Food addiction–myth or reality?

It is obvious that some Americans have serious problems with food. We eat too much or we eat too little. Big Food bombards us with references to processed food everywhere we go. Even pristine wilderness might assault us with a crumpled, empty beer can. How do we help the victims? Obesity may be a symptom of the American eating problem, but that is only the starting point.

Hooked popularizes the idea that food is as addictive as street drugs. Are Oreos as addictive as crack cocaine. Processed Food Addiction provides evidence for the addictive nature of processed products. It shows how abuse of food by chronic overeaters fits all criteria for a Substance Use Disorder. But is it real? Or are we using the language of drug addiction to describe people with unhealthy eating habits? What type of treatment is available? How successful is it? Before we solve this problem, we need a framework. I present five possible scaffolds for understanding the cause of our problems with my assessment of each.

Weight-loss programs. We used to call these diets. Most of them are restrictive. If we follow one that makes sense, we lose weight. That is, until we reach our weight goal and can’t stand the diet any more. Then we break free. Most of us resume our old habits. The pounds rush back into our bodies. We gain back some, or most, or all of what we lost. We may even overshoot our original weight. Traditional diets don’t seem to work. Diets have morphed into healthy lifestyles or wellness programs. Treatments steer us away from unhealthy foods and practices to healthy ones. These approaches only work if we really want to change and are willing to stick with the program. Welcome to more home-cooked meals, fewer processed foods, and much less eating out. It sounds so easy, but it is so difficult in the fast pace of modern-American life.

plate of pork zucchini and potatoes
Home-cooked meal with an assist from Hello Fresh

Processed Food Addiction shows why these efforts are inappropriate. It is the reason we need to rethink our problem with food. The American Medical Association declared obesity a disease in 2013. Is it actually a disease or a manifestation of metabolic dysfunction? Will declaration of obesity as a disease drive more research funds to the area? Will doctors be able to fight obesity better than changing lifestyles or embracing wellness programs? What or who can we blame? the obese person? processed food? American culture? none of the above?

The effectiveness of weight-loss programs has not kept pace with increased caloric consumption. It does not seem to be anywhere close to solving the problem, much less understanding it. I don’t hold much hope in focusing on weight reduction.

Eating disorders. A second way of looking at food pathology is through eating disorders. Anorexia nervosa is the most common of the six types of eating disorders as listed by the Anxiety & Depression Association of America. It classifies bulimia nervosa as a variant of anorexia. Binge eating disorder overlaps with food addiction, but the approach to treatment differs. Food addiction focuses on abstinent diets to eliminate all packaged food products. Eating-disorder therapy treats the underlying psychological factors before developing specific diets. Both approaches send those with severe problems to residential treatment centers. Steve Bratman introduced a seventh type of eating disorder—orthorexia nervosa. Orthorexia emphasizes healthy foods such that the diet becomes so restrictive it doesn’t provide enough nutrients to maintain good health. DSM 5 does not recognize orthorexia as an eating disorder.

Intuitive eating places the emphasis on individuals to heal themselves. IE focuses on disordered eating and does not mention eating disorders. The problem starts with society inundating us with messages on food to the point of obsession. Health coaches, rather than practitioners, work with the person to help break out. IE does not restrict specific foods. Rather it permits all foods in the context of healthy eating patterns. There are many triggers in our culture that feed a food obsession. IE adheres to ten principles to guide food-obsessed persons. Through these principles followers work to conquer their unhealthy relationship with food. American society is the source of triggers for these obsessions such as this apparently innocuous video. Food marketing and books emphasizing the importance food in our lives, are to blame. Even university classes in nutrition or food science and food blogs are potential triggers.

blue and red M&Ms wave to the audience with stars and stripes in the background
Ads on tee-shirts can serve as addiction triggers

