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Mental Health & Obesity 2014: Sensitized Reward Pathways, Depression and Obesity Treatment

Dr. David Macklin, MD, CCFP, University of Toronto

The obesity epidemic is perhaps best explained as the result of a missmatch between our ancient reward brain and our modern tasty food filled environment. The taste of hyperpalatable foods drives an opioid based emotional pleasure, and repeated “stimulation” creates an associative-Pavlovian learning. After conditioning has taken place, often over many years, exposure to these same “cues” drives a sensitized reward pathway leading to pathalogical levels of wanting often overwhelming an individuals capacity to withstand the urge to eat. This “hedonic signalling” in response to hyper palatable foods is is increasingly recognized as a leading cause of obesity world wide.

Obesity is associated with an approximately 25% increase in odds of Depression. Reward signalling mediated by the dopaminergic mesolimbic system has been postulated to play a major role in both the development of obesity as well as depression. Depression has been shown to both up modulate reward signalling as well as degrade the more cortical functions of impulse control and restraint. This presentation will demonstrate a novel behavioural weight management perspective detailing how the effects of depression can be recognized and it’s association with obesity can be clinically managed.