What Would Happen If "Food Addiction" Was Made Official?

The concept of food addiction, long the subject of controversy and debate, has recently been bolstered by a research study suggesting that it is, indeed, a real thing. Certain foods—like high fat, high sugar foods, and processed foods—are thought to operate on the brain’s reward system in the same way as other addictive substances. Brain circuits behind emotion regulation, impulse control, and reward-seeing are similarly altered in people with substance use disorders and those that have food addiction symptoms.

According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the criteria for a substance use disorder (SUD) diagnosis include symptoms such as craving, using the substance more than was intended, and continued use despite serious negative consequences. These symptoms are familiar to many people who feel out of control with eating or who binge eat. A validated scale based on the DSM-V criteria for SUD, called the Yale Food Addiction Scale, has been developed to identify people with a food addiction problem, and it is being increasingly used in research.

However, the medical and mental health fields are still reluctant to accept food addiction as a disorder. Food addiction was considered but ultimately not included as a diagnosis in the DSM-V for several reasons.

One reason is that experts are concerned that officializing the food addiction concept could have negative consequences for people who struggle with overeating or obesity. Just because something is a disorder doesn’t mean that recognizing it will be helpful.

Following is a summary of some of the pros and cons, and arguments for and against, making this a more official disorder.

Potential Downsides

• Abstinence-based food plans might trigger disordered eating. Binge eating disorder is currently treated most often with a classic eating disorder treatment model. Most eating-disorder treatment programs discourage people from avoiding sugary and processed foods, and instead encourage a “no bad foods” approach. By contrast, substance use disorder treatment models encourage people to abstain from the problem substance, since most people find the most freedom, long-term, through abstention. Suggesting someone remove certain foods from their diet, like desserts or sugary drinks, could be theoretically dangerous for some people with eating disorders because it could trigger binge eating.
• Giving someone a food addiction label could increase negative stigma. People who are overweight or have obesity are already judged harshly by our society. One study showed that adding on a label that includes the word “addict” carried more stigma than the "obesity" label, alone
• Receiving a diagnosis with the word "addiction" in it could reduce a person's self-efficacy. If the problem lies in one's biology, it might make them feel less in control of their problem, reducing their motivation to try. In one cross-sectional study, people who attributed their overeating to biology were more likely to assume their weight would not change and feel worse about themselves.

Potential Upsides

• The food addiction label could reduce the extent to which people in larger bodies are stigmatized. One study showed that people were less blamed for their weight and perceived to have lower perceived psychopathology when their larger body size was presented as resulting from addiction as opposed to not.
• More widespread acceptance of food addiction could reduce internalized stigma—which manifests as shame and expectation of discrimination in people in larger bodies. Studies of substance use disorders have shown that when people can attribute their problem to biological phenomena, they feel better about themselves. They can understand their problem as a medical problem, rather than as due to a character flaw or laziness.
• If certain foods were seen as having an addictive potential, it could fuel public-health-based measures to limit their accessibility and popularity. With tobacco, large-scale advertising campaigns and high taxes have successfully reduced tobacco use and dependence at the population level. Similar approaches to prevent the development of food addiction and its associated consequences might be more popular with the general public and politicians were the concept to be made more official.
• Identifying certain foods as addictive might help people harness motivation to try an abstinence-based plan. Although understudied, some people report relief from cravings when they cut certain foods out of their diet after some time “clean.” They also say that the first days and weeks of stopping are "torture." Helping people conceptualize their problem as an addiction might help people get through those first days with high cravings to the other side, where they might find much more peace. At the societal level, family and friends might be more supportive, applying less (albeit well-meaning) pressure to “have just one bite.”
• The establishment of food addiction as a diagnosis could fuel important and life-saving research on how to treat it. To get research funding to study treatments for a disorder, a label is essential. People with food addiction are a distinct group from those with obesity or overweight (only 15 to 25 percent of people with obesity are thought to have food addiction, and many people who meet the criteria for food addiction are not obese), and they need to be studied separately. Treatments that work for addictions need to be retested in people with food addiction once the diagnosis is established. Already we know that some medications (e.g. topiramate, lorcaserin, zonisamide) and psychotherapeutic approaches (e.g. cognitive behavior therapy, twelve-step approaches) that help people with substance use disorders also help people lose weight or reduce binge eating. These treatments might have much larger effects if they were tested in clinical trials in people with food addiction, specifically. There is much work to be done to determine the most effective nutritional recommendations and food plans, medications, and psychotherapies for food addiction; more widespread acceptance by the medical and mental health fields could make all the difference.

Conclusions

Taken as a whole, I argue that the pros of accepting food addiction as official would likely outweigh the cons. Assuming that evidence will continue to mount that food addiction is real, the medical and psychiatric community should more seriously consider making it a recognized diagnosis.

More widespread acceptance of food addiction could cause problems for some people, but if it were rolled out with care and caution, it is more likely that officializing it would have positive impacts on the lives of people who struggle with overeating and binge eating.