Susan Peirce Thompson started doing drugs when she was 14. As she explains it, “I had a weight problem in my head” at that point, but it wasn’t huge. She gravitated toward drugs because it helped her manage her eating habits.

“And also, I liked the stimulation,” she says. “They made me feel really good. I was a rule-breaker, but they escalated out of control very quickly. Even though I was a good student early in grade school, I ended up going to three different high schools and ultimately dropping out.

“By the time I was 19, I was a high school dropout, a crack addict and a prostitute and didn’t have a key to a place that I lived. I was just crashing here and there in San Francisco where I was.

“Then I got clean and sober. Really, struck clean and sober out of the blue. I got taken to a 12-step meeting on a first date with some random guy that I’d met at a gas station at three in the morning. It was quite a coincidence because I’d hit bottom spiritually and emotionally that very morning in the crack house. I walked out the door and didn’t know where to go.

Dr Susan Peirce Thompson

Susan Peirce Thompson, PhD, is an accomplished neuroscientist who spent part of her earlier career teaching in Australia. She is a former Adjunct Associate Professor of Brain and Cognitive Sciences at the University of Rochester, a business entrepreneur and an author. She founded Bright Line Eating Solutions, a weight loss and weight sustainability company.

“I happened to have a date that night, and this guy took me to a meeting (Alcoholics Anonymous), and I haven’t had a drink or a drug since. That was August 9th of 1994. It’s been well over two decades. I’m 46 now; I was 20 then.

“After that, I knocked on weight, and it’s interesting because food addiction is something that you can kind of function with. I was able to use food addictively and graduate from U.C. Berkley with highest honours and speak at the graduation. Then, I dove into studying the brain. I got fascinated with, like, how does a brain like mine just go so far off the rails?

“I never intended to get that bad; it just felt like a creeping non-choice. It was just this thing that happened, and suddenly I was where I was. So, my education continued, and I ended up ultimately as a psychology professor with a PhD in brain and cognitive sciences. Then I taught for many years until this Bright Line Eating thing took over my life a few years ago.”

In spite of her past, or perhaps because of it, Dr Peirce Thompson says food is the hardest addiction to overcome.

“There’s a lot of reasons why food is the hardest. Assuming that food addiction is real (it’s something that is controversial to a lot of folks which blows my mind a little bit) but assuming we can agree that food addiction is real, it’s harder than heroin and crack cocaine and crystal meth to beat because, on the one hand, it’s up there in the strength of addiction itself. We have good data on that in humans and rodents. They have different ways in the addiction sciences to measure the strength of an addiction.

“Sugar, for example, is an extremely strong addiction. Rats that are pre-addicted to intravenous shots of cocaine and become hooked (like they’ve been shooting them up with cocaine over and over again until they’re quivering cocaine addicts), if you take their cocaine away but give them a choice of cocaine or sugar, then, in that context, they’ll prefer sugar, even though they’re hooked on cocaine and need a hit physiologically.”

No place to eat

She says there is no place you can eat and not be exposed to the problem.

“What happens is that ques in the environment trigger you to want it again. That’s how the craving system works. One thing that’s different to addicts compared to non-addicts is that addicts have brains that are extra sensitive to the cues.

“The problems with food cues are that they’re everywhere. You can’t get home from work without being barraged by logos and billboards with dripping, melting cheese coming at your face. You are not cued to smoke crack on the way home from work, and you are not cued to shoot heroin in a business meeting at 10 am, but the plate of pastry goes around, and there’s a coffee with cream and sugar; right there, right?

“When you overeat, you get a weight problem, right? But the weight problem is ancillary. It’s got nothing to do with the food addiction; it’s like a side effect.

“Imagine if you drank alcohol, and it gave you really bad acne. That’s something you don’t want sticking around, it doesn’t look good from your perspective, and you want it gone. But it’s a separate thing. But when you stop eating addictively, you’ve still got the weight, you’ve still got the acne, let’s say. And let’s say it’s deadly acne; it’s going to kill you years before your time.

“But then, imagine that treating the acne created cravings to drink – overpowering, evolutionary, wired-in cravings to go back to the alcohol which is going to make more acne.

