Is Severe Obesity a Form of Addiction?: Rationale, Clinical Approach, and Controlled Clinical Trial GIUSEPPE RIVA, Ph.D., 1,3 MONICA BACCHETTA, Ph.D., 2,4 GIANLUCA CESA, M.S., 2,4 SARA CONTI, M.S., 2,4 GIANLUCA CASTELNUOVO, Ph.D., 3,4 FABRIZIA MANTOVANI, Ph.D., 1,3 and ENRICO MOLINARI, Ph.D. 3,4 ABSTRACT For many, obesity is just a problem of energy input and expenditure: more energy input than expenditure. However, the clinical practice and epidemiological data clearly show that weight control is more complex than expected by this simple equation. This is particularly true in morbid obesity, a form of severe obesity in which a person’s Body Mass Index (BMI, kg/m 2 ) is over 40. If we compare the definitions and diagnostic criteria for “dependence” and “addiction” with the situation of many severe obese subjects, it is apparent that they match very well. Further, different neurological studies confirm this similarity: both addiction and obesity patients have a deficiency of dopamine receptors. Nevertheless, when we compare many of the actual obesity treatments with the ones used in the area of addictions it is possi- ble to find relevant differences: obesity treatments neither consider different levels of type and intensity of care, nor a multidimensional approach. To overcome these limitations, in this paper we propose a bio-psychosocial approach—Experiential Cognitive Therapy—in which the genetic influence (lack of dopamine receptors) is matched by psychosocial issues (pres- sure for thinness and diet as main body image dissatisfaction treatment). Further, the paper outlines how this approach may influence the treatment options, by focusing both on the lessons coming from actual addiction treatment and the opportunities offered by virtual real- ity. Finally, the paper presents and discusses the outcome of a controlled trial, based on the proposed approach, including a 6-month follow-up (211 morbid obese females with a BMI of >40 and a documented history of failures). 457 CYBERPSYCHOLOGY & BEHAVIOR Volume 9, Number 4, 2006 © Mary Ann Liebert, Inc. INTRODUCTION F OR MANY , obesity is just a problem of energy input and expenditure: more energy input than expenditure. However, the clinical practice and epidemiological data clearly show that weight con- trol is more complex than expected by this simple equation. Between 2000 and 2001, obesity preva- lence climbed from 19.8% of American adults to 20.9% of American adults. Currently, more than 44 million Americans are considered obese by BMI index; that is, have a Body Mass Index (kg/m 2 ) greater than or equal to 30. This reflects an increase of 74% since 1991. 1 This is also true for severe forms of obesity in- cluding morbid obesity: a form of severe obesity in which a person’s BMI is over 40. According to Fle- gal et al., 2 morbid obesity increased significantly Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano, 1 Milan and 2 Verbania, Italy. 3 Department of Psychology, Catholic University of Milan, Milan, Italy. 4 Laboratorio Sperimentale di Ricerche Psicologiche, Istituto Auxologico Italiano, Verbania, Italy. 14300c11.pgs 7/11/06 9:30 AM Page 457