The compulsive eating paradigm: can psychedelics help in treating obesity?

Obesity involves behavioral factors that traditional treatments often fail to address. Like addiction, a chronic energy-dense diet can disrupt dopaminergic reward circuits, making individuals habitually responsive to food cues despite negative health outcomes. Psychedelics such as psilocybin and LSD may reduce the top-down influence of maladaptive reward predictions on perception and attention, potentially opening a window of psychological flexibility. This could allow individuals to adopt new cognitive and behavioral strategies through assisted psychotherapy, encouraging beneficial changes in eating behavior. However, new research is needed to assess the potential efficacy of this approach for compulsive eating.

Study at a glance

Abstract

Obesity is a multifactorial disorder involving a behavioural aetiology in subsets of patients that traditional therapeutic approaches have failed to address. Drawing parallels with addiction, the rewarding aspects of a chronic energy-dense diet can compromise dopaminergic reward circuits, eventually causing individuals to become habitually responsive to food-related stimuli despite adverse health consequences. The maladaptive prediction of reward and motivational salience that becomes associated with food-related stimuli can exert top-down influence on perception and attention, promoting compulsive eating behaviour. Emerging research suggests that psychedelics, e.g., psilocybin and LSD, induce non-ordinary mental states where the influence of such behaviours could potentially be reduced and modified. Based on current evidence, mechanisms have been proposed which suggest that psychedelics might relax the top-down influence of high-level predictions encoded within neuronal hierarchies and sensitise them to bottom-up information flow. Additionally, psychedelics are thought to open a window of psychological flexibility, allowing people to potentially become open to new cognitive and behavioural strategies that can be offered via assisted psychotherapy. Therefore, psychedelics-assisted psychotherapy may encourage beneficial changes to eating behaviour, in those with maladaptive eating habits. While promising in theory, new research is needed to assess the potential efficacy of psychedelics-assisted psychotherapy in treating compulsive eating behaviour.