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  • Writer's pictureDr. Harold Pierre

Is Food Addiction Real? The Controversial Truth

Updated: Jan 17

Is Food Addiction Real? The Controversial Truth

Food addiction is a controversial concept that has received increasing interest over the past two decades. Proponents believe certain foods, especially those high in sugar, fat and salt, may be addictive in a similar way to drugs. However, others argue that applying addiction terminology to everyday foods is unhelpful and could increase weight stigma. In this detailed guide, I objectively examine the evidence and arguments from both sides of the debate. However, at the end of the article, I will share my very strong opinion.

Chocolate bar assortment with hazelnut, redcurrant and cinnamon

What is Food Addiction?

The idea of food addiction proposes that certain eating patterns share behavioral and biological similarities with substance addictions. Scientists began exploring this concept in the early 2000s after realizing that drugs and highly processed foods both affect brain regions involved in reward, motivation and impulse control.

Specific addictive-like eating behaviors include:

  • Craving or intense urges to consume certain foods

  • Eating more than intended due to feeling out of control

  • Continuing to overeat despite negative consequences like weight gain or illness

  • Building up tolerance where more food is needed to get the same pleasure

  • Experiencing withdrawal symptoms when restricting these foods

Researchers have also reported overlaps in the neurotransmitter systems affected by addictive drugs and hyper-palatable foods. However, food addiction is not currently recognized as a clinical diagnosis.

How is Food Addiction Measured? The Yale Food Addiction Scale

In 2009, Ashley Gearhardt and colleagues developed the Yale Food Addiction Scale (YFAS) to assess addictive eating behaviors. This questionnaire applies the diagnostic criteria for substance use disorders from the Diagnostic and Statistical Manual of Mental Disorders (DSM) to the consumption of certain foods.

The scale asks questions like:

  • Have you had times when you consumed more food than intended?

  • Have you tried unsuccessfully to cut back on eating certain foods?

  • Do you spend a lot of time obtaining, using or recovering from eating?

Meeting two or three criteria would equal mild food addiction, four to five is moderate and six or more is severe.

Since its development, the YFAS has been validated in various languages and populations. Studies show it has a one-dimensional factor structure and reliably distinguishes individuals along a food addiction spectrum.

How Common is Food Addiction?

Reviews estimate that around 20% of the general population score positively for food addiction based on the YFAS. Rates are higher among individuals with binge eating disorder or bulimia nervosa, with over 85% of patients meeting the diagnostic threshold.

Some key risk factors found to be associated with food addiction include female gender, younger age, depression and impulsivity traits. However, food addiction has been reported across diverse demographic groups.

Signs and Symptoms of Food Addiction

If you identify with several of the following behaviors around food, it may indicate an addictive relationship:

Frequently eating past the point of feeling full

  • Feeling unable to cut down on certain foods or food types

  • Spending a lot of time thinking about or planning your next meal

  • Continuing to eat junk foods even though it causes emotional distress

  • Experiencing withdrawal symptoms like irritability or fatigue when trying to restrict these foods

  • Needing more and more food to get the same enjoyment

People with food addiction may also commonly report guilt, shame and secrecy around their eating habits. Weight gain is another obvious consequence in many cases.

How is Food Addiction Different from Binge Eating Disorder?

Binge eating disorder (BED) is recognized in the DSM-5 as a type of feeding or eating disorder. Key features include recurrent episodes of binge eating, accompanied by feelings of loss of control.

Food addiction and binge eating disorder clearly overlap, with most individuals who binge eat frequently scoring positively for food addiction. However, some important differences include:

  • People with BED binge on any available food while food addiction refers to addiction-like behavior around specific types of hyper-palatable foods.

  • BED requires distress around binge episodes but this is not necessary for a food addiction diagnosis.

  • Food addiction may involve cravings, tolerance and withdrawal - key criteria for substance addiction that are not part of the BED diagnosis.

So while BED and food addiction are strongly linked, food addiction provides a useful model for identifying addictive processes in eating disorders involving binge eating and overconsumption of hyper-palatable foods.

Potential Causes of Food Addiction

The etiology of food addiction is likely explained by a combination of genetic, environmental and psychological factors. Some key factors believed to contribute include:

Genetics - Research shows that markers linked to dopamine signaling and reward sensitivity are associated with greater odds of obesity and addiction. This suggests certain individuals may be biologically vulnerable.

Highly Processed Food - Foods like pizza, cookies and chips are engineered with the perfect combination of sugar, fat and salt to maximize palatability. This hyper-palatable food may have addictive effects.

