Addictive disorders are consensually defined as diseases at the crossroads between 1) a substance or a behavior that produces pleasure and reduces distress (4), 2) individual vulnerabilities and risk factors, and 3) a socio-environmental context in which the substance or the behavior is highly prevalent (5). The relative importance of each factor varies between individuals and cultures. In the aforementioned debate, the authors discussed in depth the first and the third factors, but put less emphasis on interindividual differences. Recognizing interindividual differences in the psychobiological factors or pathways leading to addictive-like eating enables the identification of patient clusters potentially requiring different treatment strategies. These differences may help in addressing some of the controversies highlighted by the authors.
Finally, previous studies conducted outside the food addiction field have already shown the importance of interindividual differences (6, 7, 8, 9). These findings include that impulsivity is a risk factor for compulsivity (6, 10) and that subgroups of patients can be identified based on psychological factors (7). By testing the reliability of these theoretical models in patients with addictive-like eating, we may better address the complexity of the food addiction puzzle and ultimately design better tailor-based treatment and policies. It may also help to determine the boundaries between addictive-like eating and other conditions and to shed light on the exclusion criteria, by differentiating the risk factors that should be targeted to prevent addiction from the factors not causally associated with the development of the disorder.
Addictive-like Eating: Interindividual Differences Matter
De Luca, Arnaud, and Brunault, Paul
Why could we not consider that the cause of addictive-like eating depends on the individual? Addictive-like eating may present as a substance-use disorder to HP foods for some, as a behavioral addiction to eating for others, and even as a combination of both. It remains unclear whether distinguishing between a substance-use disorder and a behavioral addiction will affect treatment. In both cases, harm and risk reduction strategies are needed. Policies targeting environmental factors would affect the availability and accessibility of the substance or of the behavior in the social environment. This would not preclude the use of substitution therapy or pharmacological treatment that could target food-specific and/or non-food-specific pathways. In addition to the authors’ remarks on HP foods, hyperpalatable nonprocessed foods such as nuts, walnuts, and bananas can also be addictive. A mixed addictive disorder model comprising either the possibility of a substance use disorder or a behavioral addiction is also consistent with the convergences between substance use disorders and behavioral addictions in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
Addictive-like eating is probably one part of the obesity puzzle, but the size of this puzzle piece may differ between individuals. Obesity is a complex disorder that is at the crossroads between biological, psychological, and environmental factors. To gain insight into how addictive-like eating may affect obesity, we argue here that interindividual differences leading to addictive disorders should be taken into account. Integrating them into a comprehensive mixed model comprising factors related to 1) a substance or a behavior, 2) an individual with vulnerability risk factors, and 3) the socio-environmental context may be key to meet the challenge of both being useful for clinical practice and addressing the whole complexity of addictive-like eating.
food addiction, eating behaviors, public health
De Luca, Arnaud, and Brunault, Paul . “Addictive-like Eating: Interindividual Differences Matter.” The American Journal of Clinical Nutrition, vol. 114, no. 1, July 2021, pp. 393–94. DOI.org (Crossref), https://doi.org/10.1093/ajcn/nqab181.