Food Addiction

Food addiction is the controversial contention that compulsive eating is an addiction analogousto alcohol, tobacco, and drug addictions.

Some experts believe that food addiction only applies to specific foods—refined carbohydrates and possibly fats; others argue that it is a behavioral disorder rather than a true chemical dependency. Furthermore, distinctions between food addictions and eating disorders such as binge eating and bulimia nervosa are not always clear. In any case, food addiction differs from other addictions in that it cannot be treated by total abstinence. Nevertheless, uncontrollable cravings for food can contribute to obesity and cause physical, emotional, and social problems. Self-identified food addicts describe their addiction as a chronic, progressive, and ultimately fatal disease, because it leads to life-threatening complications such as obesity, type 2 diabetes, and heart disease.

There have been few large, controlled studies examining food addiction in humans. Much of the evidence for food addiction comes from animal studies that may not be applicable to humans. Nora Volkow (1956–), director of the National Institute on Drug Abuse, has advocated categorizing food addiction as a diagnosis, and some experts, as well as self-described recovering food addicts, agree.

Two 2015 studies reported preliminary evidence that addictive-like eating behavior was associated with highly processed, high-sugar, and high-fat foods, such as chocolate, cookies, pizza, chips, and French fries. These foods may have addictive properties similar to those of heroin and cocaine, including rapid absorption by the body and the need for higher and higher doses. Pediatric endocrinologist Robert H. Lustig, who has branded sugar a poison, argues that there are three levels of motivation—liking, wanting, and needing— and that progressing from wanting to needing is a sign of addiction. Lustig believes that sugar and flour are addictive because they raise blood sugar levels rapidly and dramatically and override physiological mechanisms that signal satiety. According to Lustig, the more refined and processed a food, the higher its addictive potential, with increasing amounts required to satisfy cravings and avoid withdrawal symptoms, as with other addictive substances.

In contrast, a 2014 literature review found little evidence for food as an addictive substance or for brain responses to food that were similar to responses to addictive drugs. The authors did find support from both animal and human studies for food as a behavioral addiction, similar to gambling, and hypothesized that pleasant brain sensations associated with eating might drive addictive behaviors in some people under certain circumstances. Although the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not include food addiction, the review recommended that it be labeled eating addiction under the DSM-5 umbrella term non-substance-related disorders in the substance-related and addictive disorders category. Not surprisingly, the food industry has vehemently opposed the concept of food as an addictive substance.

Some experts argue that food addiction is a contributor to the obesity epidemic in the United States and around the world and that food addiction should be a focus of obesity-prevention strategies. More than one-third of adult Americans and 17% of children and teens are considered obese, and two-thirds of adults are overweight. Obesity causes or contributes to an estimated 400,000 deaths in the United States each year, making it the second most common cause of preventable death after smoking. However, food addicts are not necessarily obese, and obese people are not necessarily food addicts: according to some estimates, 50% of obese people, 30% of overweight people, and 20% of healthy weight people are addicted to a specific food or foods or sometimes to total amounts of food.

Other suggested causes of food addiction or cravings are:

Although food addiction is not necessarily associated with obesity, repetitive overeating that leads to weight gain may be a food-addiction symptom. For example, consuming a box of chocolates at one sitting might be a symptom of binge-eating disorder, whereas eating the box over several sittings could be a food addiction. Twelve-step food addiction programs identify the signs and symptoms as similar to those of other substance addictions:

Other signs and symptoms may include:

Yale University's Rudd Center for Food Science & Policy developed a questionnaire for identifying addictions to specific foods:

KEY TERMS

Binge-eating disorder—
An eating disorder characterized by episodes of uncontrolled bingeing on food, but without the compensatory behaviors that characterize bulimia.
Bulimia nervosa—
A serious eating disorder that primarily affects young women and is characterized by compulsive overeating, followed by self-induced vomiting, use of laxatives or diuretics, or excessive exercise.
Carbohydrates—
Sugars, starches, celluloses, and gums that are a major source of energy from foods.
Dopamine—
A neurotransmitter in the brain that may be involved in food addiction.
Endorphins—
A class of peptides in the brain that bind to opiate receptors, resulting in pleasant feelings and pain relief.
Hypothalamus—
The part of the brain that controls the autonomic nervous system and regulates hormone production and feelings of hunger and satiety.
Leptin—
A peptide hormone produced by fat cells that acts on the hypothalamus to suppress appetite and burn stored fat.
Neurotransmitter—
A chemical that transmits impulses across synapses between nerves.
Obesity—
Excessive weight due to accumulation of fat, usually defined as a body mass index (BMI) of 30 or above or body weight greater than 30% above normal on standard height-weight tables.
Serotonin—
A neurotransmitter located primarily in the brain, blood serum, and stomach membrane; low levels may be associated with food addiction.

