Food Addiction: Implications for the Diagnosis and Treatment of Overeating

As the prevalence of obesity continues to increase and traditional weight loss methods appear to be largely unsuccessful, researchers and clinicians have begun to consider the addictive potential of food. There is a substantial body of evidence demonstrating the similarities between addictive drugs and food on reward and control pathways in the brain and subsequent behaviour such as craving and impulsivity. There is also limited evidence to indicate that in some circumstances, overeating meets the physiological criteria of substance dependence, although more research is necessary to determine the validity of these symptoms in human participants. More research is also required for other behavioural criteria such as social impairment and repeated use despite negative consequences, as the evidence to date is largely anecdotal. However, meeting the physiological criteria for addiction is not necessary for a DSM diagnosis, and as food is a legal substance, just like caffeine, tobacco and alcohol, not all criteria associated with SUDs [23] readily translate to food addiction. Nevertheless, the criterion of withdrawal in SUDs has been associated with clinical severity and the number of symptoms that an individual endorses is used to determine the disorder’s overall severity [23].

With a number of these criteria having a limited application to food addiction, a clinical diagnosis appears unlikely in most cases of overeating; however, using the YFAS, it has been estimated that approximately 11% of the general population meet the criteria for a ‘severe’ food addiction [38]. It should also be made clear that the concept of food addiction does not equate with obesity. Obesity is a multifactorial condition determined by genetic, environmental, biological and behavioural components. For the majority of cases, obesity is caused by a steady increase in excess energy intake and it is not characterised by a compulsive drive for food consumption. Instead, it is thought that the concept of food addiction applies most appropriately to individuals with BED and BN [31,32,277,278].

Despite there being considerable parallels between substance use and compulsive overeating, there is still some concern regarding the use and validity of the term ‘food addiction’, which is unlikely to apply to the majority of cases [17]. There is also concern over the use of such terminology in the wider social context and whether the term may do more harm than good. While most people would believe that an addiction model reduces individual responsibility, it has also been argued that attributing the problem to a minority of individuals also reduces corporate responsibility [28,458]. As the majority of the population would not be considered ‘food addicts’, there would be less pressure for the food industry to reduce marketing or to promote healthier alternatives. Likewise, any environmental interventions to reduce access and availability may also seem less critical with a food addiction model.