Stress and Trauma - Adverse childhood experiences and chronic stress can affect our stress and reward pathways, increasing addiction risk. Comfort eating to cope may lead to addictive-like behaviors.

Mental Health - Conditions like depression and ADHD are linked to increased impulsivity and poorer self-control. This may make it harder to regulate eating habits.

Dieting - Restrictive dieting promotes rebound binge eating in some people. Going on and off “food plans” may further exacerbate food obsession and cravings.

Socioeconomic Status - People from deprived backgrounds are more exposed to addictive substances and hyper-palatable junk food. Low SES is linked to greater addictive disorders.

So in combination, biological susceptibility, highly processed food environment and psychosocial factors likely culminate in the phenomenon of food addiction for some individuals.

How Does Food Addiction Affect the Brain?

Neuroimaging studies reveal both similarities and differences in the brain regions affected by food versus drug rewards.

Some key findings include:

  • Hyper-responsiveness in reward regions like the striatum and amygdala in response to food cues, related to greater food addiction scores. This is akin to the heightened reward response seen in drug users when exposed to drug cues.

  • Reduced activation of dopamine signaling regions linked to blunted enjoyment of natural reinforcers. This deficit is seen in both obesity and drug addiction.

  • Impaired response in brain areas related to self-control like the prefrontal cortex. This may make it harder to self-regulate and resist cravings.

There is also evidence that regularly overeating highly palatable foods eventually desensitizes the dopamine system. This may lead to compulsive food seeking in an attempt to boost flagging reward signals.

This combination of heightened food reward sensitivity and poor inhibitory control is implicated in the development of addictive-like eating.

Hand of a woman cuffed on a donut. illustration for food addiction

Is Food Addiction Real? The Controversy Explained

Ever since the concept of food addiction entered mainstream discussion, it has been shrouded in controversy. Let's examine some of the key debates:

Food addiction pathologizes normal eating - Critics argue very few individuals actually meet the diagnostic threshold for substance dependence-like eating behavior. Therefore, applying an addiction label to everyday foods like sugar pathologizes generally safe substances and normal appetite.

It lacks empirical support - Some say the evidence for food addiction in humans is limited and overly reliant on animal research. They argue biomarkers like tolerance and withdrawal have not been conclusively demonstrated.

Risk of stigma - Others warn that labeling certain groups as "food addicts" may worsen weight stigma and shift blame onto individuals rather than the poor food environment.

Food is necessary for survival - Unlike illicit drugs, we have to eat to live. So some say it's unhelpful to categorize essential natural substances like sugar as "addictive".

No deficit in social functioning - Dysfunction in roles at work, school or home is a key criteria for substance addiction. But this significant impairment is not seen in food addiction.

It ignores socioeconomic and environmental drivers of overeating - Critics argue focusing narrowly on food addiction overlooks environmental causes like poverty, stress, trauma and greater junk food access.

These are all reasonable concerns that require ongoing investigation. Current evidence indicates some individuals do develop an addictive phenotype of compulsive overeating. However, food addiction is unlikely to account for most cases of overweight and obesity which have multifactorial causes.

Treatments and Interventions for Food Addiction

If you relate to signs of addictive eating behavior, various treatment options may help:

  • Cognitive behavioral therapy (CBT) - CBT involves identifying unhelpful thought and behavior patterns around food and building healthier a healthier relationship with food. This psychotherapy approach has empirical support for treating eating disorders.

  • Nutrition counseling - Working with a dietitian or nutritionist can help people overcome food rules, restriction and feelings of deprivation through a more intuitive eating approach. This alleviates the binge-restrict cycle.

  • Mindfulness training - Practices like mindful eating encourage greater awareness of hunger and satiety cues. This allows responding adaptively rather than impulsively.

  • Food addiction support groups - 12-step style programs like Food Addicts Anonymous use mutual support and a recovery model to develop a healthier bond with food.

  • Medications - Drugs that affect dopamine signaling or block opioid receptors show preliminary promise for treating addictive eating but require more research.

  • Gastric surgery - Bariatric procedures like gastric banding reduce the amount of food that can be eaten. This may help break addictive patterns, especially when combined with behavioral interventions.

The right approach depends on the individual. Combining psychosocial treatment with medical and community support often proves most successful long-term. Solving food addiction alone is very difficult.

