September 6th, 2010
10:49 AM ET

Could 'runner's high' chemical help curb overeating?

As a primary care internist, my practice spans the common adult ailments—diabetes, hypertension, high cholesterol, coronary artery disease, arthritis. It is hard not to avoid the difficult truth that obesity, while perhaps not causing all of these illness, certainly exacerbates them greatly.

With my patients, I stay away from issues of blame—it’s a pointless endeavor and causes unwarranted guilt and shame—but obesity is a critical medical issue that cannot be ignored just because it is difficult to treat.

I've always been a bit leery of medications and surgery to “treat” obesity, partly because of their limited efficacy but also because rethinking the way we eat—in the long term—is a cornerstone of good health.

Nevertheless, despite my ongoing discussions about five servings of fruits and vegetables, avoiding soda and fast food, etc, I’ve come to accept that other “treatments” have a role in treatment for at least some patients.

A few of my morbidly obese patients have had good success with bariatric surgery (others, though, have managed to regain all their weight). Despite my reservations, I’m always interested in learning about new treatments, and a study in a recent issue of the Lancet caught my eye. This study intrigued me on a personal level because it centered on the endorphin system (the biochemistry of which was the basis of my doctoral dissertation many moons ago).

Endorphins and enkephalins are the body’s natural opiate-like compounds, involved in pain regulation, addiction, “runner’s high,” and emotions, among other things. Some animal studies have a suggested a link between endorphins and eating behavior.

In a multi-center trial, 1,742 obese adults were randomized to placebo or a combination of naltrexone (an endorphin blocker) and buproprion (an antidepressant that also helps nicotine addiction). The goal was to lose at least 5 percent of body weight at the end of a year of treatment.

In the placebo group, 16 percent achieved the goal. In the naltrexone/buproprion groups (they tested two doses) 39-48 percent achieved the goal.

This is an interesting study that I believe offers some promise, though there are, of course, important limitations. The treatment group had more side effects (stomach upset, dizziness, dry mouth). Most significantly, there is no information beyond one year, and we all know that maintaining weight loss is a lifelong endeavor.

Naltrexone and buproprion are not yet ready to be prescribed for weight loss—further studies are needed, and FDA approval for this indication is important—but this is certainly an intriguing and thought-provoking study.

Danielle Ofri is associate professor of medicine at New York University School of Medicine, and editor-in-chief of the Bellevue Literary Review. Her most recent book, "Medicine in Translation: Journeys with My Patients," is about the care of immigrants and Americans in the U.S. health care system.

soundoff (48 Responses)
  1. kate

    So if you exercise that will help you lose weight, yes! People simply need to get off their couches and start eating healthy too. this site explains how to lose weight and stay healthy http://www.diet-myths.com

    September 6, 2010 at 11:40 | Report abuse | Reply
    • Underground

      I think they're saying that some people get a similar endorphin rush from overeating that athletes do from exercise. So by blocking the endorphins you're taking away the "reward" for eating too much, and hopefully that will eventually alter behavior.

      September 6, 2010 at 14:30 | Report abuse |
  2. May Voirrey

    About six years ago, a doctor prescribed bupropion (Wellbutrin) to treat my depression. It didn't do a thing for my depression other than make me very hyper. However, I dropped ten pounds in two months without even trying. I was very sad when the doctor said I couldn't take Wellbutrin anymore–he was concerned because it appeared to be making me somewhat manic. Alas, the wieght came back soon after the Wellbutrin left my life. I never changed my diet or exercise habits before or after the drug–Wellbutrin just seemed to change my metabolism. Immediately following this experience, I said it was only a matter of time until the pharmaceutical companies started marketing Wellbutrin as a weight-loss aid.

    September 6, 2010 at 11:41 | Report abuse | Reply
    • HungryNoMore

      I took Buproprion for depression about 18 years ago. I also lost 40 lbs. Didn't eat less, didn't exercise more. Although, once the weight came off I did start moving more as a consequence because exercise with 40 lbs gone was no longer painful. I ended up coming off the drug because of other side effects, and I gained all of the weight back eventually. Buproprion works for weight loss for some people, but it's not a long term solution. And if you have to come off of the drug eventually and you gain all the weight back, there's really no point in taking it/losing it in the first place. I ended up losing my weight and keeping it off by basically eating much less, and eating healthier and vegetarian.

      September 6, 2010 at 15:09 | Report abuse |
  3. Matt

    I hope they find a good solution, but before expecting great things from wellbutrin make sure not to expect same results from generic equivalents. Do a little research on problems patients have experienced using equivalents from multiple manufacturers. Most problematic seems to be the ex or extended release. My wife has been affected due to insurance limitations on name brands!

