Although there's no universally-agreed-upon definition of addiction, it’s commonly described as a condition in which a person compulsively engages in reward-seeking behaviors, despite negative consequences. For instance, someone addicted to methamphetamine may prioritize seeking and taking the drug over finances, social relationships, health, and overall well-being.
The concept of food addiction (FA) was first introduced by Dr. Theron Randolph in 1956 and has gained research interest since. However, it’s important to note that food addiction isn’t formally recognized as a psychological disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Disease (ICD-11). Consequently, FA remains a contentious and debated concept, lacking verified validity.
Although stimulation of motivational systems in the brain by food is a natural process, and often a healthy one, some researchers argue that certain highly-palatable foods (especially foods that are highly processed and rich in sugar and fat) can overstimulate these systems. In some cases, this overstimulation might lead to an addiction-like response akin to drug dependence. Food addiction may share some behavioral and neurobiological similarities with drug dependence, including neural alterations of impulse control, altered dopaminergic and endocannabinoid reward pathways, and downregulation of the dopamine system.
People with food addiction typically struggle to control their consumption of specific foods, especially energy-dense or highly-palatable ones. Individuals with food addiction usually continue eating despite feeling full and despite the negative effects on their physical and mental health and daily functioning, such as relationships, work, and school performance. Moreover, food addiction is often linked to other health conditions, particularly obesity and eating disorders such as binge eating disorder and bulimia nervosa.
Those affected by food addiction often invest substantial time and resources into their eating habits, sometimes prioritizing food consumption over other activities. Similar to individuals struggling with substance use disorders, people with food addiction experience intense cravings for certain foods, mirroring the cravings experienced by those addicted to drugs.
Food addiction is currently assessed using the Yale Food Addiction Scale (YFAS), a self-report questionnaire featuring 35 questions with responses ranging from ‘never’ to ‘every day’. The YFAS was designed by adapting the criteria for substance use disorder (drug addiction) found in the DSM-5 to the context of addictive-like eating behaviors. Individuals can be defined as affected by food addiction when they meet two or more of the 11 YFAS criteria and experience significant clinical impairment or distress as a result. The YFAS has been tailored for various demographics (e.g., adults, and children) and is available in 13 languages.
An alternative assessment tool for food addiction is the Addiction-like Eating Behavior Scale (AEBS), which doesn’t draw a direct parallel to drug addiction. Instead, this scale evaluates food addiction from a behavioral standpoint rather than a substance-addiction one.
It’s worth noting that not everyone who perceives themselves as addicted to specific foods fulfills the YFAS “diagnostic” criteria. Because self-perceived food addicts may be at risk of developing problematic eating behaviors, diagnostic tools for food addiction may inadvertently prevent individuals in this category from receiving diagnoses and treatments for other eating disorders.
Another limitation of the YFAS is that some studies reported frequent overlaps between positive scores of food addiction and other eating disorders, such as binge eating. Some researchers argue that rather than being considered a separate “disorder,” FA should instead be seen as a mechanistic explanation for binge eating.
Although food addiction is not officially recognized as a medical disorder, there are some treatments and programs available to address it.
One common approach is cognitive behavioral therapy (CBT), a psychological method often used to treat disordered eating, addiction-like behaviors, and binge eating. However, there is still limited research supporting CBT's efficacy in treating food addiction.
Certain medications, like the combination of naltrexone/bupropion or semaglutide, show potential for reducing food addiction scores and cravings. However, there is currently a lack of studies specifically evaluating their effectiveness for treating food addiction.
Additionally, although it does not specifically target food addiction, bariatric surgery (e.g., sleeve gastrectomy) in individuals with obesity has been linked with decreased YFAS scores over 24 months compared to baseline.
