Reclassifying Obesity: A Behavioral Addiction Model

Dr Jayashree Swain, IMS and SUM Hospital, Bhubaneswar, Odisha, India

“Obesity involves addictive, reward-driven eating beyond metabolic needs. Evidence supports shared neurobiology with addiction, highlighting the role of cognitive behavioral therapy and integrated treatment beyond diet- or drug-based approaches.”

Obesity is a complex and growing health concern which has traditionally been viewed as a metabolic or lifestyle-related condition.

Recent reliance on diets and weight-loss drugs has overlooked behavioral and psychological drivers of obesity, leading to short-term weight loss without lasting benefit. Failure to address compulsive eating, emotional regulation, and self-control has increased interest in viewing obesity as a behavioral addiction.

This narrative review, published in the Academia Mental Health and Well-Being, examined theoretical, clinical, and neurobiological evidence supporting the concept of obesity as a behavioral addiction and discussed its implications for possible inclusion in future editions of the Diagnostic and Statistical Manual of Mental Disorders. Relevant literature published between 2000 and 2024 was identified through PubMed, PsycINFO, and Google Scholar, focusing on obesity, food addiction, reward neurocircuitry, and addiction frameworks.

The reviewed evidence showed strong similarities between compulsive overeating and substance use disorders, including loss of control, craving, and continued behavior despite harm. Neuroimaging studies demonstrated shared involvement of the mesolimbic dopamine reward system. Eating behavioral addictions are closely related to obesity, as compulsive, reward-driven overeating contributes to excessive weight gain beyond metabolic needs. Cognitive behavioral therapy helps address obesity by targeting maladaptive eating behaviors, emotional regulation, and self-control, supporting sustainable weight management.

These findings suggested that some eating behaviors shift from homeostatic needs to reward-driven patterns. Recognizing obesity through an addiction framework may support more integrated treatment strategies, combining behavioral therapies with pharmacological approaches that target both metabolic and reward pathways. Further research is needed to refine diagnostic criteria and guide future classification decisions.

(Source: Gupta M, et al. Obesity as a behavioral addiction: moving past quick fixes and the case for inclusion in the Diagnostic and Statistical Manual of Mental Disorders. Acad Ment Health Well-Being. 2025;2(3). doi:10.20935/MHealthWellB7880.; https://www.academia.edu/2997-9196/2/3/10.20935/MHealthWellB7880#sec5-sensors-3818534)