Is food addiction real?

In my work in weight management, I’ve often heard people label themselves as “chocoholics” or “carb addicts.” They describe the experience of irresistible cravings and feeling out of control around certain foods in a way that does bear some resemblance to what we might hear from someone hooked on drugs or alcohol. But are they speaking metaphorically or do they really view themselves as addicts? The question of whether some people become addicted to certain types of food is currently receiving some serious attention from highly respected researchers.

The American Medical Association’s decision earlier this year to declare obesity a disease stirred some controversy. Many still believe that obesity is just the result of bad choices and lack of willpower, and should be addressed by the individual taking personal responsibility for weight by eating less and exercising more. Certainly, behavior change can result in successful weight loss, but it may also be true that there is an addictive process at work in some individuals that makes the accomplishment of such changes tremendously more challenging.

Defining addiction

If we are going to apply the construct of addiction to food, it’s helpful to look at the factors that we examine when we assess drugs or alcohol dependence. These include: developing a tolerance to the substance and having a withdrawal response when the substance is stopped; unintentional overuse; repeated unsuccessful attempts to cut back; preoccupation about the substance; problematic effects on relationships, social activities or work; and continued use despite negative physical or psychological consequences. For an alcoholic or drug addict, success would generally be considered achieving total abstinence from the substance that has led to such negative consequences. But we can’t completely give up food, can we?

Addicted to veggies? Not likely

Kelly Brownell, Ph.D, is one of the country’s leading experts on obesity and public health policy on issues related to food. In a New York Times article last year, he said, “We don’t abuse lettuce, turnips and oranges. But when a highly processed food is eaten, the body may go haywire. Nobody abuses corn, as far as I know, but when you process it into Cheetos, what happens?” So, the application of the concept of addiction to food is not referring to all food, but rather to certain types of what the researchers label “highly palatable foods.” Translation: foods that are high in the tempting trio of salt, sugar or fat. As easy access to highly processed, inexpensive junk food has increased, so have rates of obesity in the U.S. and around the world.

The science of food addiction

Dr. Nora Volkow is director of the National Institute on Drug Abuse (NIDA). Dr. Volkow’s work has included the use of PET scans to compare the neurological responses of some obese individuals to food with that of drug addicts, and she has found some striking similarities in the reaction of the brain’s “reward circuits.”

A group of researchers in Dr. Brownell’s group developed the Yale Food Addiction Scale, looking at signs of substance dependence in eating behaviors. They also used brain imaging to take a closer look at the reactions of individuals who scored high on their food addictions scale, and found similar patterns as those seen among substance abusers.

Do I need “food rehab?”

Research on food addiction is relatively new, and there’s a lot that we don’t know. However, if you feel that there’s an out-of-control quality to some of your eating, then that might be a helpful thing to look at. Notice what foods or types of food seem to be triggers for you. You might decide to experiment with attempting to abstain from certain foods for a period of time and see how you feel if you are able to do that. Some people report that cravings decrease over time if they avoid the target food completely, but will quickly return if they eat it again. The organization Overeaters Anonymous was founded over 50 years ago using a twelve-step model to support the efforts of individuals who identify themselves as compulsive eaters. Each of us is different and our solutions will be different as well.

New directions for treatment

Help for problematic eating behaviors can currently be found in a variety of health care disciplines. Registered dietitians can assist in the assessment and modification of dietary concerns. Psychologists and other mental-health professionals focus on social and emotional triggers for eating and strategies for behavior change. Physicians may prescribe medications that suppress appetite or reduce cravings. Professional- or patient-run support groups bolster efforts to change in an atmosphere of acceptance and safety. Continued research on neurological responses to food may open new doors in the development of therapies to address addictive eating, just as it has guided the development of medications used to treat drug addiction. While we wait for those new options, we can still move forward to make difficult changes, one step at a time.