Processed food is addictive—as addictive as crack cocaine! Or so we read on the net. Is it really? Or are these stories only click bait? Do they represent serious journalism? Or have we lost all sense of proportion? Hooked by Michael Moss and The End of Craving by Mark Schatzker are popular versions of the idea. A recent scientific book, Processed Food Addiction, edited by Joan Ifland supports the concept of addiction while eating. Brownell and Gold, editors of Food and Addiction were early adopters. Schatzker describes the dependence as an eating addiction. The other authors favor the concept of a food addiction. Why the disagreement? Does it matter? Yes, it does. I view an addictive relationship with food as an eating addiction.
Fat or obese? First, let me mention terminology. Fat has taken on a stigma that calls for limits on its use. Obese seems a more clinical and acceptable term. Fat warriors like Aubrey Gordon, embrace the term. Many of us prefer obese because it is a medical designation that doesn’t apply to us. We are in denial when our doctor claims that we are obese and need to lose 10, 20, or 30 pounds just to get down to being overweight. We don’t look at all like those obese people on TV any time there is a news story on obesity. That stock footage used by every network and local channel highlights extreme obesity not typical obesity.
Webster’s defines obesity as “a condition characterized by the excessive accumulation and storage of fat in the body.” BMI is the easiest and least effective way to measure obesity. To qualify as extremely obese, one must have a BMI over 40. The cutoff for obesity is 30. Waist circumference is a more reliable measure. At or above 40 inches in men or 35 inches in women makes us obese. An even better measure is percent body fat. Men are obese when body fat exceeds 25%; women when over 32%. I find myself at the borderline of normal and overweight by BMI. Waist circumference declares me overweight. I have no idea of my % body fat. I would rather you call me fat than obese.
Food addictions are Substance Use Disorders. Does food addiction lead to obesity? Could we decrease the prevalence of obesity in society by decreasing food addiction? It is not clear how many food addicts become obese if food addiction really exists. At present food addiction is a hypothetical construct. Examples of substances causing SUDs are alcohol, hallucinogens, marijuana, nicotine, opiods, sedatives, and stimulants. Stimulants include cocaine and methamphetamine but not caffeine or sugar. To qualify as a substance, the addictive agent must be a specific chemical or family of chemicals.
Addictive foods are known as hyperpalatable foods. A broad category of products does not qualify as a chemical dependency. The closest chemical posing as an addictive agent is sugar. If sugar is addictive, wouldn’t sugar in fruit or home-baked goods also be addictive? We need glucose in our blood and in the brain. I know of no essential nutrient that is also addictive. Declaring food addiction as a Substance Use Disorder needs redefinition of the word substance.
Eating addictions are Process Use Disorders. Process Use Disorders recognized by DSM-5 include addictions to gambling and video games. In a Process Use Disorder specific foods or a family of foods do not create dependency. It would be an uncontrollable urge to overeat. Hyperpalatable foods might fuel the compulsion. It is the behavior and not the chemical stimulation that is addictive. In an eating addiction, the food of choice may not even be hyperpalatable. Eating addictions are more like eating disorders such as bulimia and binge eating than dependence on crack cocaine.
Why does it matter? I am not sure how the type of addiction affects how much fatter America will get. Overeating over time results in weight gain and obesity. The exception would be a pattern of binge and purge. Understanding the root cause of a disorder or addiction informs treatment protocols. In some cases, treatment may be similar for a food addiction and an eating addiction. In others, very restrictive diets could make recovery more difficult. Intuitive eating or mindfulness while eating would be more effective in treating an eating addict than in treating a food addict. I am not sure that being called an addict eases the stigma associated with being fat or obese.
The reason for favoring a food addiction over an eating one may be selling it to the American public. Association with drugs prompts more sympathy for those affected than association with gambling. Big Food becomes less of a target in an eating addiction than a food addiction. Mass marketing puts tempting food images in front of any consumer of news or social media. Such images target both types of addicts. Many Americans have an unhealthy relationship with food. The sooner we can find root causes and treat them, the sooner we can improve the health of our nation.
Next week: Food in the news