Food Addiction is Real

I have practiced addiction medicine since my internship year in 1999. Although, my experience began with heroin addicts, I cannot deny that food addiction and substance abuse share so many similarities. . Both share cravings and both share withdrawal symptoms. The cycle of food addiction is similar to the cycle of other substance abuse. People gain control, become sober, and then relapse. I believe food addiction is a serious disease and one day it will become an official diagnosis in the DSM.

I believe that 2 drugs will be Food and Drug Administration approved for treating patients dealing with food addiction. I believe that both Ozempic (semaglutide) and naltrexone are the strongest drugs available to treat food addiction. I am not waiting for the FDA for approval, I am already treating patients with these two medications based on their YFAS results.

Recovery from Food Addiction is Possible

Panoramic shot of nutritionist writing diagnosis near patient

Overcoming food addiction involves re-learning how to eat normally by reducing cravings, restoring satiety signals and developing self-control. This process can be extremely challenging.

Relapse is common, but many individuals achieve abstinence from trigger foods or manage to integrate them into their diet in moderation. The keys to success involve:

  • Seeking professional and social support

  • Identifying personal triggers and high-risk situations

  • Building a balanced eating routine

  • Developing healthier coping strategies for stress and difficult emotions

  • Making other positive lifestyle changes like exercising more

With perseverance and the right help, people can break free from the prison of food addiction. The brain and body have an amazing ability to heal when given the chance.

I am Here to Help

I lead a team with decades of experience, and a commitment to providing you with comfort, care, and respect as you navigate this challenging time in your life. We also make treatment super convenient with hours of operation that extend from 0800 AM to 0900 PM, 7 days a week through scheduled appointments. We accept most insurances, making addiction treatment accessible to practically all who call 918-518-1636. Our offices are located in Tulsa, Oklahoma and The Woodlands, Texas. We are waiting for your call.

Key Takeaways

  • Food addiction is a controversial term but evidence suggests certain foods may elicit an addictive-like response in some individuals.

  • Questionnaires like the Yale Food Addiction Scale identify symptoms of addictive eating behavior like cravings, tolerance, withdrawal and loss of control around specific foods.

  • Prevalence is estimated at around 20% in the general population but may be higher in groups with binge eating disorder, bulimia or obesity.

  • Combinations of biological susceptibility, highly processed hyper-palatable foods and psychosocial factors likely contribute.

  • Brain imaging reveals both similarities and differences between food versus drug addiction. Key disruptions are seen in dopamine-mediated reward and self-control regions.

  • Critics argue it lacks empirical validation, worsens weight stigma and ignores socioeconomic drivers of overeating.

  • Treatment focuses on behavioral interventions, social support, mindfulness and nutrition education. Medications and bariatric surgery may also help in severe cases.

  • Recovery is challenging but possible through restoring balance and control around food. Support and perseverance are key.

Frequently Asked Questions

Is food addiction recognized in the DSM?

No, food addiction is not formally acknowledged as a diagnosis in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, it shares similarities with substance addictions and binge eating disorder criteria. Researchers continue working to validate food addiction as a clinical phenotype.

What foods are most addictive?

Highly processed foods with added fat, refined carbohydrates, sugar and salt appear most addictive to some individuals. Foods like pizza, chocolate, cookies, chips, soda, cake and sweets are most commonly reported triggers. But any frequently eaten hyper-palatable foods can potentially cause addiction-like behavior in vulnerable people.

How is food addiction treated?

Education, cognitive-behavioral therapy, mindfulness techniques and peer support groups focused on normalizing eating behaviors are the main psychotherapeutic approaches. In severe treatment-refractory cases, researchers are also exploring pharmacotherapy using naltrexone, bupropion or appetite-reducing drugs like Ozempic. Surgery for obesity may be another option for helping overcome food addiction by physically and psychologically restructuring eating habits.

What causes food addiction?

Research implicates a combination of genetic, environmental and psychological factors. Differences in dopamine signaling linked to greater reward sensitivity may predispose some people. The modern food environment full of engineered hyper-palatable yet junk foods also plays a key role. Underlying mental health issues like trauma, depression and stress may further drive addictive eating behaviors. Ultimately, food addiction likely arises from a complex interplay between biological vulnerability and these external triggers.

How is food addiction different from binge eating disorder?

Binge eating disorder and food addiction are closely tied. Most individuals who meet the criteria for BED also score positively for food addiction. However, food addiction refers specifically to addictive behaviors like craving, tolerance or withdrawal triggered by hyper-palatable foods. Binge eating episodes can involve any available foods and may be driven by a need for stress relief rather than addictive processes. Also, BED requires marked distress around binge eating but this is not necessitated by a food addiction diagnosis.

About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.

This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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