    September 6, 2010 at 12:05 | Report abuse | Reply
  4. Ray

    The article seems contradictory. The headline says, "Could 'runner's high' chemical help curb overating." It then identifies one of the runner's high chemicals as endorphin and one component of the drug tested as naltrexone. But naltrexone is described as an endorphin BLOCKER. So, is this telling me that too much endorphin leads to obesity. That seems wrong since we don't see many obese athletes. Maybe the headline writer missed the point; maybe the article needed to explain why an endorpin blocker might help. In any case, the article provided no helpful information.

    September 6, 2010 at 12:13 | Report abuse | Reply
    • trixie

      Naltrexone is a type of endorphine blocker that is not affected by buproprion. It affects a different type of endorphine high, often used in helping to control the high of compulsory behaviors.

      September 6, 2010 at 21:25 | Report abuse |
  5. Joseph Sroka

    An endorphin *blocking* drug seems to help with weight loss? Exercise produces endorphins as far as I know. So, is one conclusion of this article that people desiring to lose weight should avoid exercise? I don't think so, but it just seems to indicate that this article is not clearly written or omits some pertinent facts.

    September 6, 2010 at 12:19 | Report abuse | Reply
  6. Anna

    Treatment should always reflect all the conditions a morbidly obese person struggles with. Personally, I struggle with seasonal affective disorder, major depression, binge eating disorder, and PCOS (which comes with insulin resistance); I am 140 pounds over my ideal weight. Generally I eat very healthy foods– to excess. And when I do eat junk food (sugary stuff in particular) I eat to extreme excess. My body no longer recognizes those cues that I am full, and I never throw up. Last summer I ate healthy foods and exercised (weights & cardio) a full hour 3-5 days a week without losing a single pound. For people like me, a combination of drug therapy, behavioral treatment, AND bariatric surgery is appropriate. Any one treatment in isolation will ultimately fail.

    September 6, 2010 at 12:28 | Report abuse | Reply
    • Christian

      Did you ever just try starving yourself of calories. Because if your 140lbs overweight (probably closer to 160lbs) an hour of cardio and weights will do nothing.

      September 6, 2010 at 13:03 | Report abuse |
    • Anna

      I really am only 140 pounds over ideal based on the low end of healthy for my bone structure. In the past I have successfully lost weight through long-term calorie restriction (more than 6 months), but at some point my other conditions would kick in and cause rapid weight gain to more than offset the loss. When I exercised last summer, my caloric intake was no higher than before I began exercising, but stress & depression halted my metabolism. Depression medication has helped me lose some weight (I can actually feel my hunger signals now), but the other conditions still exist. My point was, no single approach works in the long-term when you have multiple contributing conditions.

      September 6, 2010 at 13:12 | Report abuse |
    • ccb

      anna, i don't want to sound harsh but the only condition contributing to your weight gain is you are eating too many calories and not exercising enough. period. PTSD, depression, SAD, these are all psychiatric conditions that make it hard to make the right decisions and cut down on overeating, but that is all. that is great you were able to exercise so much last summer but you were probably eating too much for the level of exercise you were undergoing. this is a common mistake. as you exercise more your appetite increases. you have to be very careful about how many calories you are taking in. so since you didnot lose any weight did you give up on exercise and diet? you recognize that you overeat; if so you can stop it. medicines are NOT the answer to weight loss. it takes discipline and motivation, which is why it is so hard for a lot of people, myself included. but if you keep making excuses by bringing in your other conditions, then you are for sure going to lose the battle. you need to change your attitude and lose those crutches. it does you no good to tout them as the cause of your weight problem. exercise and diet is the answer.

      September 6, 2010 at 16:55 | Report abuse |
    • Kat

      You are absolutely correct that any one treatment in isolation will ultimately fail. You must have a background in medicine.

      September 6, 2010 at 17:17 | Report abuse |
    • Anna

      PCOS is not the same as PTSD... PCOS is a hereditary condition that causes infertility, hirsutism, and obesity via insulin resistance. SAD is a physiological condition that causes hibernation-type symptoms as daylight becomes more scarce: feelings of extreme hunger/munchies, sleepiness, and a desire to hole up at home. In spring the symptoms begin to disappear.

      Of course weight is a result of eating more calories than I burn. However, knowing how much I need to eat is far from an exact science. Our bodies are designed to use hunger and fullness as signs that we either need more food or need less food. Those signals are out of whack in my body, leaving me without the simple instinct most other people have and resulting in overeating. Eating too little can actually send the body into starvation mode, making weight loss even more difficult. Why tell a person to fight their instincts when we have medical procedures and medicines that can restore them to balance? That's like telling a person they can straighten crooked teeth gradually with their tongue.

