“Food addiction” has become a focus of interest for researchers attempting to explain certain processes and/or behaviors that may contribute to the development of obesity. Although the scientific discussion on “food addiction” is in its nascent stage, it has potentially important implications for treatment and prevention strategies. As such, it is important to critically reflect on the appropriateness of the term “food addiction”, which combines the concepts of “substance-based” and behavioral addiction. The currently available evidence for a substance-based food addiction is poor, partly because systematic clinical and translational studies are still at an early stage. We do however view both animal and existing human data as consistent with the existence of addictive eating behavior. Accordingly, we stress that similar to other behaviors eating can become an addiction in thus predisposed individuals under specific environmental circumstances. Here, we introduce current diagnostic and neurobiological concepts of substance-related and non-substance-related addictive disorders, and highlight the similarities and dissimilarities between addiction and overeating. We conclude that “food addiction” is a misnomer because of the ambiguous connotation of a substance-related phenomenon. We instead propose the term “eating addiction” to underscore the behavioral addiction to eating; future research should attempt to define the diagnostic criteria for an eating addiction, for which DSM-5 now offers an umbrella via the introduction on Non-Substance-Related Disorders within the category Substance-Related and Addictive Disorders.
• Evidence for addiction to specific macronutrients is lacking in humans.
• “Eating addiction” describes a behavioral addiction.
• An “eating addiction” is not necessarily associated with obesity.
• Obesity prevention strategies should focus on “eating addiction”.
• Consider “eating addiction” as a disorder in DSM-5 “Non-Substance-Related Disorders”.
Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior
Hebebrand, Johannes; Özgür Albayrak a, Roger Adan b, Jochen Antel a, Carlos Dieguez c d, Johannes de Jong b, Gareth Leng e, John Menzies e, Julian G. Mercer f, Michelle Murphy f, Geoffrey van der Plasse b, Suzanne L. Dickson
The term ‘food addiction’ is now a part of everyday language. Vocabulary such as “chocoholic” (in use since the 1960s) and “craving” – used to refer to a person's desire and fondness for food – is in common use, and many people believe these conditions approach the severity of an addiction (Bird et al., 2013). Undoubtedly, some people believe that their relationship with problem foods constitutes an addiction, and engage with treatment regimens or approach help groups such as Food Addicts Anonymous – established in 1987. With addiction-related terminology in common use, and treatment, support and recipe books available for “food addicts” it is unsurprising that the media have accepted “food addiction” as fact, with one broadcaster (BBC), for example, having more than 40 news stories related to “food addiction” on its website.
We concur with Hone-Blanchet and Fecteau (2014) that it is premature to conclude validity of the food addiction phenotype in humans from the current behavioral and neurobiological evidence gained in rodent models. Humans who overeat usually do not restrict their diets to specific nutrients; instead the availability of a wider range of palatable foods appears to render prone subjects vulnerable to overeating. Undoubtedly, the food industry needs to act responsibly given that easy access to highly palatable and calorie dense foods promotes overeating and potentially the development of an “eating addiction” in predisposed individuals. It may ultimately be for governments to take action and regulate the food industry, by requesting informative labels and restricting advertising (Bagaric and Erbacher, 2005). At the same time, the medical field, and in particular psychiatry and clinical psychology, should continue to research “eating addiction”. In retrospect, the medicalization of tobacco use has proven extremely important in promoting large scale, individual-based, and structural prevention programs, which have successfully led to a reduction in the proportion of adolescents and adults who smoke (Schaap et al., 2008, Levy et al., 2010, White et al., 2011).
To conclude, the society as a whole should be aware of the differences between addiction in the context of substance use versus an addictive behavior. As we pointed out in this review, there is very little evidence to indicate that humans can develop a “Glucose/Sucrose/Fructose Use Disorder” as a diagnosis within the DSM-5 category Substance Use Disorders. We do, however, view both rodent and human data as consistent with the existence of addictive eating behavior. The new DSM-5 (APA, 2013) currently does not allow the classification of an “Overeating Disorder” or an “Addictive Eating Disorder” within the diagnostic category Substance-Related and Addictive Disorders; indeed, the current knowledge of addictive eating behaviors does not warrant such a diagnosis. However, efforts should be made to operationalize the diagnostic criteria for such a disorder and to test its reliability and validity. It needs to be determined if such a disorder can occur distinct from other mental disorders.
Currently, the assessment of “food addiction” mainly relies on the YFAS questionnaire, which is based on the diagnostic criteria of substance dependence according to DSM-IV (Gearhardt et al., 2009). In our opinion, the term “Eating Addiction” or “Addictive Eating Disorder” would have been more appropriate to avoid the unsubstantiated connotation that food contains chemical substances that can lead to the development of a Substance Use Disorder. We have pointed out that the mere application of the criteria used to define substance dependence does not likely appear sufficient to fully capture the phenomenological aspects of an eating addiction. As illustrated above, we are aware of the vague distinctions between substance-based and behavioral-based addictions. Nevertheless, we view the current evidence as being more in favor of addictive-like behaviors to describe the phenomenon of continuous overeating of a variety of foods.
We perceive the need to disentangle the mechanisms underlying an “eating addiction” with and without obesity. The differentiation of subjects who overeat due to increased hunger and/or a reduced satiety from those with an “eating addiction” appears difficult; research is required to uncover biological, physiological, and psychological differences. Obviously, twin and family studies are required to assess heritability of “eating addiction” (or different subgroups of “eating addiction”). Given the increasing number of gene variants known to contribute to the variance in body mass index (BMI; kg/m2) in the general population, it will be of interest to genotype normal weight and obese subjects with and without “eating addiction” to assess whether the frequencies of relevant alleles differ. As progress is made in uncovering alleles predisposing to diverse substance use disorders or addictive disorders, the overlap with “eating addiction” can be assessed.
Food addiction, Eating addiction, Obesity, Reward system, Motivation, Fat addiction, Sugar addiction, Salt addiction, Addictive disorders
Hebebrand, Johannes, et al. “‘Eating Addiction’, Rather than ‘Food Addiction’, Better Captures Addictive-like Eating Behavior.” Neuroscience & Biobehavioral Reviews, vol. 47, Nov. 2014, pp. 295–306. DOI.org (Crossref), https://doi.org/10.1016/j.neubiorev.2014.08.016.