Food Addiction 101

Like any kind of addiction, an addiction to food (which can also include beverages such as soda) typically involves a complex interplay of biological, psychological, social, genetic and environmental factors. Although the concept of food addiction has been around since the late 1950s, the understanding of it has increased dramatically in recent years thanks in large part to two developments – the creation of the Yale Food Addiction Scale (YFAS) and imaging technology that allows medical experts to look inside the living brain. With these tools, it has become possible to create a standardized way to identify people with an addictive response to food and to see activity in the brain’s reward centers and in the prefrontal cortex, which is where the ability to rein in impulsivity and control addictive behavior starts.

When it comes to food addiction, you should know:

  • Not everyone who is overweight has a food addiction and not everyone who has a food addiction is overweight. However, food addiction is believed to play a role in the rising obesity epidemic. In one study, more than 80% of those identified as food-addicted were overweight or obese.
  • Factors like a poor diet, trauma (such as being abused or otherwise experiencing violence), stress and impulsivity may increase the risk of developing a food addiction. In addition, researchers have found that those with high scores on the YFAS are likelier to strongly anticipate eating, which may make these individuals more susceptible to “food cues,” whether the smell of fresh bread or an advertisement for candy.
  • Because there’s no consensus as to what food addiction is, researchers and treatment providers generally rely on the YFAS to determine if a person qualifies. A loss of control over food and a preoccupation with it are key indicators.
  • A variety of treatment options is available for those struggling to overcome a dependence on food, including support organizations (like those founded on 12-step principles), residential and outpatient care, workshops, nutritional education and therapy. (See Treatment for more on this.)

Causes

There are no easy answers when it comes to how any addiction develops, and food addiction is no exception. That said, research that’s been done to date points to several factors behind an addiction to food or drinks, including:

Neurology: Our brains reward us with a neurochemical cascade of pleasure when we eat. This primal scenario worked well up until a few decades ago; for most of the time humans have been around we’ve consumed primarily whole foods with only the occasional treat. Today, though, we’re surrounded by processed, refined and manufactured foods that overstimulate the brain’s reward center; for those with a brain that’s vulnerable to a food addiction these foods launch a vicious addictive eating cycle. As Michael Moss writes in his book, Salt Sugar Fat: How the Food Giants Hooked Us, the food industry deliberately engineers products that achieve a “bliss point,” creating extremely rewarding combinations of the hyperpalatables – sugary, fatty, salty food combinations – to encourage overeating.

Psychology: For those with addictive tendencies, managing life’s stresses and challenges isn’t just tough, it can seem impossible to do without turning to an addictive substance or behavior for solace. When confronted with painful emotions, the food addict is likely to self-soothe with “comfort” foods, typically those same hyperpalatables. The result can be a destructive cycle of eating that gives only short-term relief before being replaced by feelings of shame, blame and guilt – emotions that can trigger more eating. Out-of-control eating can also grow out of a mental health issue such as depression and anxiety disorder, as well as past trauma.

Genetics: Studies over the past few decades have found increasing links between genes and eating patterns associated with food addiction. In the early 1990s, for example, research revealed that a group of obese study participants had the same D2 dopamine gene marker found in those with drug or alcohol addictions. At the time, it was proclaimed “the obesity gene,” but the study’s lead author, Dr. Ernest Noble, later explained that the obesity was likely a secondary result of food addiction, and a better name would be “the food addiction gene marker.”

According to the National Institutes of Health, about 40% to 60% of addiction risk is attributable to genetics, but we now know that DNA is not destiny. Lifestyle and environment can influence how a gene functions, which means that everything from the food we eat and the exercise we get to the stress we feel and the pollution we’re exposed to can change a gene’s expression. Poor choices, such as eating lots of sugary snacks, for example, have the potential to “switch on” genes related to obesity and addiction, notes scientist and nutrition expert Dr. Pamela Peeke in her book The Hunger Fix. On the plus side, efforts to improve diet and environment can do the opposite – enhance the functioning of good genes and dampen the bad.

Another Addiction: It’s not uncommon for someone to reach recovery from drugs or alcohol and to develop a “cross” or “transfer” addiction to foods that are high in fat, salt and especially sugar; the result is often weight gain. For this reason, more addiction treatment facilities are now beginning to add nutrition programs.

Symptoms of Food Addiction

Because the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the handbook of psychiatric disorders used by mental health professionals, doesn’t recognize food addiction as a disorder, this reference naturally doesn’t include diagnostic criteria either. Currently, the best source to determine whether a person’s eating patterns share similarities to an addiction is the Yale Food Addiction Scale (YFAS), a scientifically recognized tool based on the substance dependence criteria found in the previous edition of the DSM. The YFAS survey includes over two dozen questions about your (or a loved one’s) eating habits in the last year, including how often:

  • You ate more food than you intended to.
  • You attempted to quit overeating but were unsuccessful.
  • Food caused a physical problem or made one worse.
  • Eating took precedence over obligations and social commitments.
  • Your eating pattern continued despite negative consequences.
  • You needed more food to achieve the same sensation.
  • You felt withdrawal symptoms such as anxiety and agitation when a problem food was withheld.

If you think you or a loved one may have a problem with an addiction to food, taking the YFAS survey can be a good first step in identifying a possible issue. (You can find an abbreviated version of the test here.) Talking to a health care professional, physician or therapist may be worthwhile; each can help you or your friend or family member get on the road to healthy eating and recovery.

Risk Factors

Anyone of any size, shape or gender can be affected by food addiction, but there are factors that can increase your or a loved one’s risk. These include:

Trauma: Having experienced physical or sexual abuse in childhood can dramatically boost the chance of developing a food addiction. In one study, those who reported both severe physical and sexual abuse had a 90% increase in the risk of becoming addicted to food. Research also shows a link to post-traumatic stress disorder (PTSD): One study of nearly 50,000 women between the ages of 25 and 42 found double the prevalence of food addiction in those with severe PTSD.

Sugar, Fat and Salt: Eating the so-called “hyperpalatable” foods can make your brain want more of them. One study in the American Journal of Clinical Nutrition showed that foods with a high glycemic index, such as a milkshake or white bread, dramatically boost activity in the region of the brain involved in addiction.

Being Overweight and/or Having an Eating Disorder: A recent roundup of studies involving food addiction as measured by the Yale Food Addiction Scale shows food addiction is twice as prevalent in those who are obese or overweight and more than four times as common in those with disordered eating, such as binge eating disorder or bulimia.

Reactivity to Food Cues: Those who develop food addictions may be more affected by food cues, such as food-industry advertising that’s all around us. In one study, those with a high score on the YFAS had the same kind of neural responses to a picture of a milkshake that drug-dependent people demonstrate when shown images of drugs of abuse. Interestingly, though, actually drinking the milkshake corresponded with less reward response in the brain. That’s led some researchers to theorize that those who develop food addictions may be overeating in an attempt to make up this “reward deficit” – the difference between the pleasure they anticipate and the pleasure they actually feel.

Impulsivity: Researchers know that impulsive personality traits, such as difficulty sticking with a task or exhibiting self-control, often play a role in drug and alcohol addiction. A 2014 study shows the same appears to hold true for food addiction.

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