If the Hatfield and McCoys were still feuding, I’m sure they’d love to discuss food addiction. Researchers, clinicians, and people affected by compulsive overeating argue about whether it exists and what to do about it.
Why all the Fuss?
Animal research suggests that highly palatable food can impact pleasure centers in the brain similarly to drugs of abuse. In fact, rats prefer sweetened water over cocaine, even after extended self-administration of the drug. Studying addiction in humans is much more difficult to do in controlled settings. But we do have the benefit of talking to people, whereas discussions with rats are a bit harder. Clients I work with often tell me they’re addicted to carbohydrates, sugar, potato chips, soda, or chocolate. Others simply tell me they’re “addicted to food.” Although some people do overeat healthier foods, most folks who binge eat, engage in high-volume grazing, or drink large amounts of liquid calories, choose highly processed foods with just the right amount of added fat, sugar, or salt. Asparagus, lima beans, and fresh peaches aren’t usually the problem.
But our bodies are designed to crave calorie-dense foods. Historically speaking, we’ve needed to have extremely high motivation to hunt, gather, prepare, and process foods. If not, our laissez-faire approach to food would have led to starvation and extinction. So, can we be addicted to something we can’t survive without and multiple neuroendocrine systems push us towards? Is saying we’re addicted to food sort of like saying we’re addicted to oxygen or water? Food addiction is a unique concept compared to drug addictions because we are not hard-wired to begin using drugs like we are to consume food. For that reason, and the observation that physical withdrawal related to food addiction is generally mild compared to withdrawal from drugs such as alcohol or heroin, some place food addictions into the "behavioral addictions" category alongside gambling, sex, shopping, etc.
Some scientists argue that food addiction is really just extreme binge eating disorder, something already accepted as a condition. “Much of the research shows overlapping features of binge eating disorder and measures of food addiction,” according to Dr. Valentina Ivezaj, a colleague and friend of who studies eating pathology at Yale University. “Some people argue that what is thought of as food addiction could be classified as a more severe variant of binge eating disorder,” she said. But as she pointed out, this observation doesn’t mean food addiction doesn’t exist.
Food Addiction Symptoms
Addictions are often described as a condition that progresses from impulsive (acting without thinking about negative consequences) to compulsive (repetitive, rule-driven behavior). Addiction generally has three stages: preoccupation/anticipation, binging/intoxication, and withdrawal/mood changes. In research circles, food addiction has generally been assessed by the Yale Food Addiction Scale (YFAS) which has questions related to desire, cravings, attempts to stop, time consumption, social/occupational consequences, withdrawal, amounts of food eaten, and overall distress caused by behavior.
Does it Matter What We Call it?
To me, the main reason the classification matters is related to how we treat it. Most drug addiction treatments focus on abstinence. But research with binge eating suggests that if we overly restrict calories, binge eating is more likely. Likewise, too many food rules can lead to restraint fatigue and overeating of trigger foods. Since foods are so variable and frequently combined, overly simplistic approaches often fail. Deciding sugar is the problem, and that you must eliminate all of it from your diet, may not lead to success. What about the sugars that are naturally found in fruit and vegetables--will that lead to a reaction? If you accept that you are addicted to carbohydrates, that means eliminating all foods except protein and fat. It’s a slippery slope. In most cases I try to help clients determine the factors that influence their urges and discuss their long-term goals about including certain foods in their diet. Cutting out all added sugar is tough (canned corn, a slice of bread, salad dressing), but deciding to at least temporarily stop eating doughnuts may be a bit more realistic.
A previous client who is in long-term recovery for alcoholism and has been managing her obesity for many years told me that she could not moderate her drinking--she needed to totally abstain. In contrast, moderation approaches with eating have been helpful for her. Total abstinence with food only fuels all-or-nothing thinking that has time after time caused her to fall back into unhealthy eating practices when she couldn’t maintain her perfection.
Abstinence in Special Circumstances?
I generally ask clients to consider abstinence in at least one instance--when they drink multiple sugar-sweetened beverages daily and describe it as an addiction. In this situation, I feel abstinence is often the best long-term goal. Sugar sweetened beverages are not filling and lead to overconsuming calories, especially among those with obesity. Trying to simply “cut back” often leads to falling back into old patterns of behavior. Since it’s a beverage, it is much more black and white than things we put on a plate. Either it’s a sugar sweetened beverage or it’s not. Foods have more ingredients and combinations of nutrients and are harder to classify as healthy or unhealthy.
When it comes to food addiction, Dr. Ivezaj put it best, “No matter how we classify it, people are suffering with this condition. Professionals need to listen and individualize strategies to help.” We also need to continue studying the underpinnings of overeating while at the same time developing effective treatments. If you or someone you care about struggles with what you consider a food addiction, I’d love to hear from you.