Is Food Addiction a Myth?

Is Food Addiction a Myth?

By Jeanene Swanson 09/17/14

Some scoff at the idea, others clamor for a cure. Is it an eating disorder, or an actual addiction?

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Is food addiction real? Some might scoff at the idea, saying that being overweight or obese is a choice, or a failure of willpower. However, research over the last five years has moved toward defining “food addiction” along the lines of a disorder akin to a substance use disorder—it’s real, and it’s just like any other addiction.

In essence, addiction to a substance like cocaine, heroin, or alcohol is defined by tolerance, withdrawal, excessive intake, and a persistent desire to obtain the substance after prolonged use. Now, many of these same behaviors are being shown through research studies to have correlates in binge eating, especially and specifically of highly palatable foods (high in sugar, fat, or salt). In fact, excessive intake of highly palatable foods has the same effects on brain and behavior that are seen with some drugs of abuse, and studies are beginning to back up the hypothesis that food can be an addictive substance like any other drug of abuse.

Just another eating disorder?

It is important to begin any conversation about food addiction with the fact that a substance use disorder—ultimately, food addiction would be defined as such—and an eating disorder share common traits, but they are considered separate disorders. Most treatment facilities house them in separate silos entirely, and for good reason: if food is a trigger, then only the most holistic centers can treat both food addiction and substance use disorders under the same roof.

“It’s sort of like in the middle of an eating disorder and an addiction,” says Nicole Avena, describing food addiction. Avena is a research neuroscientist, author, and expert in the fields of nutrition, diet, and addiction, and she works at the New York Obesity Research Center of Columbia University.

Not everyone agrees. Eliza Pertz, a LCSW who operates a private practice in the New York City area and specializes in eating disorders, says there is no difference between an eating disorder and food addiction. They are both maladaptive relationships with food. “Food addiction is an eating disorder,” she says. “Food is just another substance.” Avena says that food addiction is more similar to some eating disorders, namely binge eating disorder, than others. “Often is the case, people will binge on a food, [and] it will temporarily alleviate some sort of feelings of distress,” Avena says.

Eating disorders are, in a word, heterogeneous. They can come in the form of restrictive eating, such as anorexia and bulimia, or in the form of binge eating, as in binge eating disorder—only recently recognized by the DSM-V. Eating disorders are categorized within the DSM outside of substance use disorders. Anorexia and bulimia share elements of restrictive eating—however, while patients may be addicted to feeling hungry, or trying to stay thin, or the purging process; they are not addicted per se to any particular substance. And they don’t meet criteria of dependence, which include tolerance and withdrawal.

Binge eating disorder, or BED, might be considered the closest thing, by diagnostic criteria, to food addiction. “Individuals who are diagnosed with binge eating disorder and bulimia do feel a lack of control or compulsivity related to food consumption, which is similar to the dysfunctional pattern of substance use in substance use disorders,” says Dr. Nia Sipp, who is on the medical staff at Sierra Tucson treatment center in Tucson, Arizona. “Individuals who binge eat tend to experience a similar sense of shame and guilt related to excessive food consumption and cravings for food.” Both groups try to hide their abuse, and BED patients “tend to experience low or negative moods after binge episodes in a fashion most analogous to substance users after excessive consumption of their substance of choice.”

Co-morbidities exist, however, across the spectrum of addiction and eating disorders, which suggest they might share a “common substrate.” According to Avena, there is a high co-morbidity—or co-occurrence—of binge eating disorder and food addiction. Avena says that up to 50% of people who have binge eating disorder will meet the criteria for having a food addiction. However, all kinds of people can be addicted to food, including those who are obese, normal weight, and those who have had bariatric surgery. It’s not about being thin. “There is a very high co-morbidity between having an eating disorder and having an addiction [of any kind],” she says. “The high co-morbidity to me suggests that there is a strong overlap.”

In fact, Yale University’s Rudd Center for Food Policy and Obesity drew up the Yale Food Addiction Scale (YFAS) in 2009 to measure food addiction. It is a 25-point questionnaire, based on DSM-IV codes for substance dependence criteria. While there is currently no official diagnosis of “food addiction” in the DSM-V, the YFAS can be used to identify symptoms of dependency towards certain foods as well as people at risk for food addiction, regardless of previous diagnosis of binge eating disorder or another eating disorder and regardless of weight.

