A NEUROPSYCHOLOGICAL PERSPECTIVE: “MY BIG FAT BRAIN”

by Gerard Williams, PhD

Obesity is a structural brain disorder.

“I call that bold talk for one-eyed fat man.”   Ned Pepper (Robert Duval) to Rooster Cogburn (John Wayne) from the movie True Grit.

It seems like such a simple statement to make. Who could have believed it would be such a controversial thing to say.  When I posed this statement in the late 1980’s, I could have never predicted the intensity of the reactions it created.

Since we, the intelligent species called humans, began addressing the whole topic of dieting and weight management, we've always viewed obesity as originating in the stomach or the mouth or the hand. The brain was always looked at as included but not central to the process of weight management. This article is about a shift in thinking away from obesity as just a behavioral, psychological, or metabolic disorder to viewing obesity as a true structural brain disorder.  If we are ever to win this battle against weight related health disorders, we absolutely must reconceptualize obesity and especially morbid obesity as a brain dysfunction or as I’ve titled it, a structural brain disorder.  First, a little orientation is needed.

We have all read the brain researchers who have gleefully pointed out that we lose millions of neurons every day. Sometimes I wonder if a good sneeze costs me at least several thousand neurons. The problem with this linear brain shrinkage idea is that it creates a lot of unnecessary anxiety and, more importantly, it fails to explain the true complexity of the human brain. If our brains are shrinking every day, the great fear is that by age 60 we are going to have a brain the size of a walnut. With full credit to the designer, the human brain doesn't work that way. Although we have a decreased number of neurons as we age, the interconnections between neurons can actually increase.   And most interesting, the number of interconnections between neurons is something we can exert control over. This is why we have some interesting and successful ways to treat brain disorders like head injuries and strokes. The science behind this changeable brain is called neuro-plasticity. The idea here is that by exposing the brain to the right types of stimuli or activities, we can, in fact, increase the number of interconnections between neurons.  We can therefore change the physical structure of our brain.  The loss of neurons called neuro-pruning is viewed as a way the brain actually increases its potential efficiency as we age.  Our brain removes neurons which are no longer needed (hmm, use it or lose it?).  If we increase both the type and number of the interconnections between neurons we will clearly and definitely increase the efficiency of the brain.  And this is something all of us have the ability to do throughout our lifetime.  So, not only do we need to shift our beliefs that obesity and morbid obesity are disorders of the mouth and stomach and hand, we need to shift our beliefs that our brains are fixed and unchangeable (or even decaying).

I have to throw out a caveat.  In a society which publicizes and promotes victimization, it will be very tempting to use this change in perspective as an excuse or rationalization for poor weight management.  In other words, “It’s not my fault I’m morbidly obese. You see, I have a brain disorder.”  Self-victimization creates developmental paralysis.  We must always take responsibility for where we stand.  The purpose of this article is to begin the shift away from traditional unsuccessful “diets” to “positive brain development.”  Positive brain development refers to the process of engaging in activities specifically designed to change the structure of our brains in ways which will result in a healthier more satisfying life.   

You are what you eat.  What you think, and feel, and experience, how you behave and the responses to those behaviors, what you read and watch, and listen to, all alter the structures of your brain.  Sequences of neurons firing called pathways and multiple pathways called neural networks are established through neuro-plasticity for all we see, do, touch, experience, and feel both now and in the past.  These pathways and networks run through multiple areas of the brain.  The more often a pathway or network is used, the stronger the intensity of the firing and easier it becomes to fire.  Things used frequently or repetitively or that are attached to intense emotions have well established and resilient pathways and networks in our brains.  They are resistant to change.  Examples would be our locker combination from school, traumatic events from our past, a song we can’t get out of our head or even foods consumed now or in the past.  Unfortunately, if we focus on things negative or pathological, we will initiate a process of becoming more negative.  Read enough Stephen King and you will elevate your anxiety levels.  Watch the local and national TV news and become skeptical and jaded.  Watch The Food Network and you will create additional pathways just to think about food.   
“Just thinking positive” is not enough.  In order to change these dysfunctional pathways and networks surrounding eating and weight management in our brain, we need to simultaneously change our thoughts, feelings, and behaviors by attacking the dysfunctional pathways and networks and creating or developing new more functional networks and pathways.  Genetics cannot be ignored either.  Genetics create increased potentials to develop certain pathways and networks like optimism or conversely, depression and anxiety. 

Why does dieting fail?  By only addressing behavior, your thoughts (cognition) and emotions (affects) keep the dysfunctional pathway(s) and network(s) operating.  All three (thoughts, feelings, and behaviors) must be successfully and simultaneously addressed or the eating behaviors will continue.  When you think about eating a particular dessert, you evoke or elicit a whole series of sensory, cognitive, and emotional experiences from your brain.  Just focusing on the behavior of not eating dessert does nothing to stop the thoughts, feelings and sensory memories from repeatedly attempting to grab your attention and override your attempts at behavior control.  And our world is rich with things called stimuli which elicit or trigger these pathways and networks.  It’s no accident that bakeries in malls and markets blow exhaust from the cooling baked goods out to where people will smell them.    

We are therefore both the sum total of our thoughts, feelings, behaviors, and experiences, and the vast potential to be far more.

So, how do we change?  That’s the really cool part.  Read my article in the next Obesity Help magazine.