A recent systematic review of the current scientific literature “assigning obesity to the spectrum of neuropsychological diseases” has proposed “an integrative model” for understanding obesity not simply as a “deliberately flawed food intake behavior with the consequence of dysbalanced energetic uptake and expenditure,” but as a complex condition “linked to neurobio-logical and psychological aspects such as mood status, addictive behavior, motivation and reward processing as well as coping with psychosocial stress.” Kamila Jauch-Chara and Kerstin Oltmanns, “Obesity – A neuropsychological disease? Systematic review and neuropsychological model,” Progress in Neuro- biology, January 2014. To this end, the reviewers highlight obesity research concluding, among other things, that (i) “chronic stress enhances food intake,” with both humans and animals choosing energy dense foods “to blunt their stress responses”; (ii) “food intake activates the reward circuitry” in the brain, increasing dopamine concentrations that correlate “positively with the rating of food pleasantness in humans”; and (iii) “stress per se stimulates the reward system.”They also suggest that “obesity is a consequence of a vicious circle built on cross-links between chronically enhanced stress axis activity and reward-related mechanisms within the mesolimbic system.”

“At minimum, obesity is a brain disease that is mediated by the interaction between energy homeostasis, detrimental hyperactivity of the stress systems, and activation of the dopaminergic reward pathways,” note the authors. “Against this background, the growing epidemic of obesity requires a change in thinking to overcome this challenge. A step in the right direction would be to realize that concepts to readjust detrimental neuropsychological dysfunc- tioning necessarily need to be integrated into the prevention of and therapy for overeating and obesity in the future.”