      Only 3% of people who try to lose weight with diet and exercise alone succeed and are able to keep it off. People who are morbidly obese NEED permanent, effective treatments if they want to live a full natural lifespan and actually enjoy the benefits of good health. Bariatric surgery alone gives the average person *sustained* loss of 40% or more of their excess weight, and a new treatment called the Endobarrier (a tube covering the first 2 feet of your intestine, currently in Phase III U.S. clinical trials and already approved in Europe) has a similar impact without surgery, and you don't even have to change what you eat for it to work! Interesting, isn't it?

      September 6, 2010 at 21:12 | Report abuse |
    • Jake

      This is the typical response the majority of overweight Americans respond as the cause of their obesity. "It's not my fault, I have blah, blah, blah and blah which make me eat more and burn less calories." The 3% of people who succeed are the ones who are able to change their eating and exercise habits over the long-term. Because we are Americans and demand quick fixes, we are continuing to push for bariatric surgery. That way, people are more likely to be FORCED into losing weight because one can't eat as much. Unfortunately people still manage to eat their weight back even after surgery. Like it was said earlier...you gain weight because your caloric intake>>>>metabolic rate. You need to change that and it may take years to accomplish your goals. Psychotherapy, nutritional education, cognitive behavioral therapy, and lastly medications and surgery can all be a part of someone's weight loss therapy when added to the foundation of Eating Less and Exercising More. We need to provide a better support network for obese patients but I can never support the acceptance of surgery or medications to fix something that still is ultimately fixable through daily choices/decisions.

      September 7, 2010 at 01:13 | Report abuse |
    • Anna

      Jake, nobody is claiming there is no degree of personal responsibility. I am ultimately responsible for the food I put in my body. The problem comes when people make an enemy of medical tools in treating and training ourselves. You should be ashamed for assuming that the unsuccessful ones are the people who don't put enough effort into the process. For many of us, personal effort isn't enough. Medicine is not evil; it is meant to treat and correct things that don't function according to nature. I am on depression medication because I am 'neurologically' depressed, not because I am fat; a SIDE-EFFECT has been an increased sensation of satisfaction (i.e. – body saying I am not hungry), resulting in weight loss. The depression medication has partially healed some part of me that previously forgot to send satisfaction signals. How is that wrong?

      September 7, 2010 at 09:09 | Report abuse |
    • C

      PCOS is caused by obesity, which is caused by being overweight, which then causes insulin resistance, hyperandrongenism, amennorhea, hirsutism, other androgenic side effects, as well as a decreased FSH/LH ratio and cystic ovaries. Depression does not affect your metabolism it affects your eating habits.

      September 7, 2010 at 20:58 | Report abuse |
    • C

      BTW from reading your initial post it sounds like you list off your diagnoses like a laundry/supermarket list, which makes it see as if it is a crutch or excuse. I believe you suffer from depression, but seasonal affective disorder? where do you live alaska? that is probably just a facet of your MDD and your binge eating is a response to your MDD is it really a disorder? Do all these disorders help justify your weight?

      The treatment/cure to PCOS is losing weight (or clomiphene to induce ovulation). I bet your seasonal affective and binge eating disorder would also improve with weight loss. MDD is also treatable and curable, so rather than defy yourself with diagnoses x 10 conquer 1 at a time. BTW the majority of this country is overweight and "stressed" so I cant really say there's anything unique about your situation.

      September 7, 2010 at 21:30 | Report abuse |
  7. IMO

    Yes, this article was poorly written because it does seem to contradict itself about how endorphins may help prevent obesity, but taking an endorphin-blocking supplement resulted in greater weight loss. The answer is this: endorphins in and of themselves do not affect weight gain or loss. Rather, it's our addiction to the feeling that endorphins produce that cause weight loss/gain. Avid runners enjoy running often because doing so releases endorphins, which make the runner feel good (the runner's high), and of course, running a lot will result in reduced fat/lower weight. Overeaters enjoy eating a lot because eating also releases endorphins, which make the eater feel good, and of course, eating a lot will result in increased fat/higher weight.

    In both cases, while it may be the activity itself (running or eating), that causes weight loss/gain, it's the endorphin rush one gets from engaging in those activities that causes the desire to engage repeatedly in the activity. In this study, the subjects probably weren't avid runners, but rather overeaters, so that when they were given something to block the endorphin rush they feel after eating, it took away much of the reason for overeating, which caused them not to want to overeat, and so that group lost weight.

    My suspicion is that if you did a study on a bunch of avid runners in the same way (where you gave one group placebos and the other group an endorphin blocker), the group given the endorphin blocker would probably not run as much, and consequently would gain more weight relative to the control group.

