Written by Sioned Bryant
The concept of food addiction is a highly controversial topic. We usually associate the term 'addiction' with illicit drugs and alcohol, so how can food (something we must eat every day) be grouped with substances that can have such a negative impact on our health?
What is addiction?
‘Addiction’ is a commonly used term despite there being no established consensus on its clinical definition. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) refers to addictions as severe substance dependence, however, behavioural addictions have gathered momentum recently and the latest DSM review included a chapter on ‘Substance-Related and Addictive Disorders’ (1).
Addiction is defined as:
a process by which a behaviour is utilised to provide both pleasure and relief from internal negative affect (2).
The behaviour is characterised by recurrent failure to control or stop and;
a persistence of the behaviour despite negative consequences.
Everyday behaviours that can be abused or used to excess, with physical and psychological impacts are gaining attention as to whether they can be considered behavioural addictions. For example, exercise is unarguably good for our health. However, it has the ability to become unhealthy or compulsive exercise when it becomes a strategy to compensate for eating or when it is bound by strict rules that prevent you from socialising or engaging in other daily activities.
What is food addiction?
Food addiction is a controversial topic that has gathered increasing attention in recent years. The obesity epidemic and rise in eating disorders have raised questions around food addiction and the psychological drivers and triggers underlying overeating and its relevance to public health.
Food addiction refers to the excessive and dysregulated consumption of food that is high in sugar, salt and fat (3). Currently, only ‘pathological gambling’ (a recognised mental disorder for gambling) is included in the addictive disorders chapter of the DSM-5, however, interestingly compulsive overeating is being considered for the next edition.
Is food addiction an eating disorder?
Binge eating disorder (BED) and bulimia nervosa (BN) are the eating disorders that have been considered to exhibit features of food addiction (4, 5). Both BED and BN are characterised by binge eating episodes. These episodes are often experienced as ‘out of control eating’ and involve the consumption of an objectively large volume of food, between 2000 – 6000 kcal, within a discrete time period (2 hours) (6). Currently, food addiction as a stand alone diagnosis is not considered an eating disorder.
What evidence is there for food addiction?
Neuroimaging studies have revealed that highly palatable foods have the ability to activate the dopamine reward pathways in the brain and addictive potential (7). The Yale Food Addiction Scale (YFAS) was developed in line with the 11 substance-related and addictive criteria of the DSM-5 to assess the dependency that can occur in the context of food and eating behaviours (8). Food addiction has been recognised and researched extensively in obesity, BED and BN, revealing that overeating behaviours in these clinical populations are characteristic to substance-use disorder at both the behavioural and neurological levels (9).
One study revealed that all bulimic participants met the criteria for food addiction by the YFAS (5). Additionally, only 30% of participants with a history (but no current pathology) of bulimia nervosa met the food addiction diagnosis, suggesting remission of the eating disorder was accompanied with a remission of addictive behaviours. Substance and alcohol abuse are chronic and incurable brain diseases that can only be treated with complete abstinence (10). This is not a feasible approach to, and most definitely not a recommended approach, to the treatment of compulsive eating.
What implications does this have for treatment of BN and BED?
Currently cognitive behavioural therapy (CBT) is the recommended first line treatment for BN and CBT self-help programmes are recommended as the first line treatment for BED (11). If one is to conceptualise binge eating in the framework of addiction, then this has implications for the course of treatment and management. The use of treatment approaches that target addiction or pharmacological treatments with dopaminergic effects may prove beneficial. However, this area requires far more research to determine whether this would be appropriate and have a positive impact on the lives of those who suffer with binge eating and addiction-like eating behaviours.
At TC Nutrition, our registered eating disorder dietitians can support you to repair your relationship with food, find balance and move away from compulsive eating behaviours. Get in touch to book a 15 minute discovery call for free and find out how we can support you.
Sioned Bryant
Guest contributor
Follow Sioned on Instagram @life_of_bry-_
REFERENCES:
1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5 (R)). 5th ed. Arlington, TX: American Psychiatric Association Publishing; 2013.
[2] Goodman A. Addiction: definition and implications. Addiction. 1990;85(11):1403–8.
[3] Imperatori C, Fabbricatore M, Vumbaca V, Innamorati M, Contardi A, Farina B. Food Addiction: definition, measurement and prevalence in healthy subjects and in patients with eating disorders. Riv Psichiatr. 2016;51(2):60–5.
[4] Adams RC, Sedgmond J, Maizey L, Chambers CD, Lawrence NS. Food addiction: Implications for the diagnosis and treatment of overeating. Nutrients. 2019;11(9):2086.
[5] Meule A, von Rezori V, Blechert J. Food addiction and bulimia nervosa: Food addiction and bulimia nervosa. Eur Eat Disord Rev. 2014;22(5):331–7.
[6] Gearhardt AN, Corbin WR, Brownell KD. Food Addiction. Journal of Addiction Medicine. 2009;3(1):1-7
[7] Gearhardt AN, Corbin WR, Brownell KD. Preliminary validation of the Yaloe Food Addiction Scale. Appetite. 2009; 52(2):430-436
[8] Adams RC, Sedgmond J, Maizey L, Chambers CD, Lawrence NS. Food addiction: Implications for the diagnosis and treatment of overeating. Nutrients. 2019;11(9):2086.
[9] Meule A, von Rezori V, Blechert J. Food addiction and bulimia nervosa: Food addiction and bulimia nervosa. Eur Eat Disord Rev. 2014;22(5):331–7.
[10] Berridge, KC. Is Addiction a Brain Disease? Neuroethics. 2016; 10(1):29-33
[11] Nice.org.uk. 2021. Overview | Eating disorders: recognition and treatment | Guidance | NICE. [online] Available at: <https://www.nice.org.uk/guidance/ng69> [Accessed 5 September 2021].
Talia Cecchele Nutrition is a team of registered dietitians that specialise in eating disorder recovery, disordered eating, digestive issues and sports nutrition. We aim to bring balance back to nutrition, help you to break free from food rules and find food freedom. We offer virtual consultations and group programs so whether you are based in London, the United Kingdom or around the world we would love to support you. To enquire about a private consultation please fill out a contact form.