One trial has evaluated a probiotic for FA. The participants in this double-blind placebo-controlled RCT were on people with obesity who underwent weight-loss surgery. The study analyzed the impact of 90 days of supplementation with a specific probiotic (Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07) on food addiction and binge eating scores, both 3 months and 1 year after surgery. Both placebo and probiotic groups showed reduced YFAS scores at the 3-month mark. However, those receiving probiotics maintained significantly lower YFAS and binge eating scores 1 year after the intervention. It’s important to note that this study had some limitations: the effectiveness of probiotics was assessed post-bariatric-surgery, not as a standalone intervention, and changes in the gut microbiota were not analyzed.
Diet significantly impacts food addiction, and various studies revealed that a diet rich in highly processed, energy-dense foods may lead to addictive-like eating behaviors.
One study examined the impact of a weight loss treatment (including a portion-controlled 1000- to 1200-kcal diet, behavioral obesity treatments, and some physical activity) on both total food cravings and specific food cravings (e.g., sweets, high-fat foods) among individuals with obesity. The findings revealed that people with YFAS-defined food addiction had higher levels of food cravings at baseline, but YFAS-defined food addiction didn’t significantly impact weight loss after the intervention. Cravings and YFAS symptoms were diminished both in people with and without food addiction. It’s worth noting that this study had a limited sample size, with only 12 out of 178 participants meeting the YFAS food addiction criteria, though, and there was no control group.
Abstinence-based programs called 12-step programs are often offered to people with food addiction. These programs, which are adapted from the 12-step program originally developed for alcoholism, take place over a series of face-to-face or online group meetings aimed at helping people to overcome addiction to specific foods through a support system. In this context, the term “abstinence” doesn’t refer to abstaining from food in general, since one can’t abstain from eating, but to abstaining from specific ingredients (e.g., refined sugar). Although 12-step programs are effective for alcoholism, there is currently limited evidence supporting their efficacy for food addiction.
The exact cause of food addiction is still unknown, and food addiction remains a highly debated topic. However, various hypotheses have been formulated both through preliminary in vivo animal and human studies.
It appears that drug and food stimuli impact similar regions of the brain (e.g., striatum, amygdala, and anterior insula), and share similar reward system pathways (e.g., dopaminergic, opioid, and cannabinoid systems). Notably, downregulating dopamine receptors (for example, by taking certain medications) might disrupt the reward system and trigger food addiction. The endocannabinoid system (ECS) also plays a role in modulating the brain's reward system and in regulating appetite. Conditions such as disrupted lipid metabolism, which is common in obesity, or an increased intake of polyunsaturated fatty acids (PUFAs), which is common in the western diet, can influence the production of endocannabinoids and the expression of cannabinoid type 1 receptors (CB1), which in turn promote both fat mass accumulation and appetite stimulation, the latter of which may lead to overeating. Obesity has been linked to a dysregulated ECS system, which may be influenced by food intake, and appears to be positively correlated with biomarkers of obesity. This suggests that food addiction in people with overweight or obesity could be linked to a heightened reward-system response to high-calorie/highly-palatable foods.
Translating findings from animal studies to human conclusions is complex due to differing brain and body structures and the intricate human food and social environment, but animal studies can suggest pathways that might be involved in food addiction in people; these could then be explored and verified in clinical studies. For instance, rat studies exploring the potential addictive effect of sugar reported specific behavioral and neurochemical changes when sucrose consumption was stopped, including anxiety, nervousness, and an increase in body temperature, which are similar to the changes observed in drug-dependent rats when drug consumption is stopped. Another rat study detected brain activity changes similar to those seen in drug addiction.
Other studies found increasing evidence that food addiction may be connected to a disruption of the gut-brain axis and intestinal dysbiosis, which could have any one of a number of causes (e.g., prenatal and postnatal influences, breastfeeding, environmental factors, diet). Dysfunctional emotional coping mechanisms may also contribute to food addiction. One study showed that people with food addiction displayed significantly higher emotional eating scores, suggesting that eating excessively may be triggered by feelings such as loneliness, anger, fear, or sadness, in an attempt to overcome them.
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