Food addiction, specifically ultra-processed food addiction, has been discussed in thousands of peer-reviewed publications. Although 20% of adults meet criteria for this condition, food addiction is not a recognized clinical diagnosis, leading to a dearth of tested treatment protocols and published outcome data. Growing numbers of clinicians are offering services to individuals on the basis that the food addiction construct has clinical utility. This audit reports on clinical teams across three locations offering a common approach to programs delivered online. Each team focused on a whole food low-carbohydrate approach along with delivering educational materials and psychosocial support relating to food addiction recovery. The programs involved weekly sessions for 10-14 weeks, followed by monthly support. The data comprised pre- and post- program outcomes relating to food addiction symptoms measured by the modified Yale Food Addiction Scale 2.0, ICD-10 symptoms of food related substance use disorder (CRAVED), mental wellbeing as measured by the short version of the Warwick Edinburgh Mental Wellbeing Scale, and body weight. Sample size across programs was 103 participants. Food addiction symptoms were significantly reduced across settings; mYFAS2 score -1.52 (95% CI: -2.22, -0.81), CRAVED score -1.53 (95% CI: -1.93, -1.13) and body weight was reduced -2.34 kg (95% CI: -4.02, -0.66). Mental wellbeing showed significant improvements across all settings; short version Warwick Edinburgh Mental Wellbeing Scale 2.37 (95% CI: 1.55, 3.19). Follow-up data will be published in due course. Further research is needed to evaluate and compare long-term interventions for this complex and increasingly burdensome biopsychosocial condition.
Food addiction (FA) was first described in 1956 (1). Considerable debate has continued and it remains unresolved if FA is a distinct disorder warranting official recognition (2–4). To date, FA has not been classified in the Diagnostic and Statistical Manual of Mental Disorders (5) (DSM-5) or in the International Classification of Diseases (6) (ICD-10). There is also ongoing discussion amongst clinicians as to how to refer to this disorder. For the purposes of this paper, we will use the term food addiction to refer to dependency behaviors relating to sugar and processed foods, although it is increasingly being referred to as ultra-processed food addiction (7).
Low Carbohydrate and Psychoeducational Programs Show Promise for Treatment of Ultra-processed Food Addiction
Unwin J, Delon C, Giæver H, Kennedy C, Painschab M, Sandin F, Poulsen CS, Wiss DA
The symptoms of FA are captured using the 11 criteria for substance use disorder (SUD) from the DSM-5 (5) and applying those to foods high in refined carbohydrates/sugar, fat, and salt. Two or three symptoms indicate mild SUD, four or five is moderate and six or more indicates severe SUD. The criteria include:
Consuming the substance in larger amounts or for longer than intended.
Efforts to cut down or stop using the substance but not managing to.
Time spent getting, using, or recovering from the substance.
Cravings and urges to use the substance.
Not managing to perform at work, home or school because of substance use.
Continuing to use the substance despite causing problems in relationships.
Giving up important social, occupational, or leisure activities because of substance use.
Using the substance repeatedly despite harmful consequences.
Continuing to use the substance despite physical or psychological problem caused or worsened by the substance.
Needing more of the substance to get the desired effect.
Development of withdrawal symptoms which are relieved by consumption of substance.
Similarly, there are six criteria from the ICD-10 (6), where three or more symptoms indicate SUD:
“Craving,” a strong desire or urge to use the substance.
Difficulty controlling the onset, duration, amount, and termination of substance use.
Increasing priority of substance use over other activities over time.
Increased tolerance and the need to increase consumption over time.
Physiological features of withdrawal when trying to abstain.
Continued use of the substance despite mental or physical harm.
Clinics in three locations [the United Kingdom (UK); North America (NA); Sweden (SE)] already offering similar online programs for people with FA used the same measures for screening and follow up. The ethics protocol for the National Health Service in the UK was reviewed and indicated that since the project was an audit of pre-existing routine practice and participants were self-referred, formal ethical review was not required.
The current data are the first to demonstrate the short-term clinical effectiveness of a low-carbohydrate “real food” intervention delivered in an online group format with education and social support for individuals with FA symptoms. Larger, controlled and randomized intervention studies are urgently needed to continue to explore ways to help people with this serious and multi-faceted condition which often goes undiagnosed and untreated. It would be extremely useful to compare this approach to more inclusive “all foods fit” approaches among those with co-occurring FA and EDs, particularly BED.
addiction; ketogenic diets; low-carbohydrate diet; processed-food; sugar
Unwin, Jen, et al. “Low Carbohydrate and Psychoeducational Programs Show Promise for the Treatment of Ultra-Processed Food Addiction.” Frontiers in Psychiatry, vol. 13, Sept. 2022, p. 1005523. DOI.org (Crossref), https://doi.org/10.3389/fpsyt.2022.1005523.