“Food addiction” is an emerging area, and behavioral and biological overlaps have been observed between eating and addictive disorders. Potential misconceptions about applying an addiction framework to problematic eating behavior may inhibit scientific progress. Critiques of “food addiction” that focus on descriptive differences between overeating and illicit drugs are similar to early criticisms of the addictiveness of tobacco. Although food is necessary for survival, the highly processed foods associated with addictive-like eating may provide little health benefit. Individual differences are important in determining who develops an addiction. If certain foods are addictive, the identification of possible risk factors for “food addiction” is an important next step. Not all treatments for addiction require abstinence. Addiction interventions that focus on moderation or controlled use may lead to novel approaches to treating eating-related problems. Finally, addiction-related policies that focus on environmental (instead of educational) targets may have a larger public health impact in reducing overeating.
The concept of food addiction is an area of growing scientific interest and ongoing debate. Animal models suggest that rats given highly palatable foods (e.g., icing, bacon, cheesecake) or intermittent access to sugar will display neurobiological and behavioral indicators similar to those observed in models of drug addiction [1, 2]. In humans, overlapping neurobiological systems (e.g., mesolimbic dopamine system) appear activated by both drugs of abuse and highly palatable foods [3•]. Individuals with addiction or eating-related problems (e.g., obesity, binge eating disorder) exhibit similar patterns of neural reactivity to drug or food cues, respectively [4•, 5]. Higher scores on the Yale Food Addiction Scale (YFAS)
, which applies the diagnostic criteria for substance dependence to the consumption of highly palatable foods, are associated with increased body mass index (BMI), more frequent binge eating, greater impulsivity, and stronger cravings for fatty, processed foods . Patterns of neural response and genetic profiles implicated in addiction have also been related to higher YFAS scores [8, 9]. Although these findings are important and provide support for food addiction as a clinically relevant concept, more scientific inquiry is needed before the “food addiction” concept can be either accepted or rejected and applied routinely in clinical settings. A major obstacle to evaluating whether an addictive process contributes to problematic eating may involve potential misconceptions about what an addiction perspective means when applied to eating behavior. In the current paper, we will address many of these notions and highlight important gaps that should be addressed to empirically evaluate whether an addictive process contributes to problematic eating behavior.
Current Considerations Regarding Food Addiction
Schulte, E. M., Joyner, M. A., Potenza, M. N., Grilo, C. M., & Gearhardt, A. N
Another possible misconception about addictions is that all addiction treatments require abstinence. While this is the case for many common treatment approaches (e.g., 12-step programs), empirically supported interventions exist in which abstinence is not required. For example, harm reduction, which aims to reduce the harm associated with addictive behaviors and increase the individual’s quality of life, has been found to be effective without a treatment goal of abstinence [86–88]. A major concern about the application of an addiction approach to eating behavior is that it would require patients to abstain from all addictive foods, which may lead to more disordered eating . Indeed, there currently exist multiple addiction-based eating programs that focus on the goal of not consuming certain food groups (e.g., Food Addicts Anonymous, Overeaters Anonymous), and the effectiveness of such programs has received almost no research study. In sharp contrast, effective cognitive-behavioral therapy (CBT) and behavioral interventions for overeating and binge-eating  focus on moderation rather than avoidance or abstinence from foods. The documented effectiveness of such CBT approaches is not at odds with many of the concepts reviewed
here regarding potentially addiction-like processes or properties associated with foods. Rather, like various evidence-based methods for controlling, for example, alcohol misuse, such CBT methods use structure and coping methods to normalize eating and reduce vulnerability to disrupted eating in response to external/internal cues. Additionally, modified CBT-based interventions may help individuals with co-existing eating and substance use problems and individuals who struggle with food cravings and high responsivity to food cues [91–93].
Food addiction, Obesity, Addiction, Substance dependence
Schulte, E. M., Joyner, M. A., Potenza, M. N., Grilo, C. M., & Gearhardt, A. N. (2015). Current Considerations Regarding Food Addiction. Current Psychiatry Reports, 17(4). doi:10.1007/s11920-015-0563-3