ABSTRACT
Obesity and substance use disorders (SUDs) are both major public health issues in the United States and other industrialized nations of the world. Both obesity and SUDs cause preventable premature death, disability, and contribute to an ever-expanding health care budget. Obesity, substance abuse, and substance dependence have increased alarmingly in adolescents. Competition between food and drugs of abuse at brain sites, critical for reward and pleasure, may explain the common comorbidities of starvation or bingeing and purging and drug use on the one hand and morbid obesity and lack of drug use on the other hand. Culture appears to play a role in the relationship between obesity and substance abuse, because patients with eating disorders in Western countries have higher rates of comorbid substance abuse. Eating disorders and obesity are both suspected to represent dysfunctional regulation of neurotransmitters such as dopamine and serotonin, and endogenous opioids and other neuropeptides.
