The concept of "food addiction" has become increasingly prevalent in modern society, yet it remains a highly debated and often misunderstood topic. While the term suggests a parallel between substance dependence and compulsive eating behaviors, the scientific community is still working to define and validate it as a distinct clinical diagnosis. This article aims to explore the current understanding of food addiction, examining the evidence, controversies, and potential paths to recovery.
Defining "Food Addiction": A Complex Landscape
The term "addiction" is commonly used today, even though there is no agreement on a clear clinical definition. Various health organizations offer their own definitions, highlighting different aspects of addiction.
- Addiction is "a chronic disorder with biological, psychological, social and environmental factors influencing its development and maintenance." Genes can influence how rewarding a substance or behavior feels and how the body processes substances.
- The American Society of Addiction Medicine (ASAM) defines addiction as "a primary, chronic disease of brain reward, motivation, memory and related circuitry." Dysfunction in these circuits leads to seeking reward and/or relief through substance use and other behaviors. It is characterized by an inability to consistently abstain, impaired behavioral control, craving, diminished recognition of problems, and dysfunctional emotional responses.
- The American Psychiatric Association (APA) describes addiction as "a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence." People with addiction have an intense focus on using a substance, even when it causes problems.
These definitions emphasize the multifaceted nature of addiction, encompassing biological, psychological, and social factors.
Behavioral vs. Substance-Related Addictions
Research has revealed similarities between behavioral and substance addictions. Behavioral addictions involve dependence on a behavior or feeling, while substance addictions involve dependence on a substance. Studies have shown that both types of addictions share common features such as changes in brain chemistry, impaired control, neglect of relationships, and continued problematic behavior despite negative consequences.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) has introduced a new diagnostic category called Non-Substance-Related Disorders, which currently includes gambling disorder. Other behaviors, such as compulsive overeating, problematic sexual behavior, and excessive Internet gaming, were considered but ultimately excluded due to insufficient evidence.
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The Food Addiction Debate
Despite the exclusion of compulsive overeating from the DSM-5's Non-Substance-Related Disorders category, the discussion about the addictive potential of food continues. Organizations like ASAM include "food addiction" in their list of possible addictive disorders. Studies have observed biological and behavioral similarities between drug use and overeating, such as altered dopamine expression, cravings, and relapse to highly palatable food.
Highly palatable foods often contain unnatural substances or higher-than-normal levels of natural substances that your body and brain can't process.
However, inconsistencies exist in the definition and measurement of food addiction. Various approaches are used, including self-report questionnaires, patient self-identification, and the Yale Food Addiction Scale (YFAS). The YFAS is currently the best available measure for evaluating food addiction based on modified DSM criteria for substance use disorders.
It's important to note that food addiction is not the same as obesity or binge eating, although these constructs can be related. While some individuals with obesity may exhibit neurological and behavioral similarities to individuals addicted to drugs, only a percentage of overweight/obese individuals report clinically significant symptoms of food addiction. Similarly, while food addiction symptoms are associated with binge eating behavior, only a percentage of individuals with binge eating disorder report clinically significant food addiction symptoms.
Arguments Against Food Addiction
- Food is necessary for survival, so it cannot be addictive.
- There is a lack of a clear clinical definition.
- There is not enough research or clinical trials to draw conclusions.
- Studies haven't found that humans behave the same way as rodents in animal studies.
Arguments For Food Addiction
- There are biological, behavioral, and psychological similarities between compulsive consumption of highly palatable foods and use of addictive drugs.
- Consuming “highly palatable” foods triggers the pleasure centers of the brain and releases “feel-good” chemicals such as dopamine and serotonin.
- There is significant overlap between animal and human models of food addiction to characteristics of substance use disorder.
Characteristics of Addiction in Relation to Food
Research suggests that food addiction shares several characteristics with other substance use disorders, including:
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- Brain reward dysfunction: Studies have shown that certain foods, particularly those high in fat and sugar, can alter brain activity in a way that is similar to drugs of abuse. Sharma, Fernandes, and Fulton [46] showed that rats placed on a 12-week high-fat diet of primarily hydrogenated coconut oil, maltodextrin, sucrose, and casein had significantly higher ∆FosB, dopamine D2 receptor, and brain-derived neurotrophic factor expression, and lower dopamine D1 receptor expression, in the NAc. These changes were observed before the onset of obesity and were linked to behaviors suggestive of anhedonia. The authors concluded that the brain changes may have put the animals at greater risk for addictive-like symptoms.
- Preoccupation: Individuals with food addiction may spend a significant amount of time thinking about food, planning their next meal, or feeling guilty about what they have eaten.
- Impaired control: This involves a loss of control over eating behaviors, such as eating larger amounts of food than intended or feeling unable to stop eating even when full.
- Risky use: This refers to continuing to eat certain foods despite knowing that they are harmful to one's health.
- Tolerance/withdrawal: Some individuals may experience a decreased response to certain foods over time, requiring them to eat more to achieve the same level of satisfaction. They may also experience withdrawal symptoms, such as irritability or cravings, when they stop eating certain foods.
- Social impairment: Food addiction can negatively impact relationships and social life, as individuals may isolate themselves to eat or avoid social situations where certain foods are present.
- Chronicity: Food addiction is often a chronic condition that can persist over time, with periods of relapse and remission.
- Relapse: Even after successful treatment, individuals with food addiction are at risk of relapsing, especially when exposed to triggers or stressful situations.
Factors Contributing to Food Addiction
Several factors can contribute to the development of food addiction, including:
- Genetics: Studies show that there are genes that put people at a higher-than-average risk of developing any type of addiction.