Processed Food Addiction makes a compelling case for the addictive nature of foods. For the first 150 pages or so, I remained skeptical that it was addiction. The chapters on the DSM 5 criteria started to convince me that there was some merit to their argument. The case study by a recovering food addict (1) and the almost 200 testimonials were compelling. When equating dangers of processed foods and street drugs, I became more skeptical. Claims that processed food addiction was a Substance Use Disorder (SUD) caused me to push back. Yes, processed foods are substances, but all SUDs accepted by DSM 5 link to specific chemicals.

chemical structure of fructose
Fructose
chemical structure of caffeine
Caffeine

Dairy, fat, flour, gluten, and polysubstances are offered as addictive components of processed foods. These broad groups of compounds are not specific enough.  Do any of them measure up to the potency of cocaine, meth, morphine, or other drugs? Fructose and caffeine are possible addictive chemicals. No specific testing of fructose as an addictive agent is evident. Caffeine has already been excluded as a Stimulant Use Disorder by DSM 5. Isolate and identify of specific chemicals tied to a Food Use Disorder, and I will change my mind. Note, neither Hooked nor Processed Food Addition mention chemical dependence. That is because food addiction as described in these two books does not induce chemical dependence.

Eating addiction is another possibility. Both Hooked and my book mention the possibility. Everything in Processed Food Addiction still applies to an eating addiction. The disease becomes a Process Use Disorder (PUD) instead of a SUD. Throughout both books we read the phrase chronic overeating. Here the sugar-fat connection makes sense (2). It is the combination of a small number of sugars and a wide range of fat molecules. Think chocolate products (anything less than 80 % cacao), ice cream, and pastries.

Hyperpalatable foods trigger food addiction as advanced by Gearhardt et al. (3). To me, the Criscitelli & Avena chapter (2) combined with the Gearhardt article (3) make a much stronger case for an eating addiction than for a food addiction. What’s the resistance to a PUD instead of an SUD? I can only speculate. Tying a food addiction to drug abuse is compelling in popular media. Tying an eating addiction to gambling, sex, and videogame addictions, not so much. By the way the dopamine pathway (4) and neuroimaging (5) are indicators of PUDs as well as SUDs.

Moving forward we await the judgement of DSM 6. The best estimate for release of the next version is between 2023 and 2028. A revision of DSM 5 may come out as early as later this year. Don’t expect me to rush out and buy one with an estimated price tag of $45,000. The American Psychological Association publishes the DSM. I expect this decision to be a controversial one. Opponents of industrial food production will line up against drug specialists. Expect drug practitioners to adhere to a chemical basis for Substance Use Disorders. Will DSM 6 compromise to call it a Process Use Disorder? Until then research will continue in all areas to provide a clearer decision.

Myth or reality? With respect to a processed food addiction, ‘myth’ is too strong a word. So is ‘reality’. Something is going on in our relationship with food. An eating addiction is a much more credible framework for study than a food addiction.

References

(1) Gold, N., 2018. Case study: Severe processed food addiction. Processed Food Addiction 147-155.

(2) Criscitelli, K. and N.M. Avena, 2018. Sugar and fat addiction. Processed Food Addiction 67-75.

(3) Gearhardt, A.N., C. Davis, R. Kuschner, and K.D. Brownell, 2011. The addiction potential of hyperpalatable foods. Current Drug Abuse Reviews 4(3): 140-145.

(4) Linnet, J. 2020. The anticipatory dopamine response in addiction: A common neurobiological of gambling disorder and substance use disorder. Progress in Neuropharmacology & Biological Psychiatry 98, 2020, 109802. https://doi.org/10.1016/jpnpbp.2019.109802

(5) Klugah-Brown, B., X. Zhou, B.K. Pradhan, J. Zweerings, K. Mathiak, B. Biswal, and B. Becker, 2021. Common neurofunctional dysregulations characterize obsessive-compulsive, substance use, and gaming disorders—An activation likelihood meta-analysis of functional imaging studies. Addiction Biology 26:e12997. https://doi.org/10.1111/adb.12997

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