“That’s the situation we’re in with food. It creates this weight problem, and the trouble is your brain adapts to whatever your higher weight is. It doesn’t want you to lose that weight. It has built-in mechanisms to cue you to eat more as soon as you start to pull off that weight.

“It does things like increase ghrelin, the hunger hormone. It decreases leptin, the satiety hormone. It slows down your thyroid, so your metabolism stops functioning as well. It cues you hormonally to be driven to go back to eating excessively to drive your weight back to where it was. So, now you’re trying to treat the weight problem that you got from the food problem. It’s a maddening, confounding trap to be stuck in.

The problem with sugar

Returning to the problem with sugar, Dr Peirce Thompson says sugar is more addictive than cigarettes.

“If you look at those ways that scientists measure addictive strength, sugar is more addictive than nicotine by a fair bit.”

She says sugar hijacks the brain’s dopamine system in the same way as addictive drugs like cocaine and heroin.

“It doesn’t just release the dopamine and activate those centres like in the nucleus accumbens and the other reward/pleasure centres of the brain, but it blows them out. It causes them to downregulate, which means the receptors become less numerous, less responsive, thinner. What that means is that you are left in a depleted, kind of itchy, uncomfortable, dis-eased, disquieted state in-between times. Now you don’t have enough baseline dopamine on board to just feel ok anymore unless you go get some sugar or flour. Flour does it too.

“The brains of people who have been hooked on food look just like the brains of people who are hooked on heroin and cocaine.”

Science has found that the tongue and our taste buds have a direct connection to the addiction centres in the human brain and our taste buds regenerate every two weeks. Because of this, our sense of taste can be recalibrated if we stop eating foods that are addictive.

“This is why I recommend that people don’t eat stevia if they are trying to quit sugar because its just that sweet taste, in itself, that can be problematic.”

On a wider, societal basis, she says the social impact and people’s attitudes to obese people were shocking and unacceptable. Sometimes, she even wonders if we’ve lost our ability to empathise.

“In an anonymous survey, over 90 per cent of healthcare providers agreed to statements like obese people are lazy, obese people are stupid. And formerly obese people who have now lost a bunch of weight on surveys will say they’d rather accept blindness, deafness, leg amputation than go back to being obese. Research like this makes it clear how incredibly difficult it is to carry excess weight in this society.

“I have three daughters, so this stuff is super present for me. My daughters are pre-teens, and my hunch is that there are positive changes happening in our societal perception of body size. However, I also think some of those changes are problematic and worry me. But the parts that go along with reduced stigma, more compassion and acceptance, less discrimination, less prejudice, I’m so relieved about because being overweight in our society has been so hard for so long.

“I think it’s disproportionate for women. I think the societal standard has been for a long time that a woman isn’t successful, shouldn’t feel good about herself if she is carrying excess weight, and I think that is horrible. It’s gotta change.

When asked how she relates to the idea of health at any size, she says the subject of weight has become such a nuanced topic, “and if I’m honest in terms of feelings, I have some feelings of anger. I think the data are very strong that every excess pound we carry confers health risk.”

She referred to a study that examined the relationship between body size, activity level, and cardiovascular health in over 500,000 people, and the results were surprising.

“They showed that no matter how much someone exercises, if they are obese, they have a higher risk of poor heart health than someone who is not overweight, even if that person is completely sedentary.

“The study author was quite blunt. He said one could not be fat but healthy. Full stop. I’m reminded of the notion called the obesity paradox. It’s a term that was thrown around several years ago. It’s been debunked, but I think it was the wind in the sales of the health at any size movement, and I don’t know that they’ve updated their scientific schemas and the information that they disseminated to people.

“Very briefly, the obesity paradox was that a set of studies showed that, mysteriously, people that carried a little bit of extra weight tended to live longer. It looked like having some fat on you could be a really good thing. Similarly, there were data that losing weight were correlated with increased odds of death.

“They said, don’t try to lose weight, carry your extra weight, be proud, exercise, you’re fine. But someone ran the numbers again and took out all the people who were fatally ill. If you remove the data because people are losing weight unintentionally because they’re ill, what emerges is the true pattern, which is that if you don’t have a fatal diagnosis, every pound of weight you carry that is excess confers additional risk of all-cause mortality. Trying to lose weight intentionally is a very good thing. You want to get that excess weight off.

