“Focusing on trying to control anything that we can seems quite compelling when we are living in a world where lack of control from the outside seems the norm. This includes managing what and how much we put into our mouths and placing the results neatly into a category of “good” or “bad.” Yet, I think this practice can also be extremely dangerous.” – Dr. Sarah
Food Addiction within Diet and Wellness Culture
Recently, I discussed the dangers of diet and wellness culture.
I purposely addressed these topics first. This is because, when trying to understand eating disorders, including “food addiction,” it’s important to keep in mind the cultural, sociological, and psychological contexts and belief systems the behavior is stemming from.
In fact, I argued that disordered eating may even be quietly applauded, though perhaps unintentionally, in our current wellness and diet culture. The Washington Post discussed this point in the article, “Could social media and diet trends be contributing to a little-known eating disorder?”
Specifically, the author focused on how orthorexia, the obsession with clean, healthy eating, is often hidden in plain sight. After all, these restrictive practices have been normalized, rationalized, and even exalted in health communities:
Controlling food has history
Though the conditions in which orthorexia would seem to thrive might feel new, there’s a moral component to “clean eating” — orthorexia’s central fixation — that feels old. “This idea that exercising restraint over biological impulses is good and virtuous; there’s a whole history of that,” Merwin says. “There were saints who starved themselves to be seen as pure, divine and closer to God.” She says striving toward increased “purity” is a mechanism of exercising control. Orthorexia is not dissimilar to anorexia in this way.
In fact, many clinicians see the overlap clearly. “The commonality between anorexia and orthorexia is perfectionism and anxiety, sometimes obsessive-compulsiveness,” says Linda Hamilton, a clinical psychologist in private practice in New York City, specializing in eating disorders. “There’s also often a desire to be thinner.”
The condition can morph from a healthy intention into a means of control, Merwin says. “Oftentimes, the extreme nature comes in time,” she says. “It starts with, ‘I just want to be healthier,’ but then more and more things become restricted.” Maybe first it’s dairy, then sugar, and then gluten or carbs. “It’s the same with anorexia,” Merwin says. “Nothing is ever enough.” ….
Angela Guarda, an associate professor of psychiatry and behavioral sciences at Johns Hopkins Hospital, says anorexia patients typically “have a rationalization for why they do what they do.” With orthorexia, that rationalization is clear and more societally accepted: “Those explanations are that they’re vegan, gluten-free, lactose-free or so on,” she says. (source)
In the past, I took on the controversial topic of labeling food as an “addiction” from both sides of the spectrum. Whereas some may feel labeling food as addictive could clear the stigma of viewing those with excessive consumption of food as lazy and lacking willpower, others feel it may actually cause more eating disorders, restraint, and increased prejudice of those who “lack control.”
I believe we need to be very cautious in designating certain types of foods or behavior as “addictive.” Just like with alcohol, not everyone will experience the physical drive to overconsume. Furthermore, not everyone who eats large amounts of food may be doing so because they are “addicted.”
In this article, I will provide a summary of the arguments for and against food addiction. Later, I will get into even more details regarding the topic of viewing food as a substance of abuse.
Let’s get started by revisiting and revising the concepts of food addiction that I have already covered.
Revisiting the Topic of Food Addiction
The Brain Patterns Pointing to Addiction
In 2016, prior to becoming a HAES practitioner and still steeped in wellness culture, I wrote a two-part series, “Why We Are Addicted to Food.” In it, I cited evidence on the pro side.
These arguments that pointed to how food could become addictive included:
- How certain foods are made to be hyperpalatable, stimulating pleasure signals and reward centers in the brain. According to this theory, it made “eating just one” almost impossible.
- Small studies in dieters and food restrictors that demonstrated that certain foods triggered a dopamine response and change in brain chemicals.
- How deregulations in the hormonal signals of hunger, satiety, adiposity (leptin, ghrelin), and insulin could lead to imbalanced eating patterns.
- That combinations of the above hormonal shifts, genetic predispositions, and changes in the brain reward symptoms (related to palatability and food quality) could all affect food motivation. These factors are similar to the complex interactions that result in an addictive pattern.
- Specific areas in the brain are activated in response to appetizing foods or food cues. These include the dorsal striatum, insula, orbitofrontal cortex, amygdala, nucleus accumbens, substantia nigra, ventral tegmental area, and lateral hypothalamus. Various responses of different neurotransmitters and hormonal signals in these brain pathways can also act to increase or decrease food behavior.
