Can People Really Be Addicted to Food?

The food addiction concept–defined as “substance-based addiction to highly-palatable foods containing unnaturally high concentrations of refined carbohydrates and fat”–is a highly controversial one in the medical and mental health fields.

Many hold that it is not a valid disorder. When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was developed in 2013, the committee considered adding food addiction as an official diagnosis but ultimately decided not to, despite fact that there is strong evidence in animal models that overeating behavior is rooted in brain chemistry, and, in humans, that many people eat in addictive ways.

Here are some reasons people give for their skepticism followed by counter arguments from food addiction proponents:

1. Food is different from drugs and alcohol; we need it to survive and you can’t quit food like you can drugs and alcohol.

Counter argument: Some foods, namely sugary and processed foods, have different biochemical effects from and more powerfully activate brain reward circuitry compared to other foods; we don’t need sugary and processed food to survive.

2. An over-active hedonic drive is not the primary cause of overweight or obesity; metabolism, hormones, low levels of physical activity and medications are the primary drivers.

Counter argument: Not all people who are overweight have food addiction. In fact, many people with food addiction are normal weight. Although food addiction can cause overweight and obesity–people with food addiction tend to have higher weights–it is a distinct entity. Only about 15-25% of individuals with obesity meet food addiction criteria.

3. A food addiction label doesn’t help anyone and might hurt. Equating food with drugs stigmatizes people who are overweight and it does not inform treatment, since we don’t yet know what works.

Counter argument: Without a label, it’s hard to find treatments. How are researchers going to ask for grant funding for something that doesn’t officially exist?

The controversy hasn’t stopped some researchers from continuing to study the construct. For example, an active research group at Yale has developed a self-report scale for food addiction based on the DSM-V criteria for substance use disorder, and has demonstrated its validity. This scale—called the Yale Food Addiction Scale (YFAS)—can now be used to identify people who eat addictively.

The study:

The same group that developed the YFAS also recently published results from a simple yet elegant study to further test if the food addiction construct is valid.

People with overweight and obesity were surveyed and asked about food addiction symptoms, substance use (alcohol use, smoking, and vaping, cannabis), and parental history of problematic alcohol use.

In their sample of 357 adults, 24.1 percent met criteria for food addiction on the YFAS, and the mean age was 41.

They found that the participants who used alcohol problematically and who smoked, and vaped, had a more than two-fold higher risk of also having food addiction. These associations were still significant after correcting for age, sex assigned at birth, and socioeconomic status. The co-occurrence of food and substance use was unlikely to be caused by substances themselves, since smoking and alcohol differ in their impact on satiety and hunger: alcohol increases appetite and reduces impulse control, whereas nicotine is an appetite suppressant.

Cannabis use was also associated with food addiction, but the effects were weaker and may have been driven by demographic factors.

People with a parental history of problematic alcohol use also had a two-fold higher risk of food addiction. These associations were still significant after correcting for demographics as well.

By contrast, obesity was not associated with personal problematic substance use or a parental history of problematic alcohol use.

The researchers also remarked that there was a stronger link between parental alcohol history and food addiction than there was between parental alcohol history and alcohol problems. They attributed this to the fact that people are exposed to rewarding foods early in development, giving them more of a chance to develop an addictive relationship with food than with alcohol, exposure to which occurs much later, and in a more limited fashion.

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Takeaways

That food addiction but not obesity was linked to problematic substance use and parental history of alcohol problems lends support to theories that food addiction is an addictive disorder, sharing roots with other substance use disorders, and highlights the fact that it is something distinct from obesity.

Findings have important treatment and prevention implications.

1. If parental history of alcohol use is a risk factor for food addiction and weight problems, prevention efforts could be targeted to these individuals.
2. People being treated for other addictions should also be counseled about addictive eating and vice versa, since “addiction transfer” can occur, where after one substance is stopped addiction to another takes its place.
3. As we develop treatments for food addiction, we should target traits that are common to all addictions—like impulsivity, reward dysfunction, and emotion dysregulation—and their underlying biology. Treatments that work for other addictions—certain medications, and psychotherapies—can be “repurposed” and tested for food addiction. Treatment studies are sorely needed, because we still know so little about what treatments work best for food addiction, and for whom.

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