All of a sudden, you need pizza. A thick, dripping-with-cheese-and-sausage slice. Or you have spent the afternoon at the office, but thinking about nothing but chocolate. A fine piece that you would eat undistracted, savoring every bite. You'd take that first bite, let the filling ooze out, and enjoy the chocolatey texture on your tongue as long as possible.
Everyone has cravings, but some people deal with them better than others. Recently, researchers have taken a closer look at cravings, and they are finding that yes, they do play a role in whether your weight will be at a healthy level or out of control.
"Control of body weight now appears to be due to both the physiologic control of hunger through the hypothalamus and the control of craving through the reward system," says Frank Greenway, MD, professor and chief medical officer at the Pennington Biomedical Research Center, Baton Rouge, LA. He recently presented a roundup of research on cravings, including his own research, at the Obesity Medicine 2017 Spring Obesity Summit in Seattle.1
What Dr. Greenway and other researchers are learning about cravings may not keep you from ever gobbling down a slice of greasy pizza or a fine piece of chocolate, but that's not the point. Learning how the cravings affect your weight and how to tame them—yes, it's possible—may help keep your weight healthy—and, by extension, your blood sugar under control.
''Certainly there are some people in which cravings play a role in their inability to stay on a diet," Greenway says. "I think we are just now recognizing it is playing a role [in obesity]. It looks to me like it is significant."
"Cravings are certainly associated with weight gain and overweight," agrees Marney White, PhD, MS, associate professor of chronic disease epidemiology and psychiatry at Yale University School of Public Health, who has also researched the topic.
All cravings are not created equal."There seems to be a gender difference," Dr. Greenway says. Women tend to experience cravings more than men do, he says, in general, and that may be due to women's fluctuating hormone levels, especially for those who still have monthly menstrual cycles.
Men and women tend to crave different types of foods. Women often crave sweets, including chocolates, he says. Men go for foods laden with fat and protein, such as sausages, pizza and steak, Dr. Greenway says. Younger people tend to crave foods more than do older people, Dr. Greenway says. By the 60's, cravings tend to subside, he says.
Cravings also differ by geographic regions and cultures, Dr. White has noticed. For instance, she says, ''people in the south, such as Louisiana, do crave red beans and rice, cornbread and gravy." In the Northeast, it's often bagels and sushi.
And the danger zone as far as time of day? "People crave most in the early evening," Dr. Greenway says.
It sounds counter-intuitive, but the fewer calories you eat, the fewer your cravings. In a study that compared people on a 1,200-calorie diet with those on a very low-calorie diet of 420 calories (medically supervised), those on the very low-calorie plan had fewer cravings.2
Obesity surgery has been shown to reduce cravings, Dr. Greenway says.1 A number of medications and medication combinations has also been shown to reduce cravings, Dr. Greenway says. Among the studies:
Liraglutide (Saxenda, Victoza), approved for weight loss and diabetes, appears to reduce the activity of the reward system involved in cravings, according to one study.3
Naltrexone (Evzio) and bupropion (Wellbutrin), when combined, appear to act together on the reward system, according to research by Dr. Greenway's team.4 While bupropion is used to help people stop smoking, naltrexone helps people with alcohol or opioid dependence. Since both drugs treat addictive conditions, he says, the combination might work even better together to reduce cravings.1
Phentermine (Adipex-P, Fastin, others) is an appetite suppressant. In one study, those with obesity who added phentermine to their liquid meal replacement diet reduced their craving for fats and sweets much more than those on the liquid meal replacement who did not. The phentermine group also lost more weight—12% of body weight compared to 8.8% average in the placebo group over 12 weeks.5
Phentermine plus lorcaserin (Belviq), the weight loss medicine, help reduce cravings when used together, as Dr. Greenway reported at an Obesity Society meeting in 2015. 6
Transcranial Magnetic Stimulation also reduces craving, according to other research. It is a noninvasive procedure using magnetic fields to stimulate nerve cells; it is only approved for major depression in the U.S. In one study, those who received the stimulation for 20 minutes a session for 5 days, compared to those who got the sham treatment, reported fewer cravings for sweet and fast food and, to a lesser extent, fatty food, for the next 30 days.7
Anti-Craving Strategy. In working with people, Dr. White has some anecdotal observations about cravings. If you are ravenously hungry and give in to a specific craving you have immediately, you may well be reinforcing the craving for that food, she says. "People crave the kind of food they eat most often when they are hungry," she says.
Instead, she suggests reaching for another food first—in a perfect world, it would be a balanced meal—and then cave in to the craving. "If someone wants to have chocolate, cake, a brownie, have them," she says. "But make sure you eat it after a full, balanced meal." That just may lessen the power of that craving over time, she says.
Dr. White reports no disclosures. Dr. Greenway is a consultant for Eisai (lorcaserin-Belviq) and an advisory board member for Novo Nordisk (liraglutide-Victoza, Saxenda).