- Some evidence that those diagnosed with “obesity” experience dysregulated brain stress systems and deficiency in inhibitory food responses.
- Studies that demonstrated that the incentives for sugar could be regulated by amygdalar circuitries that trump homeostatic (balanced) eating.
The Limitations in Meeting Criteria
It’s important to note that while these points on the neurophysiology of responses to food are enticing, they do not necessarily meet all the conditions to make food addictive. In order for that to be fully elucidated, several criteria should be considered.
According to the 2021 article, “Current Status of Evidence for a New Diagnosis: Food Addiction-A Literature Review,”
Five dimensions are considered important in order to delineate such a disorder:
(1) clinical criteria for diagnosis,
(2) one or more validated instruments for the quantification of this disorder’s severity,
(3) epidemiological data,
(4) evidence for specific pathophysiology, and
(5) available treatments.
I will explore these dimensions in more depth and the limitations that currently exist within them for labeling food as an addiction in a future post. Importantly, for now, I will say that an agreed upon criteria and clinical trials of available treatments have not been met.
The Caveats of Food Being Labeled as Addictive
More recently, I discussed the caveats and dangers that could entail with notating food an addiction; specifically how it could fuel eating disordered practices if not handled carefully.
I argued how the food addiction theory had its flaws. These included:
- Many studies did not account for the fact that participants were coming from a place of food restriction. This can make foods that are hyperpalatable more rewarding based on one’s psychological drive from deprivation.
- My personal experience and my interactions with clients that have consistently demonstrated that taking away restriction and shame around “addicted” foods led to the ability to eat them in a balanced manner.
- A study comparing rats that were given free range to eat sugar to rats that were prohibited to eat it. The rodents who were allowed to partake in unconditional sugar imbibing were normal sized and able to moderate intake. The rats that had their access to the sugar cut off ate it excessively and exhibited binge-like behavior with it when they finally could get their little, tiny paws on it!
- How food, just like sex, relationships, and fun, is meant to be pleasurable. These all also “light up” reward centers in the brain, especially after times of scarcity. Anything can be “addictive” if this is a determining factor.
- How the whole aspect of food shaming and weight stigma is damaging in the first place. Now, with “food addiction,” mental health and fat bias could co-exist. Yikes!
Summarizing the Pros and Cons of Food Addiction…So Far
I think it’s important to keep in mind the culture of wellness and dietary principles that we exist in today when evaluating food addiction. It is easy to point the blame at a type of food, but that is such a superficial fix. One’s patterns with food intake are based on a variety of exceptionally complex aspects. These include their genetic predispositions, food and health history, culture, environmental exposures, socioeconomic background, access to food, brain health, stress resiliency, and ability to cope with emotional triggers.
Am I saying that we should promote eating foods that are highly processed, hurt the environment, and lack nourishment for our brains and bodies?
Heck no! As a naturopathic doctor, I uphold the belief that food can be a form of medicine. In fact, I have many articles on personalizing diets and how certain nutrients can impact mental, emotional, and physical health. I also have discussed how genetic variations in individuals can affect how someone will metabolize certain foods and that addressing these can be one part of the puzzle to optimizing hormonal balance and overall wellness.
However, I do feel that demonizing food and eating practices and using shame, blame, and morality around them is extremely damaging.
As the science evolves regarding “eating addiction” and “food addiction,” and the pros and cons on labeling food addiction continues to populate research, it’s important to keep in mind the delicacy of this topic and the complexity it entails.
I am not proclaiming to be the final judge in the matter, but I do feel we need to walk lightly and acknowledge that, if not careful, this kind of branding could lead to harm and fuel eating disorders.
In an upcoming article, I will summarize more of the major considerations, pros, cons, and characteristics associated with “food addiction.”
I do ask all healthcare providers to be aware of the potential dangers of mental health labels and to not confuse opinion and selected literature citations as final proof. The science and psychology is not fully settled at the time of my writing this. Let’s recognize this and be accountable.
For all consumers, please know you are not alone. If you are struggling with eating and it is causing you distress and to miss out on events because of the food there, please reach out to an eating disorder specialist. Preferably, find one who is also awake to the dangers of diet and wellness culture and will not perpetuate the sick cycle.
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Disclaimer: This material is for information purposes only and is not intended to diagnose, treat, or prescribe for any illness. You should check with your doctor regarding implementing any new strategies into your wellness regime. These statements have not been evaluated by the FDA. (Affiliation link.)
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