There are a lot of different opinions and viewpoints around the concept of food addiction, some well-informed, others not so much.
Nevertheless, food addiction is a highly controversial topic that is gaining an enormous amount of scientific, media, and public attention.
I will first point out that the scientific literature on food addiction is in its infancy – there is so much more research to be done on this topic before we conclusively endorse or reject this concept.
In this article, I’m going to draw from the latest scientific literature and provide a comprehensive discussion around the idea of food addiction, including the following:
What is Food Addiction?
Research from the addiction and nutrition fields have recently discovered some important similarities in patterns of food intake and consumption of illicit drugs.
This line of work has prompted the notion of food addiction, which refers to the idea that certain foods (typically “junk” foods) may trigger an addictive-like response in some people1Gearhardt AN, Corbin WR, Brownell KD. Preliminary validation of the Yale Food Addiction Scale. Appetite. 2009;52:430-436..
Some have suggested that food addiction is very useful in explaining why some people have so much trouble adhering to a healthier diet, and why some people go onto develop obesity.
So, is food addiction “a thing”?
Let’s take a look at the scientific evidence supporting the concept of food addiction.
Scientific Evidence for Food Addiction
Most of the evidence supporting the concept of food addiction is biological in nature, with some behavioural evidence also available.
Here are some of the key findings from studies that support the notion of food addiction:
- Evidence shows that various processed (“junk”) foods and illicit drugs take advantage of the same neurobiological systems in the brain, namely the dopamine and opiate systems 2Nieto MM, Wilson J, Cupo A, et al. Chronic morphine treatment modulates the extracellular levels of endogenous enkephalins in rat brain structures involved in opiate dependence: a microdialysis study. Journal of Neuroscience. 2002;22(3):1034-1041.. Both systems are responsible for the perceived value of reward from both food and drugs.
- Damage to the dopaminergic system has been shown to reduce the reward value of both sugary-rich foods and illicit drugs3Avena NM, Hoebel BG. A diet promoting sugar dependency causes behavioral cross-sensitization to a low dose of amphetamine. Neuroscience. 2003;122(1):17-20..
- Positron emission tomographic (PET) imaging studies have also shown that both obese individuals and drug dependent individuals (compared to health controls) exhibit a decreased sensitivity of the dopamine-reward system4Wang G-J, Volkow ND, Logan J, et al. Brain dopamine and obesity. The Lancet. 2001;357(9253):354-357..
- Administering an opiate blocker, such as naloxone, has been shown to reduce, to a similar extent, the reinforcement value of alcohol for people with alcohol dependence and sugary foods for people with binge eating disorder5Drewnowski A, Krahn DD, Demitrack MA, et al. Naloxone, an opiate blocker, reduces the consumption of sweet high-fat foods in obese and lean female binge eaters. The American journal of clinical nutrition. 1995;61(6):1206-1212..
- Behavioural evidence for food addiction comes from research showing large similarities in the behavioural and psychological profile of people meeting diagnostic criteria for substance use disorder and people with binge-eating disorder6Gearhardt AN, Corbin WR, Brownell KD. Preliminary validation of the Yale Food Addiction Scale. Appetite. 2009;52:430-436.. These similarities include:
- Loss of control during periods of consumption.
- Repeated failed attempts to reduce or stop the behaviour.
- Continually doing the behaviour despite its negative consequences.
- The behaviour is associated with clinically significant distress and impairment.
- Attempts to hide the behaviour from significant others.
- Consumption is typically triggered by cravings or negative affect.
- Elevated levels of impulsivity.
The Signs and Symptoms of Food Addiction
You might be wondering whether you show signs of food addiction.
According to the available research, there are 12 criteria that underpin a “food addiction” diagnosis7Gearhardt AN, Corbin WR, Brownell K. Development of the Yale Food Addiction Scale Version 2.0. Psychology of Addictive Behaviors. 2016;30:113..
The 12 criteria are taken from the substance-use disorder diagnostic criteria but are assessed in the context of a person’s eating behaviour:
- A substance taken in larger amounts and for longer periods than intended
- Persistent desire or repeated unsuccessful attempts to quit
- Much time/activity to obtain, use, recover
- Important social, occupational, or recreational activities given up or reduced
- Use continues despite knowledge of adverse consequences
- Characteristic withdrawal symptoms; substance taken to relieve withdrawal
- Continued use despite social or interpersonal problems
- Failure to fulfil major role obligation
- Use in physically hazardous situations
- Craving, or a strong desire or urge to use
- Use causes clinically significant impairment or distress
In order to receive a “diagnosis” of food addiction, the person must meet at least two of the above criteria plus show signs that their eating behaviour causes them clinically significant distress and impairment.
If the person exhibits many of the signs and symptoms mentioned above but doesn’t feel like their behaviour is causing them clinically significant impairment or distress, then the person wouldn’t be classified with food addiction.
How Many People have “Food Addiction”?
A recent systematic review examined the total prevalence of food addiction in people all over the world8Pursey K, Stanwell P, Gearhardt A, et al. The prevalence of food addiction as assessed by the Yale Food Addiction Scale: a systematic review. Nutrients. 2014;6(10):4552-4590.. Some interesting findings from this review emerged:
- The global prevalence of food addiction is 19.9%.
- Females (12.2%) had higher rates of food addiction than males (6.4%).
- Overweight/obese people (24.9%) had higher rates of food addiction than normal weight people (11.1%).
- People with an eating disorder had much higher rates of food addiction (57.6%) than people without an eating disorder (16.2%).
Some people think that food addiction is just another term for binge-eating disorder.