- Upbringing: The eating behaviors and attitudes we’re taught can significantly affect a person’s risk factors for developing food addiction.
- Exposure to highly palatable foods: Overexposure to highly palatable foods can increase your risk of developing a food addiction-and people who are overexposed at a young age are at an even higher risk. Highly palatable foods include highly processed food products containing large amounts of sugar, fat, and salt.
- Dietary restriction: A history of dieting can intensify cravings and a drive to eat, mimicking signs of what’s labeled as food addiction.
- Food insecurity: Emerging studies reveal a compelling link between food insecurity and an increased risk of problematic eating behaviors, particularly food addiction and binge eating disorders.
- Emotional and psychological factors: When clients have not yet developed adequate emotional coping or regulating tools, and only go to food to self-soothe and manage hard feelings, they seem more prone to feeling like they are addicted to food.
The Role of Restriction and "Food Noise"
“A history of dieting can intensify cravings and a drive to eat, mimicking signs of what’s labeled as food addiction,” says dietitian Kristin Draayer, MS, RDN. That’s exactly what happened to the rodents in the study referenced above: they only displayed “addictive” behaviors when given intermittent access to sugar. “When given free access to sugar alongside adequate access to food and water, the rodents did not binge, suggesting that it's the deprivation, not the sugar itself, that triggers this response,” Draayer explains. There's also the famous Minnesota Starvation Experiment, in which healthy young males put on a severely calorie-restricted diet became obsessed with food (experiencing what would be referred to today as "food noise")-and then, when given free access to food again, many engaged in extreme overeating.
Subsequent studies on humans also show that intermittent fasting or other types of caloric restriction-particularly of “forbidden foods” high in fat and sugar-causes some people to develop binge eating behaviors.
Prevalence and Impact
The prevalence of food addiction is escalating globally, becoming a significant public health issue. Food addiction is closely linked to eating disorders such as bulimia nervosa and binge eating disorder, suggesting it may be a unique condition within the spectrum of eating behaviors.
Globally, food addiction affects approximately 20% of people. Women are more than twice as likely to develop food addiction compared to men. Food addiction is a significant and growing health concern globally, with an average of one in five individuals across various populations affected. This issue spans all age groups and contributes to a considerable economic impact, largely due to productivity losses.
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Eating disorders cost about $64.7 billion annually, with the biggest portion, $48.6 billion, lost in productivity.
Treatment and Recovery
The approach to treating food addiction is multifaceted, emphasizing the importance of addressing both the psychological and nutritional elements of the disorder.
- Individual therapy: Individual therapy, particularly cognitive behavioral therapy (CBT), is considered one of the most effective and well-established treatments for food addiction and related eating disorders. Individual psychotherapy is the most important component of eating disorder treatment, helping individuals develop healthier eating patterns, replace unhealthy habits, create problem-solving skills, and learn healthy coping mechanisms for stress.
- Nutritional counseling: A registered dietitian can help individuals develop a healthy eating plan that meets their nutritional needs without triggering cravings or promoting restrictive eating behaviors.
- Support groups: Support groups can provide a sense of community and understanding, as well as practical tips for managing food addiction.
- Medication: In some cases, medication may be used to treat underlying conditions such as depression or anxiety, which can contribute to food addiction.
Strategies for Overcoming Food Addiction
- Detoxify your body: You’ll need to detoxify your body by avoiding trigger foods, such as fast food or foods with processed sugar.
- Change your eating behaviors: You may need to avoid certain people, places (such as restaurants), situations and foods that intensify cravings or make you more likely to consume the problem food. Although some people can gradually reintroduce small amounts of problem foods into their diets, other people must avoid them indefinitely to maintain control over their food addiction.
- Diversify your coping tools: With the help of a therapist or trusted friend, you can identify what food symbolizes for you when you’re eating without physical hunger and feeling out of control, and then brainstorm ways to meet your underlying emotional needs.
- Work toward eating adequate meals and snacks: Since restriction is often what’s driving feelings of food addiction and lack of control around food, it’s key to eat enough.
- Learn about food habituation: When it comes to foods that feel addicting, the more you casually expose yourself to them (instead of swearing them off), the less emotionally charged your experience becomes-cookies are just cookies, pizza is just pizza, and chips are just chips.
Why Food Addiction Treatment Based on Abstinence Fails
Despite the availability of so-called food addiction treatment programs, there's no research to support these treatments. Worse, some of these approaches are based on substance abuse treatment protocols, where abstinence is often a necessary goal for healing and health. However, if we treat food or certain foods like a drug and try to avoid them at all costs, it not only makes it challenging to get the nutrients your body needs to function, it also makes it basically impossible to develop a healthy, positive relationship with food.
“Avoiding certain foods reinforces your belief that you can't handle them, and this thought gets wired into your brain's neural pathways,” Draayer says. “This creates a self-perpetuating cycle: You might think you're preventing out-of-control eating by staying away, but you're actually reinforcing the idea that you can't trust yourself around that food.” In other words, the rules you make to curb your “addiction” become a self-fulfilling prophecy.
The core flaw: food isn't a drug.
Is Relapse Possible?
Yes, it is possible to relapse from food addiction. Just like other forms of addiction, food addiction can be overcome, but the risk of relapse is always present. According to a study published in the journal Appetite, individuals with food addiction who have successfully recovered are more likely to relapse if they encounter triggers or stressful situations. These triggers could be emotional, environmental, or social factors that drive them to engage in compulsive eating behaviors again.