Reconceptualization of eating addiction and obesity as displacement behavior and a possible treatment.

PURPOSE: Displacement behavior is a biobehavioral mechanism that allows an animal to deal with situations that cannot readily be faced nor avoided, or that are thwarting. It may explain compulsive overeating (eating addiction). Resembling addiction, displacement behavior is irrepressible behavior that is contextually inappropriate, e.g., sleeping or feeding when threatened by a predator, or binge eating in response to a work altercation. It is thought to be due to rechanneling of overflow brain energy to another drive (e.g., feeding drive) when two drives, e.g., fight or flight, equally oppose each other. Moving the opposing drives out of equilibrium, by resolving the person's underlying problems/stressful situations, theoretically should mitigate the displacement mechanism and addictive overeating.

METHODS: We developed a mobile phone intervention targeting addictive overeating, including a displacement mechanism component. A displacement use subgroup (N = 37) ages 14-18 with obesity (mean BMI = 38.1) identified life situations they could neither face nor avoid, or that were thwarting them, and developed action plans to address each situation. Feasibility and acceptability were evaluated.

RESULTS: Participants found the displacement component to be understandable and user-friendly. The majority (26/37-70%) used the core "Dread List" feature to input 90 individual dreaded/problem situations fueling displacement-based overeating, coupled with action plans to address each problem. Dread items related to school accounted for nearly one-half (46%: 41/90) of all dread situations reported by participants.

CONCLUSION: The displacement mechanism may be a useful basis for treatment of eating addiction and obesity and may provide individuals with hope that they can curb their addiction without relying on willpower to not overeat. A randomized trial evaluating the displacement intervention is planned.

LEVEL OF EVIDENCE: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

REGISTRATION: The study was reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement and was registered with ClinicalTrials.gov (NCT03500835) April 18, 2018.