and its logical requirement for a lock-and-key solution. It is disingenuous to have it both ways. Either the meds fix it and external interventions are superfluous, or the environmental solutions are critical, thus deflating the purported organic disease model as causal.

Certainly, I endorse good parenting, behavior modification, healthy diet, and appropriate educational services. I’ve built my career around these cornerstones. In some situations, as temporary relief or for crisis management, psychotropic medications may be helpful. And collateral interventions can by synergistic. If you contend that the problem is primarily neurochemical and organic, then you may discount the central solution as environmental and behavioral. With conviction that social influences, behavioral conditioning, and characterological forces are what constitute the problem, then you will not look to chemical solutions as necessary or even appropriate.

What About Brain Disease?

With the contemporary thinking that asserts that alcoholism, addictions, and obesity are brain diseases, those afflicted with these problems may feel they too naturally feel that they cannot control their behaviors constellating around indulgence, habit, cravings, and relapses. The difficulties and self-fulfilling prophecies deduced from such a position are obvious and unavoidable:

“I cannot control my appetites, cravings, and behaviors.”

“There’s something wrong with my brain that I cannot fix.”

“I should not be punished or even held responsible for the damage I cause to myself or others.”

“Critics and natural consequences victimize me and induce shame and guilt I don’t deserve.”

After years of struggling with weight, self-control, addictions, and the attendant guilt and shame, patients are eager to latch on to explanations and diagnoses that absolve them from personal and societal blame. Though understandable, such pronouncements may also hinder personal responsibility.

I have been an addict, and my own son died from drug addiction. I treat addictions and their associated and underlying conditions (known as comorbidities). I am empathetic and sympathetic to the terrible conundrums of those caught in the grip of these maladies.

I have no doubt in my mind—nor in the medical evidence—that poor diet, overuse of alcohol, and addictive drugs cause and result in diseases, including brain diseases.

But here’s some breaking news: behaviors are not diseases! Cirrhosis of the liver is a deadly disease, and chronic alcohol excess causes it. Diabetes is a devastating disease, and sugar causes it. But heavy drinking itself and eating too much cake are not diseases. They are compulsions and habits caused by the interactions of these unhealthy substances with the dysregulatory functions of the majority of Americans who have metabolic disorders. Metabolic disorders are frequently the normal consequences of abnormal and dysregulation eating and nutrition.

When the vicious cycle of ingestion and indulgence, relief and withdrawal, craving and repetition reaches its predictable unhealthy outcomes, we should not fault the body for reacting as it’s supposed to. A nutritional expert colleague has likened this to “blaming the fire department when it shows up to put out the fire.”

Diagnosis By Prescription

Sometimes physicians will “confirm” a hypothesized diagnosis by pointing to the patient’s response to a medication. Thus, if a rowdy or inattentive child focuses better on a stimulant, then this is presumed evidence of attention-deficit disorder. This seeming empirical justification short-cuts the differential diagnostic process and conflates effect with cause in an unscientific manner.

Patients about to undergo surgery are routinely given a dose of anxiolytics (anxiety medication) right before surgery to calm and prepare them. Obviously, the expected and observed response is a significant general relaxation, even a mild “high.” We certainly should not pull this response out of context to conclude that the patient has an anxiety disorder!

Yet this seat-of-the-pants approach is used to assess and make diagnostic conclusions about other state-related disorders. Let’s prescribe an antidepressant and, if the patient feels better, we’ll know they have depression.

Let’s not overlook two common scenarios that undercut this hypothesis. First, many obviously and historically depressed people do not respond well to antidepressants; but they are clearly depressed. Second, it’s common in medical practice to try numerous medications in combination or consecutively when patients don’t respond adequately to the first medication. Diagnosis confirmation by treatment response has its flaws. This is not to obviate the prompt administration of medications to relieve symptoms or treat illnesses. We would not quibble with using antibiotics to arrest infection, even if the lab test has not arrived or been conclusive. Seasonal sniffles and congestion may warrant a nasal spray even before or without rigorous allergy testing.

The current wave of positive responses to the new weight loss drugs seems to have encouraged a “brain disease” by success mentality. The thinking goes like this: I’ve struggled to lose weight for years and have been unsuccessful (and miserable) on a sustainable, consistent basis. On the new weight loss medication, I’ve lost weight, reduced my appetite, and think less compulsively about food. The medication affects my liver, pancreas, and gut hormones as well as their signals to my brain; therefore, I must have a brain disease that was lacking proper diagnosis and treatment.

