“Before you drop that potato chip or chocolate bar and start shaming yourself, let’s have a discussion and truly “weigh” the evidence for and against labeling food as an addiction.” – Dr. Sarah

In this post, we will continue the discussion on food addiction. First, let’s have a recap on this topic so that you’re up to speed….

1. The Context

In this series on eating disorders, I first discussed the dangers of diet and wellness culture. This is because, when trying to understand disordered eating and eating disorders, it’s important to consider the cultural, sociological, and psychological contexts and belief systems the behavior is stemming from.

Currently, our society is not only normalizing disordered eating behaviors, but healthcare and wellness communities are likely contributing to them. Perhaps unintentionally, and definitely unfortunately, many wellness and diet communities have been promoting restrictive eating practices. Furthermore, at a time of intense scrutiny in many areas of stigma, body size prejudice and substandard medical care based on weight biases is rampant.

It was bad enough to face diet culture’s damaging messages of sizeism, fat-shaming, and food morality. Now, its messages and idolism of the perfect specimens of health have etched into healthcare. (The Washington Post discussed this point in an article on orthorexia, “Could social media and diet trends be contributing to a little-known eating disorder?”)

2. The Overview of the Arguments for and Against Food Addiction

In the preceding article, I provided a summary of the overarching arguments for and against food addiction. These included:

• The implications and tender points of placing mental health labels on eating behavior.
• The support for food addiction including (1) the neurophysiology and psychological alterations that occur with food intake and which impact food behaviors and (2) how hyperpalatable food ignites the brain’s reward and pleasure centers.
• The caveats of notating food as a substance of abuse, such as (1) not accounting for restriction and dieting in food addiction studies, (2) how deprivation affects food behavior in humans and rodents, (3) how pleasure in all forms impact brain processing (not just food), and (4) the dangers of stigma.
• That food addiction has not yet met the criteria to be classified under addictions.

Now, I will continue with the most current and key points for and against a food and eating addiction.

My goal is to educate you on where the science is on this topic and present both sides.

In my next blog, I hope to finish off this subtopic before continuing on with eating disorders.

That being said, here is my review of the current literature…

The First 3 Major Issues with Talking About Food Addiction Summarized

For those who want an overview, or are in a hurry, here’s the condensed version of the caveats of diagnosing a “food addiction”:

1. Distinguishing between food addiction and other eating disorders, as the behavior could be similar, but the treatments would differ.
2. The definition itself has not been agreed upon among experts.
3. Conflicting evidence between mechanisms, theories, and associations in studies and actual human trial results.

Where Does the Research Stand Right Now on Food & Eating Addiction?

Three Major Issues with Labeling Food as Addiction

Below is the in-depth version of three areas of research regarding food addiction.

1. There exists a blur in identifying differences between behaviors of eating addiction, food addiction, and eating disorders.

For example, those with binge eating disorder aren’t necessary “addicted” to a certain food. Rather, it is an underlying behavioral pattern and/or misguided coping mechanism.

According to the 2021 article, “Current Status of Evidence for a New Diagnosis: Food Addiction-A Literature Review:”

… the presence of a behavior (like binging) is not enough to trigger an addictive-like response without the presence of a substance with abuse potential, while the food addiction requires the interaction of certain foods, behavioral patterns of engagement, and individual risk factors for addiction (15). (source)

If this form of eating disorder was misdiagnosed as “food addiction,” and restriction and deprivation as a treatment were prescribed, it could actually aggravate one’s symptoms. According to the Mayo Clinic, when treating binge-eating disorder:

Avoid dieting, unless it’s supervised. Trying to diet can trigger more binge episodes, leading to a vicious cycle that’s hard to break.

(Conventionally, many experts recommend avoidance of “triggers” for those with binge-eating disorders. This also could be perpetuating the issue. See here.)

2. Food has not officially been classified as an addiction and still does not meet all the criteria.

Although the above cited paper argues that there should be enough data to classify food as addictive, there are limitations the author spells out.

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.

Based on these criteria regarding food addiction, the author writes in the conclusion:

a. No agreed upon definition was found in the review and its criteria was inferred from substance abuse:

Food addiction is a controversial diagnosis which is not included in the current classificatory systems created by either American Psychiatric Association or World Health Organization (1, 3). Also, no unanimously accepted, well-defined diagnosis criteria were detected in the literature during this review. However, the vast majority of the found papers used the same criteria for food addiction that are commonly used for substance use disorders. A set of psychometric instruments has been validated (YFAS, mYFAS, YFAS 2.0, YFAS-C) for quantification of the food addiction severity in adult and children populations….