The research behind food addiction

 While food addiction remains a controversial topic, animal studies are proving that in some cases, food addiction does, in fact, exist, and can therefore become a diagnosable disorder. For some people, the same reward (dopamine) and pleasure (opioid) centers of the brain that are triggered by substances of abuse are also overly-activated by food, especially highly-palatable foods like those high in added sugar, salt and fat. When excess dopamine is released by these foods, the brain experiences a high, from which it then withdraws and needs more. People can begin to eat compulsively—that is, they don’t want to stop eating, even though they’re already satiated and no longer hungry—as well as develop a tolerance to these foods—the same amount no longer gets them high, so they have to eat more to achieve the same level of buzz or satisfaction. These are hallmarks of addiction.

Additionally, people who are addicted to these types of food will continue to binge eat despite negative consequences—feeling bad or guilty while doing so, or becoming overweight or obese.

There is behavioral and neurobiological evidence for sugar addiction. Animal studies out of Avena’s lab and others show that when given access to high-sugar foods, rats will binge and then go through withdrawal. The parts of their brains that would be affected by drugs of abuse are also affected by overly sugared foods, namely the mesolimbic dopamine pathway. Avena believes that the foods on our grocery store shelves are precipitating addictive reactions—too much sugar, fat, and refined carbohydrates are causing our brains to consider them more like substances of abuse and less like food.

At this point, the evidence for food addiction is inconclusive—at least in terms of getting it listed in the DSM. In a literature review, Laval University scientist Shirley Fecteau summarized the research that would have food addiction be a substance use disorder, looking specifically at sugar, fat, and sweet-fat binging in rodent models, as well as behavioral and neurobiological assessments in different human populations. “Although natural rewards [food, versus substances] are a hot topic in the [DSM-V] definition and categorization of Substance Use Disorders, proofs of concept and definite evidence are still inconclusive.” Further, she writes, “Although pieces of behavioral and neurobiological evidence supporting a food addiction phenotype in animals and humans are interesting, it seems premature to conclude on its validity.”

“[Eating disorders] are highly heterogeneous, and hard to link them as a group to [substance use disorders],” she says.

Better treatment

Classic eating disorder therapies do not treat eating disorders as addictions. “Eating disorders involve a high level of restraint, [but] when we talk about an addiction, the typical treatment involves a high level of restraint, meaning, do not use drugs,” Avena says. “So, the treatment modalities don’t necessarily fit well with someone with an eating disorder.”

While eating disorders are not one-size-fits-all, it’s not necessarily that eating disorders should be treated separately from addictions. Most rehabs consider substance use disorders and eating disorders as two separate things, however Sierra Tucson treats both at its facility. “Attempting to treat the substance use disorder without treating the eating disorder can result in an exacerbation in eating disorder symptoms,” says Sierra Tucson’s Sipp. “Typically, revolving addictions tend to occur when an individual has an unresolved diagnosis of mood, personality or psychotic disorder,” which ultimately needs to be addressed.

While Sierra Tucson has a dual diagnosis program, many patients have to seek outside help, or seek treatment for one and then the other. That’s not to say that nutritionists are not realizing the importance of non-addictive food in addiction recovery. Nutritionists advise to stay away from foods high in sugar, fat, and refined carbohydrates in early recovery, as well as get plenty of protein and good fats. Adopting a diet whereby one eats small meals throughout the day can help prevent mood swings, too.

Pertz suggests 12-step meetings, like Overeaters Anonymous and Food Addicts Anonymous, and cognitive-behavioral therapy to address behavior change. However, the most important thing is addressing the underlying emotional causes. Pertz says the missing piece that connects eating disorders and addiction disorders is emotion. “People are using substances to try to control they way they feel—and people are using food to control how they feel.”

Future focus needs to be around changing how we source, process, and consume food—a big endeavor, especially in the face of a worldwide obesity epidemic. “We live in a food environment that is plagued by high-calorie, high-sugar, highly processed foods…[that] lead us to eat in ways that make us eat more,” Avena says. “Instead of asking the question, ‘Is food addiction real?,’ I think we need to change the conversation [and ask,] ‘What is a food?’”

Jeanene Swanson is a regular contributor to The Fix. She last wrote about the science of nicotine addictionerasing your traumas and alcoholism and genetics.

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Jeanene Swanson is a science journalist who specializes in mental health and addiction. As a science writer with a background in biotechnology, she enjoys turning complex subjects into stories that everyone can understand—and apply to their lives. You can find Jeanene on Linkedin.

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