Food Addiction: The science shows us it's not a thing.
There has been a lot of controversy on the idea of food addiction. This annotated bibliography address the controversy. It is my understanding that based on the research presented below that at this point in time it is inappropriate to diagnose an individual with a food addiction. Rather, a clinician should explore the possibility that what might be classified as a food addiction may be more properly diagnosed as binge eating disorder. This is important because the treatment for a food addiction and an eating disorder may vary, and eating disorder treatment has been researched and backed empirically. As mental health professionals, we have the obligation to make informed best practice decisions to assist our client’s recovery, so a proper diagnosis and treatment plan is most appropriate.
Franklin, J. C., Schiele, B. C., Brozek, J., & Keys, A. (1948). Observations on human behavior in experimental semi starvation and rehabilitation. Journal of Clinical Psychology, 4(1), 28-45.
Ancel Keys, a professor at the University of Minnesota, worked during World War II along with Josef Brozek, a PhD in the University of Minnesota’s lab, two of the key researchers of this study who later used their findings to publish “The Biology of Human Starvation”. This study was intended to assist the US Department of Defense with understanding the dietary restraints during the war. The Minnesota Starvation study was done in in 1948, yet it’s recognized and cited to date. The participants in the study presented with healthy behaviors around food prior to the experiment, and at the conclusion of the study there was a significant shift in their behaviors towards food. Although the experiment concluded, and they had unlimited access to food the men reported they were constantly hungry, they overate to the point of feeling sick – some needing hospitalization. Essentially, these men had developed similar behaviors to qualify as “severe” on the Yale Food Addiction Scale, although they were merely reacting to a period of semi-starvation, not addiction. This sheds light on what factors drive a person to feel compulsive around food.
Gearhardt, A. N., Corbin, W. R., & Brownell, K. D. (2009). Yale Food Addiction Scale. New Haven: Yale Rudd Center for Policy and Obesity.
The Yale Food Addiction Scale was developed by Dr. Ashley Gearhardt a graduate of Yale University and is currently an associate professor at the University of Michigan; William Corbin is a professor of psychology at ASU focusing on alcohol addictions; and Kelly Brownell, a clinical psychologist and professor at Duke University focused on the prevention of obesity. The YFAS is a scale of 25 questions based on DSM criteria for substance use disorders intended for individuals to gauge a possible food addiction. The YFAS does a good job of detecting if someone has an issue with food, however food addiction might be a misclassification of the issue as noted in the study done by Ziauddeen, H., & Fletcher, P. C. (2013). “Is Food Addiction a valid a useful concept?” Every single statement listed on the YFAS can be marked by someone who is diagnosed with Binge Eating Disorder.
Gearhardt, A. N., Grilo, C. M., DiLeone, R. J., Brownell, K. D., & Potenza, M. N. (2011). Can food be addictive? Public health and policy implications. Addiction, 106(7), 1208-1212.
Dr. Ashley Gearhardt a graduate of Yale University and a current associate professor at the University of Michigan; Kelly Brownell, a clinical psychologist and professor at Duke University; Ralph Dileone a professor of psychiatry and neuroscience at Yale University; and CM Grilo, professor of psychiatry at Yale University and Director of the Program for Obesity Weight and Eating Research, published this paper to validate food addiction. They hoped to use their findings to shift public policy around food to save on health costs linked with obesity. The authors of this study reasoned that if policy change force marketing teams to advertise foods differently, similar to how Tobacco laws worked to prevent cigarette use, it can prevent the “obesity crisis”. They compared drug studies performed on rats with food studies, and found a correlation between how both substances hijack brain circuitry. The science cited is viewed as weak by the studies conducted by Ziauddeen, H., & Fletcher, P. C. However strong the desire the study’s authors were to establish food addiction, the study states that a major limitation of the research is that food is necessary for survival, unlike tobacco or drugs.
Ziauddeen, H., & Fletcher, P. C. (2013). Is food addiction a valid and useful concept?.obesity reviews, 14(1), 19-28.
Hisham Ziauddeen is a senior research associate of psychiatry in Cambridge; and Paul Fletcher is a cognitive neuroscientist at Cambridge University. The two researchers use this study to approach the food addiction model from a neuroscientific perspective to satisfy the growing debate of the validity of food addiction. They found that in drug addiction the brain needed to increase the intensity of the drug to have the same striatal D2 receptors to attain the same reward, but the same was not true for food. This piece is important in understanding the science to back food addiction because if this was the case then food addicts would report trying to attain a food induced high with higher concentrations of a substance, like straight sugar vs a donut. This was further confirmed by a later study done by Ziaudden and Fletcher again three years later along with Westwater titled Sugar addiction: the state of the science, where they once again could not link the neurochemical effects of sugar to a food addiction model.
Westwater, M. L., Fletcher, P. C., & Ziauddeen, H. (2016). Sugar addiction: the state of the science. European journal of nutrition, 55(Suppl 2), 55-69.
Margaret Westwater is a PHD student at Cambridge University working along with Paul Fletcher, a cognitive neuroscientist at Cambridge University, and Hisham Ziauddeen, a senior research associate of psychiatry in Cambridge use this published article to analyze the current research on Sugar Addictions. They find that the rat studies done to prove sugar addiction are flawed when applied to human beings. Particularly because during the study the rats subjects were not allowed sugar or chow for either a 12 or 24 hour period and were then only intermittently given access to food. This once again shows the strong biological affect that restriction has on rats or human alike, as studied in the Minnesota starvation study. They also point out that the animal test subjects were tested with pure sugar which is quite different then the high sugar content foods listed as the criteria for the YFAS.
Tribole, E., & Resch, E. (2012). Intuitive eating, (pp 73-91). Macmillan.
Evelyn Tribole and Elyse Resch are both Registered Dieticians who authored the revolutionary non-diet approach to eating, known as Intuitive Eating, for individuals who feel compulsive around food. In the Chapter of the book titled “Make Peace with Food”, they suggest that the process to reduce food cravings and eliminate feeling out of control around food is to allow oneself to eat those foods they crave, referred to as the Habituation Response. This works to reduce compulsive eating because they found that as an individual eats the same food over and over, the food loses its appeal. This is significant because this shows the very opposite of what Volkow, Knoob and McLellan explain in their research that as a chemically dependent brain increases in use, this increases tolerance, withdrawal and dysphoria, which is dangerous for an individual. The treatment for drug and alcohol addiction is necessitated by abstinence, where compulsive eating is treated with increased exposure.
Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371.
This article was researched and written by Nora Volkow a renowned researcher and current director of National institute on Drug Abuse, George Koob current director of the National Institute on Alcohol Abuse and Alcoholism, and Thomas McLellan a previous deputy director of the office of national drug control policy. This article goes deep into the neurological affects that drugs have on the brain to understand addiction as a brain disease. This article supports what Ziauddeen, H., & Fletcher, P. C. have concluded as well around the brains reactions to drugs, particularly around cravings, tolerance and withdrawal. A person with a drug addiction are in pursuit of a dopamine reward, causing cravings. However the degree of reward is lessened as the addict continues to use, creating a tolerance and a need to increase the dosage. Additionally, when the drugs wear off the there is a highly dysphoric phase of drug addiction that is known as withdrawal. This information is important to understand addictions as a brain disease when contrasting it with the evidence claiming food addiction has similar properties as drugs.