The evidence does not support this, because more than 40% of people with binge-eating disorder do not receive a diagnosis of food addiction9Linardon J, Messer M. Assessment of food addiction using the Yale Food Addiction Scale 2.0 in individuals with binge-eating disorder symptomatology: Factor structure, psychometric properties, and clinical significance. Psychiatry Research. 2019..
This suggests that the food addiction construct is not entirely overlapping (or explained by) binge-eating disorder.
How To Overcome Food Addiction
You might be wondering how food addiction can be treated.
Unfortunately, the evidence surrounding the effectiveness of psychological interventions for food addiction is essentially non-existent. No studies, and more importantly no randomized controlled trials, have been conducted in this area.
However, that’s not to say what don’t have any answers. In fact, we can usefully “borrow” treatment techniques from psychological treatments known to be effective for binge-eating disorder and substance use disorders, as these conditions overlap to some extent with food addiction.
Because these strategies are known to help people with binge-eating disorder and substance-use disorder, there is a reason to suspect that they might also be beneficial for people with signs of food addiction.
Some key strategies to implement are:
- Normalize eating behaviour: Adopt a pattern of flexible and regular eating. Adhering to 3 meals and 3 snacks per day is important for eliminating any cravings that may trigger compulsive eating. Implementing this technique requires you to plan, before each night, the precise times you intend on eating these meals and snacks and executing this plan daily.
- Effective problem solving: Episodes of compulsive eating are predictable; they usually occur after someone’s in a bad mood, broke a diet rule, or had interpersonal conflict. Learning how to effectively solve these problems without resorting to food is necessary to regain control over your eating. The four steps to problem-solving are:
- Identify the problem.
- Think of a range of solutions to this problem.
- Carefully think through each solutions implication.
- Select the most appropriate solution and act on it.
- Cue exposure: people who are “addicted to food” generally overeat on “forbidden foods”. We need to prevent these foods from being “trigger” foods, and to do this requires you to slowly reintroduce these foods back into your diet in small amounts. Exposure to small amounts of these foods on a regular basis will prevent the urge to over-indulge on them and will allow for a pattern of normalized eating.
- Skills training: being more assertive can help you tackle your food addiction. Sometimes, people pressure us into eating things we don’t feel like eating at that moment. It’s OK to say no with some degree of assertion. Try practising some “assertive training” on a friend.
Critics of “Food Addiction”
Food addiction is not as widely endorsed as the literature suggests.
Some of the main criticisms of the food addiction concept are10Fletcher PC, Kenny PJ. Food addiction: a valid concept? Neuropsychopharmacology. 2018:1.:
- The addictive substances within foods are unclear: This a major problem because the food addiction model assumes that some foods directly affect the brain, hijacking its “reward systems”. Critics argue that it is difficult to accept claims that food can be addictive if we are yet to pinpoint what the addictive properties are.
- Food addiction = binge-eating disorder: There is a lot of overlap between food addiction and binge-eating disorder, both at the diagnostic level and the symptom level. Given the substantial overlap, critics are wondering whether food addiction is just another fancy term for binge-eating disorder.
- The neurobiological evidence is poor: Critics argue that there is no convincing human evidence showing that neurobiological changes do indeed underlie food addicted behaviours. Also, the same areas of the brain that “light up” in response to food and drugs may also light up to other pleasurable stimuli.
- Too much reliance on animal models: Although rats show evidence of compulsive eating and a range of other characteristics associated with addiction when given intermittent availability of high-sugar foods, whether these findings can be generalized to humans has been questioned.
Food addiction is an interesting area of study. It is a concept that is still being widely studied, and, like most areas of study, there is evidence for and against it.
Much more needs to be done in this area, and I hope this article has further informed you on food addiction.
Tell us below in the comments what you think about this field of study.
|↑1, ↑6||Gearhardt AN, Corbin WR, Brownell KD. Preliminary validation of the Yale Food Addiction Scale. Appetite. 2009;52:430-436.|
|↑2||Nieto MM, Wilson J, Cupo A, et al. Chronic morphine treatment modulates the extracellular levels of endogenous enkephalins in rat brain structures involved in opiate dependence: a microdialysis study. Journal of Neuroscience. 2002;22(3):1034-1041.|
|↑3||Avena NM, Hoebel BG. A diet promoting sugar dependency causes behavioral cross-sensitization to a low dose of amphetamine. Neuroscience. 2003;122(1):17-20.|
|↑4||Wang G-J, Volkow ND, Logan J, et al. Brain dopamine and obesity. The Lancet. 2001;357(9253):354-357.|
|↑5||Drewnowski A, Krahn DD, Demitrack MA, et al. Naloxone, an opiate blocker, reduces the consumption of sweet high-fat foods in obese and lean female binge eaters. The American journal of clinical nutrition. 1995;61(6):1206-1212.|
|↑7||Gearhardt AN, Corbin WR, Brownell K. Development of the Yale Food Addiction Scale Version 2.0. Psychology of Addictive Behaviors. 2016;30:113.|
|↑8||Pursey K, Stanwell P, Gearhardt A, et al. The prevalence of food addiction as assessed by the Yale Food Addiction Scale: a systematic review. Nutrients. 2014;6(10):4552-4590.|
|↑9||Linardon J, Messer M. Assessment of food addiction using the Yale Food Addiction Scale 2.0 in individuals with binge-eating disorder symptomatology: Factor structure, psychometric properties, and clinical significance. Psychiatry Research. 2019.|
|↑10||Fletcher PC, Kenny PJ. Food addiction: a valid concept? Neuropsychopharmacology. 2018:1.|