    September 6, 2010 at 12:41 | Report abuse | Reply
    • Anna

      Excellent logic!

      September 6, 2010 at 13:03 | Report abuse |
    • Khru

      Bravo! YOU should have written the article.

      September 6, 2010 at 13:42 | Report abuse |
  8. Joseph Sroka

    Great explanation, IMO. I did not know that eating could produce a "runner's high". 🙂 And a razzberry to the author of the article.

    September 6, 2010 at 12:57 | Report abuse | Reply
  9. Catharin

    "Nevertheless, despite my ongoing discussions about five servings of fruits and vegetables, avoiding soda and fast food, etc, I’ve come to accept that other “treatments” have a role in treatment for at least some patients."
    Sounds like someone is being leaned on by pharmas who would rather sell pills than healthy lifestyles. Fight the good fight, doctor! Make common sense win!

    September 6, 2010 at 16:33 | Report abuse | Reply
  10. Kat

    As someone who has long had a weight problem (10-40 pounds), while I have experienced the release of endorphins, thank God, by running inside my home in an attempt to eradicate or dull severe and excruciating fibromyalgia and RA pain, I have never experienced a similar "feeling" after eating, whether it was a peach, a spinach salad or Ben & Jerry's. I did have success in quitting smoking several years ago (about 15, I think) not by using buproprion but an anti-anxiety medication called buspar in combination with a "mass hypnosis" seminar and nicotine gum, which was then available only by prescription, was not covered by my insurance and resulted in an "addiction" to chewing gum, in the past several years to Wrigley's Extra gum, Polar Ice®. While I think IMO's explanation is superb, I still don't comprehend how using an endorphin blocker would help achieve weight loss ... I would think that since we are, as humans, "addicted" to endorphins, then the lack of endorphins would result in depression and other ill effects.

    September 6, 2010 at 17:12 | Report abuse | Reply
  11. C.V. Compton Shaw

    My personal experience has been that individuals with substance abuse problems, in general, DO NOT exercise appropriately such as to produce those endorphins associated with exercise. These individuals, also, often have psychiatric diagnoses such as depression. Therefore, an endorphin blocking agent with an antidepressant might, intuitively, address psychiatric problems associated with obesity in some individuals thus ameliorating obesity. However, the utilization of these medications, as other responders have noted, as a biochemical means to reduce obesity appears to be counter intuitive. Thus, the actual biochemical pathways that this combination of medications utilizes to reduce obesity should be elucidated before they conclusively related, biochemically, rather than psychiatrically to obesity reduction.

    September 7, 2010 at 06:07 | Report abuse | Reply
  12. neilred

    While looking for inspiration, I came across an excellent website that I have since become a member of which provides endless tips, advice and dietary information on weight loss, most of which I hadn't seen or heard of before. It really is good. The address is http://www.weight-loss-secrets-now.com . Definitely worth a look

    September 7, 2010 at 18:49 | Report abuse | Reply
  13. Rabbi Morey Huckleman//Great Neck New York

    Fat people are human too.

    Gay people should try some self Regulation and Control.

    September 19, 2010 at 16:25 | Report abuse | Reply
  14. Jerry Jay Berkman of Short Hills

    Self Regulation is about a good self image.

    FATTY"S should gain some self respect.

    September 19, 2010 at 16:40 | Report abuse | Reply
  15. Travis Contino

    Are you saying all Fat People have no sense of Control?

    September 19, 2010 at 16:40 | Report abuse | Reply
  16. Travis Contino

    Gay people are going against the Bible and should seek and ask for Help.

    September 19, 2010 at 16:41 | Report abuse | Reply
  17. Arthur Big Big Belly Pellulo Sr.

    I am working to regain my figure.

    September 19, 2010 at 16:42 | Report abuse | Reply
  18. Rabbi Morey Huckleman//Great Neck New York

    We must have a crusade to become physically fit.

    We need people with the courage of DADDY CLAUSS.

    September 25, 2010 at 20:55 | Report abuse | Reply
  19. Morris Wilensky//Jenkintown Pa.

    Matt Damon was my idol.

    September 25, 2010 at 20:56 | Report abuse | Reply
  20. Richard Toben //Jenkintown Pa.

    Matt Damon is way Kool!

    September 25, 2010 at 20:56 | Report abuse | Reply
  21. Sallie Contino //Utah

    Self regulation is key to happiness.

    September 25, 2010 at 20:57 | Report abuse | Reply
  22. Charles Koritan

    Where is Rabbi Huckleman

    October 3, 2010 at 14:54 | Report abuse | Reply
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    Dad Clauss is a big loser!

    October 3, 2010 at 14:54 | Report abuse | Reply
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