“Turning to the pandemic and its connection to weight and all-cause mortality (see Newsbite article) Dr Peirce Thompson says it’s the first connection she’s seen to a direct link with obesity.

“Obesity is a direct risk factor for death from Covid-19 – not obesity is problematic because then your lungs are likely to be this, that or the other or you’re likely to have a high this marker or that marker or something else. Even if you are not suffering from anything else, just that, at this moment, you are obese, then that is enough to be more likely to die from Covid.

No rally

“But for the last year there’s been no rallying cry. Now the writing is on the wall. The gig is up. It’s really time to get healthy. Let’s band together and do what we can for each other and our own health and support each other in finally making the dietary changes we know that we have needed to make for a long time.

“Why aren’t we saying it’s time to put major taxes on candy bars and soda. It’s time to not allow advertising of sugar serials to kids in the same way we don’t allow advertising of cigarettes to kids. It’s time to change what is allowed in vending machines in schools. So, are we highlighting what is going on with our obesity pandemic? I don’t see evidence of that.”

For those trying to deal with weight issues, Dr Peirce Thompson has every ounce of empathy, however. She struggled with weight issues for many years.

“It is the hardest thing to be addicted to foods or to feel cravings or compulsion. There is hope, but you have to be rigorous about it. The research that showed that diets don’t work was not done in any way, shape or form using the approaches that I use – approaches that work with the brain in a whole different way. There is a way to lose your excess weight and keep it off.”

In reference to her own Bright Line programme, she says they have seen remarkable change when it comes to dealing with craving.

“What we see is that at the end of just eight weeks, people in our Bright Line Eating boot camp are experiencing little to no cravings, ever. That’s data clocked on thousands of people.  We see it on the clinical side, but I don’t have the brain imaging smoking gun for you yet.”

For those that use food to suppress feelings, there is an answer too.

“The amazing thing is when you stop using food to suppress your feelings, the feelings still come up and need to be dealt with, but not all at once. The magical thing is called one day at a time, one feeling at a time. What happens is people who really commit to a Bright Line approach typically are afraid that they are going to be overwhelmed with the enormity of not using food as a crutch.

“But one challenging situation at a time, one craving at a time, one urge, one fit of anger at a time, little by little they are able to find a different way of coping with their feelings. We focus on that a lot in my programme. I recommend that anyone who decides to change the way they eat put a lot of thought and attention into that.

“What are my substitutions, where is my support coming from, what am I going to do differently? What am I going to do? I help people to craft an emergency action plan for coping when an emergency rises up.

“We teach people the acronym BFF, which doesn’t stand for best friends forever. It stands for breathe, feel your body, find your feet. It can be that simple, and you realise that you have a lot of skills for handling emotions. You don’t have to eat over that, and you build more and more capacity over time. It becomes a beautiful, upward spiral.”

Stepping over the line

But what happens if you break the rules and step over the line?

“First of all, not everyone breaks their Bright Lines, most people do at some point but we have a lot of people in our community that really just commit; they have a full identity shift just like I’ve been clean and sober for 26 years. People actually do stick with their bright lines.

“But, at that moment when you know, you have broken a bright line, to have support. In psychology, there’s a term called co-regulation, and the idea is that we’re not all in a mess on the same day. So, if you have someone else to lean into, that can be really helpful, and they can remind you of some good adaptive strategies.”

Falling from grace

Falling ‘off the wagon’ has various meanings for different people.

“There are people who want to adopt some bright lines but start off without really a weight problem. For example, someone who wants to give up meat and dairy and they have a piece of cheese or whatever; it’s not life-shattering. Then you have the person who just lost 250lbs and has been immaculate with their food plan; now they’ve just eaten a piece of pie. Those are different situations. It’s important to recognise that difference.

In my experience, the people that drift from whatever programme they’re trying to follow will gain back their weight. They need to be part of a community because the outside world doesn’t get it.

“There’s no respect for the kind of deference someone gives me when I say I don’t drink champaign because I’m a recovering alcoholic. On New Year’s Eve, they don’t say, oh right, well, I’ll get you some sparkling water.

“People out there don’t get it. So, if you’re not surrounding yourself with people who are not reinforcing your highest best good, then maybe it’s time to make a change.”