In the body of the paper, it is also stated (bold emphasis and underline mine):

Diagnostic criteria for food addiction have mainly been extrapolated from the DSM criteria for substance dependence, based on the model of a common pathogenetic and clinical background for behavioral and drug addictions (28). The consumption of more than initially desired substance/food, or for a longer period of time, intense preoccupation with the substance/food, craving for specific substance/food, and continuous use despite knowledge of adverse events have been the core criteria for the diagnosis of food addiction.

b. No treatment exists for food addiction. According to the review, “No clinical trial focused on the treatment of food addiction has been identified in the literature, therefore no clear therapeutic recommendation could yet be formulated.”

The author does propose various options based on some understood mechanisms. These include:

• Physiological: “Serotonin, dopamine, and endogenous opioids are considered the main neurotransmitters involved in the dysregulation of eating behaviors, therefore pharmacologic agents targeting these systems have been suggested as possible interventions in food addiction.” (Note: Various health influencers have also advocated for using nutrients for modulating neurotransmitters to “treat food addictions and cravings naturally.”)
• Psychological: Cognitive behavioral therapy and support groups
• Neuromodulation using brain stimulation
• Various behavioral techniques
• Macro-social interventions such as food taxes

None of these therapies have been fully approved and/or agreed upon for “food addiction.”

3. There is conflicting information between mechanistic pathways in studies and human trial results.

Specific pathways have been explored in several clinical trials finding correlations with reward pathways in the brain in those with “obesity” or high food addiction scores. Although this explains the potential pathophysiology that could be linked to making food “addictive,” the literature still has some conflicting information in human trials relating to actual behavior.

The author states the following regarding the mechanisms:

… similar patterns of neural activation have been found in food addiction and substance use disorders, consisting mainly in elevated activity within the reward circuitry in response to food/drug cues and low activity in the circuitry responsible for inhibition of responses to food intake…

Three main mechanisms have been suggested in the pathogenesis of obesity as an addictive disorder: reward dysfunction, impulsivity, and emotion dysregulation

In the cited article, the author further reports that the evidence for sugar addiction is not existent in human trials, even though the mechanisms are enticing. (Although large of amounts of sugar were consumed by rats who were also restricted from its access, this was not substantiated in humans or in rats that had free access to sugar.) (Bold emphasis mine):

In conclusion, sugar recruits a specific dopaminergic circuitry that acts to prioritize energy-seeking over taste quality, and its localization and functioning indicate a possible involvement of the reward system (23). A literature review focused on sugar and food addiction did not find, however, enough evidence to support the existence of sugar addiction in humans, while data from the animal literature suggest that addiction-like behaviors occur only in the context of intermittent access to sugar (as a consequence of limited access to sweet tasting/highly palatable foods, not due to the neurochemical effects of sugar) (22).

As noted in part one and confirmed above, studies on food addiction to sugar do not consider restriction in context to the binge-like behavior. Furthermore, just because substances are rewarding, doesn’t make them addictive or something we should completely abstain from.

Summary on the First Three Key Points in Food Addiction Research

I have done my best to summarize some major sticking points in the food addiction theory.

To be transparent, my bias is very much cautionary on labeling food or eating behaviors as an addiction. Unlike a substance of abuse, food is essential for life.

Though some nutritional and fitness influencers may disagree, I believe we need a balance and variety of all foods in our diet to thrive physically, emotionally, relationally, and spiritually.

I also feel incredible psychological damage can be done with moralizing food choices and fitness regimes.

Health and wellness incorporate so much more than diet and exercise.

It makes me wonder, does our society really have a food addiction problem, or a soul sickness that is acting out and screaming for attention?

As I previously stated:

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.

One who truly loves and embraces who they are and has a passion and vision for their life will likely choose to make decisions that are nourishing for them.

Do we need to label a means of coping in traumatic and uncertain times as an addiction, or should we view it as a call for help to pay attention to what’s really going on?

We are scared, and controlling food may make us temporarily feel better or divert our attention away from what really is irking us. Food is an easy target to try to control when the rest of the world seems out of control.

Stay tuned for part 3.

A Request:

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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Many blessings.

*Important Note:

If you struggle with mental health, please reach out for professional mental health support.

You may also wish to consider implementing holistic resources and partnering with a naturopathic doctor.

For example, I offer mind-body support for general mood issues using a functional medicine and wellness-oriented approach.