Can you see the flaws in this line of reasoning? Let’s also add that the weight loss drugs slow down digestive transit time which leaves food in the stomach much longer. Of course, this feeling of fullness signals to the brain that eating more is no longer of interest. This is a very helpful outcome—but it is normal for the brain to respond this way, not evidence of a disease.

And What’s More . . .

Hunger is not a disease! We are mammals, first and foremost. Yes, we’ve got a lot more going on than animals who hunt in the wild; but remember, mammals think about food constantly. It’s wired into our survival.

Consider also that behavior itself, even destructive behavior, is not a disease (though its consequences may lead to disease). Eating behaviors are patterns largely conditioned by learned payoffs to the relief of internal crises provoked by neurophysiological dysregulation.

I resonate with those who admit: I’m not even done with breakfast, but I’m thinking about what’s for lunch. I get it—me too. Much of this is normal, but some of it is not.

Constant preoccupation with and dwelling upon food and eating originates with the longstanding habit of reward deficiency in digestive satiety. In common parlance, we can’t get our mind off food because we lack the routine experience in our gut (starts there) and our brain that we are satisfied, we have had enough, we are not missing out, and we won’t feel better if we eat more. Because of our evolutionary roots, overeating now is vestigial and maladaptive.

The basis of the “food noise” is the problematic and disruptive lack of blood sugar maintenance that afflicts the majority of people. Inadequate blood sugar regulation is the culprit in a multitude of health diseases and disorders, including and especially obesity. Due to evolutionary programming (it’s in our genes to store calories, just in case), diets of unnatural and processed foods, and the constant rollercoaster of uneven blood sugar, the brain is provoked and commandeered into thinking about, planning, and seeking food. This is a normal combination of biochemical, cognitive, and behavioral responses to a lifetime of dysregulated and dissatisfied eating.

People overeat out of boredom (under-arousal), emotional overload and stress (over-arousal), and because the foods themselves are engineered and processed to cause cravings, overindulgence, and addiction. Sugar, salt, fat, taste additives, and the habit of addressing stress through food may trick us into eating until “food coma” shutoff kicks in. This is a maladaptive anxiety-reducing and sedating response. Unfortunately, it’s often accompanied by self-criticism and self-derogation.

Notwithstanding these factors, the problem—and the solution—is the regulation and controlled maintenance of the digestive biome through hormone balance and blood sugar regulation. Along with such gastric regulation, the brain must become more regulated in its neuronal transmission to reduce high-alert vigilance in which anxiety is mediated by thinking about food as a reward.

This leads us into an exciting new world of good news: modern weight loss drugs go a long way toward correcting the imbalances suffered by tens of millions.

In sum, rest assured that you are not diseased if or because you crave food, love food, and think about it constantly. These are normal responses to the dysregulated states of deprivation you have endured for so many years.

Extensive preoccupation with food (unless you are in the food industry) is annoying overkill and stretches the limits of normal mental balance. But it’s not a brain disease. It’s your gut signaling relentlessly to your brain that you are not satisfied and something’s not right. When there’s a fire and the alarm is pulled, don’t blame the fire department.

Remember also (in the words of my wise father): opinions come easily on a full stomach. Your brain and stomach should work harmoniously instead of vying in conflict for who is slave and who is master.

Obesity reflects an ongoing internal crisis of neurophysiology, a battle for self-regulatory control with hormonal normalcy and functionality.

When you look in the mirror, do you see a sick person? Someone with a bad, diseased brain? Or do you see a person who is sick and tired of being frustrated and stuck after years of earnestly putting forth effort to achieve goals with eating and weight?

You can stop blaming yourself, ascribing character flaws to your failed attempts, comparing yourself negatively and incessantly, and reject the idea that you have a diseased brain just because you like to eat and enjoy feeling satisfied. Your internal house is out of order. Let’s clean it up and maintain the digestive and metabolic housekeeping.

I’ll keep reminding you: You are a worthy person, a person of infinite value, someone who deserves to feel good about yourself and to see fruitful results from your intention and hard work.

My intention and in writing is to help you achieve goals along those lines—to have a more peaceable and healthy relationship with your mind, body, and with food, regardless of how many pounds you lose along the way.

And, if you follow the simple (perhaps not always easy, but they are simple and straightforward) steps I outline, I promise you will lose weight.

Let’s get started with practical information and plans to get you healthier, happier, and looking and feeling much better.

Call (408) 356-1002