Food addiction is considered an important link for a better understanding of psychiatric and medical problems triggered by dysfunctions of eating behaviors, e. g., obesity, metabolic syndrome, binge eating disorder, or bulimia nervosa. At behavioral level, food addiction has high degrees of similarity with other eating disorders, a phenomenon that creates difficulties in finding specific diagnostic criteria. Food addiction has been also described as “eating addiction” or “eating dependence” by several researchers, who placed the emphasis on the behavior and not on the food itself. High-sodium foods, artificially flavored-foods, rich carbohydrate- and saturated fats-containing foods are triggers for the activation of the same neural pathways, therefore they act similarly to any drug of abuse. Food addiction is considered a disorder based on functional negative consequences, associated distress and potential risks to both psychological well-being and physical health. A clinical scale was validated for the quantification of the eating addiction severity, namely the Yale Food Addiction Severity Scale (YFAS), constructed to match DSM IV criteria for substance dependence. Using this instrument, a high prevalence of food addiction was found in the general population, up to 20% according to a meta-analytic research. The pathogenesis of this entity is still uncertain, but reward dysfunction, impulsivity and emotion dysregulation have been considered basic mechanisms that trigger both eating dysfunctions and addictive behaviors. Genetic factors may be involved in this dependence, as modulators of higher carbohydrate and saturate fat craving. Regarding the existence of potential therapeutic solutions, lorcaserin, antiepileptic drugs, opioid antagonists, antiaddictive agents are recommended for obesity and eating disorders, and they may be intuitively used in food addiction, but clinical trials are necessary to confirm their efficacy. In conclusion, a better understanding of food addiction's clinical profile and pathogenesis may help clinicians in finding prevention- and therapeutic-focused interventions in the near future.
Food addiction has a high degree of comorbidity with other psychiatric disorders, a phenomenon which is also frequently reported in patients presenting other substance use disorders or behavioral addictions (16, 17). Some authors even state that dual diagnosis is the rule, rather than the exception, especially in clinical samples (8). Possible explanations for this high rate of comorbidity may include self-medication, shared genetic vulnerability, common environment, lifestyle, or neural pathways (16). This clinically- and epidemiologically-supported observation has severe negative consequences reflected in lower treatment adherence, higher risk for physical complications, poorer overall health, poorer self-care, increased suicide or aggression risks, possible legal problems, and greater health burden for patients with dual diagnosis (16). Also, co-addiction is frequently reported in patients, and multiple substance and/or behavioral addictions are being clustered together (17, 18). Mental health professional may, however, be more focused on the acute psychological manifestations of a certain disorder, and ignore or minimize the importance of addictive behaviors, which may occupy the background of the clinical presentation. The use of screening questionnaires or structured interviews may increase the rate of early detection, especially in cases of behavioral addictions, a nosological category that is not yet very well-acknowledged by clinicians (18).
The objective of the current review is to verify if there are enough data in the literature to support the existence of this newly described diagnosis, i.e., “food addiction.” Five dimensions are considered important in order to delineate such a disorder: (1) clinical criteria for diagnosis, (2) one or more validated instruments for the quantification of this disorder's severity, (3) epidemiological data, (4) evidence for specific pathophysiology, and (5) available treatments.
Current Status of Evidence for a New Diagnosis: Food Addiction-A Literature Review
A literature review dedicated to finding available evidence for the diagnosis, pathogenesis, epidemiology, methods of structured evaluation, and treatment of food addiction was based upon electronic databases search. The main databases included in the analysis were PubMed, Cochrane, Medscape, Thomson Reuters/Web of Knowledge, APA PsycNet, and the search paradigm was “food addiction” OR “eating addiction” AND “treatment” OR “therapy” OR “epidemiology” OR “diagnosis” OR “clinical criteria” OR “pathogenesis” OR “clinical scales” OR “psychometric instruments.” All papers published between January 1990 and October 2021 were screened for eligibility.
A number of 1,740 papers surfaced after the primary search, with 13 citations identified by other sources. After filtering these papers using the inclusion/exclusion criteria, only 43 remained for the secondary analysis. An important degree of overlap between papers regarding the information retrieved was detected, because they analyzed in the same time multiple variables of interest for food addiction. A number of 10 papers explored clinical criteria for the diagnosis of food addiction and its subtypes, while 6 papers investigated psychometric properties of a scale dedicated to this pathology. Regarding the pathophysiology of food addiction, 6 papers were retrieved, and 16 papers were reviewed in order to find available information about its epidemiology. Data about the efficacy and/or tolerability of potential treatments for food addiction were extracted from 10 papers, which were mainly reviews.
Food addiction is a controversial diagnosis which is not included in the current classificatory systems created by either American Psychiatric Association or World Health Organization (1, 3). Also, no unanimously accepted, well-defined diagnosis criteria were detected in the literature during this review. However, the vast majority of the found papers used the same criteria for food addiction that are commonly used for substance use disorders. A set of psychometric instruments has been validated (YFAS, mYFAS, YFAS 2.0, YFAS-C) for quantification of the food addiction severity in adult and children populations.
As in the case of other behavioral addictions, the neurobiological, and psychological factors contributing to the food addiction pathophysiology are common with other substance use disorders. The main explanation for the pathogenesis of food addiction remains a dysfunction in the reward system. Similar clinical, neurobiological, psychopathological, and sociocultural risk factors have been identified in food addiction and substance use disorders (35). Data derived from genetic studies are still sparse, but the less functional dopamine 2 receptor allele has been associated with food addiction and substance dependence (41).
No clinical trial focused on the treatment of food addiction has been identified in the literature, therefore no clear therapeutic recommendation could yet be formulated. A high degree of overlap between food addiction, eating disorders recognized by current classifications, and obesity could be a significant obstacle for designing such trials. The importance of finding a correct conceptual framework for food addiction derives from the same, high degree of overlap between this pathology and obesity. Also, integration of food addiction in the therapeutic management of obese patients could be useful in reaching better outcomes for this population.
This review has inherent limitations based on the scarcity of data derived from clinical trials, which seriously limits the possibility of treatment recommendations. Diagnostic criteria for “food addiction” are controversial, and the heterogeneity of the studied population also limits the possibility of formulating screening strategies that are already implemented for other addictive disorders.
food addiction, sugar addiction, highly pallatble foods
Vasiliu, Octavian. “Current Status of Evidence for a New Diagnosis: Food Addiction-A Literature Review.” Frontiers in Psychiatry, vol. 12, Jan. 2022, p. 824936. DOI.org (Crossref), https://doi.org/10.3389/fpsyt.2021.824936.