Overeating and obesity have historically been diagnosed as eating disorders caused by emotional problems that can be treated with counseling or psychotherapy. Although therapy can help people who use food to deal with emotions or stress, it may not be sufficient for a true food addict with a physiological craving for specific foods. Therefore, food addiction treatments are usually similar to treatments for other types of addiction. Although complete abstinence from food is not possible, complete abstinence from addictive foods is often recommended. There are several 12-step self-help programs for food addiction, as well as residential detoxification and treatment programs, halfway houses, and food-addiction recovery homes and groups. Food Addicts Anonymous combines a 12-step program with a strict diet that avoids sugar, refined flour, and wheat.

Most recommended food-addiction treatments are successful for at least some people. After a period of abstinence, food addicts often find that their cravings disappear, and they may not even want the addictive food(s).

See also Anorexia ; Bulimia nervosa.

Resources

BOOKS

Brzezinski, Mika, and Diane Smith. Obsessed: America's Food Addiction—and My Own. New York: Weinstein, 2013.

Fraser, Suzanne, David Moore, and Helen Keane. Habits: Remaking Addiction. New York: Palgrave Macmillan, 2014.

Gold, Jessica A., Kimberly A. Teitelbaum, and Mark S. Gold. “Food Addiction: Sugar High.” In The Behavioral Addictions, edited by Michael S. Ascher and Petros Levounis. Washington, DC: American Psychiatric, 2015.

Haugen, David M., and Susan Musser, eds. Addiction. Detroit: Greenhaven, 2013.

Rosenberg, Kenneth Paul, and Laura Curtiss Feder, eds. Behavioral Addictions: Criteria, Evidence, and Treatment. New York: Academic, 2014.

Sullivan, Emily, et al. “Food Addiction.” In Hedonic Eating: How the Pleasure of Food Affects Our Brains and Behavior, edited by Nicole M. Avena. New York: Oxford University Press, 2015.

Tarman, Vera Ingrid, and Philip R. Werdell. Food Junkies: The Truth About Food Addiction. Toronto: Dundurn, 2014.

PERIODICALS

Hedebrand, Johannes, et al. “‘Eating Addiction,’ Rather than ‘Food Addiction,’ Better Captures Addictive-Like Eating Behavior.” Neuroscience & Biobehavioral Reviews 47 (November 2014): 295–306. http://www.sciencedirect.com/science/article/pii/S0149763414002140 (accessed August 26, 2015).

Kenny, Paul J. “Is Obesity an Addiction?” Scientific American 309, no. 3 (August 20, 2013). http://www.scientificamerican.com/article/is-obesity-an-addiction (accessed August 26, 2015).

Schulte, Erica M., Nicole M. Avena, and Ashley N. Gearhardt. “Which Foods May Be Addictive? The Roles of Processing, Fat Content, and Glycemic Load.” PLOS ONE (February 18, 2015). http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0117959 (accessed August 26, 2015).

WEBSITES

American Heart Association. “Carbohydrate Addiction.” http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/Carbohydrate-Addiction_UCM_305906_Article.jsp (accessed August 26, 2015).

“Are You a Food Addict?” CBS News. http://www.cbsnews.com/news/are-you-a-food-addict-take-the-yale-foodaddiction-scale-survey (accessed August 26, 2015).

“Are You a Food Addict?” Food Addicts Anonymous. http://www.foodaddictsanonymous.org/are-you-foodaddict (accessed August 26, 2015).

Food Addiction Institute. “Assess, Treat and Refer.” http://foodaddictioninstitute.org/for-professionals/assess-treatand-refer (accessed August 26, 2015).

Food Addiction Research Education (FARE). “What Is Food Addiction?” http://foodaddictionresearch.org/question-and-answer/what-is-food-addiction (accessed August 26, 2015).

Lustig, Robert H. “The Sugar-Addiction Taboo: When Can You Call a Food Addictive?” Atlantic. http://www.theatlantic.com/health/archive/2014/01/the-sugaraddiction-taboo/282699 (accessed August 26, 2015).

Miller, Anna Medaris. “I'm an Addict. A Food Addict.” U.S. New & World Report Health. http://health.usnews.com/health-news/health-wellness/articles/2015/06/15/im-anaddict-a-food-addict (accessed August 26, 2015).

Obesity and Food Addiction Summit. “Food Addiction: What Is Food Addiction?” http://www.foodaddictionsummit.org/foodaddiction.htm (accessed August 26, 2015).

ORGANIZATIONS

American Heart Association, 7272 Greenville Ave., Dallas, TX, 75231, (800) AHA-USA-1 (242-8721), http://www.heart.org .

Food Addiction Institute, (941) 747-1972, foodaddiction institute@gmail.com, http://foodaddictioninstitute.org.

Food Addicts Anonymous, 529 NW Prima Vista Blvd., Rm. 301A, Port St. Lucie, FL, 34983, (772) 878-9657, http://www.foodaddictsanonymous.org .