The diagnostic construct of “food addiction” is a highly controversial subject. The current systematic review is the first to evaluate empirical studies examining the construct of “food addiction” in humans and animals. Studies were included if they were quantitative, peer-reviewed, and in the English language. The 52 identified studies (35 articles) were qualitatively assessed to determine the extent to which their findings indicated the following addiction characteristics in relation to food: brain reward dysfunction, preoccupation, risky use, impaired control, tolerance/withdrawal, social impairment, chronicity, and relapse. Each pre-defined criterion was supported by at least one study. Brain reward dysfunction and impaired control were supported by the largest number of studies (n = 21 and n = 12, respectively); whereas risky use was supported by the fewest (n = 1). Overall, findings support food addiction as a unique construct consistent with criteria for other substance use disorder diagnoses. The evidence further suggests that certain foods, particularly processed foods with added sweeteners and fats, demonstrate the greatest addictive potential. Though both behavioral and substance-related factors are implicated in the addictive process, symptoms appear to better fit criteria for substance use disorder than behavioral addiction. Future research should explore social/role impairment, preoccupation, and risky use associated with food addiction and evaluate potential interventions for prevention and treatment.
The concept of food addiction remains controversial [25,30,31]. Some researchers question whether food or eating can be addictive if it is necessary to our survival , while others point out the common biological (e.g., brain reward pathways, ΔFosB expression), behavioral (e.g., relapse, using more than intended), and psychological (e.g., preoccupation, impaired control) similarities between the compulsive consumption of highly palatable foods and use of addictive drugs [2,32,33]. Nevertheless, critics and proponents alike agree that more research is needed to confirm the validity of food addiction [30,34]. A non-systematic review by Hone-Blanchet and Fecteau  comparing animal and human models of food addiction to characteristics of substance use disorder concluded that there was significant overlap between the two conditions, but that more research was needed. Extant published systematic reviews on the concept of food addiction have either conflated obesity with food addiction or excluded animal studies [22,28,29]. As such, a more recent and inclusive systematic review was needed. The present systematic review aimed to summarize the peer-reviewed empirical literature examining the evidence for food addiction in both animal and human studies. The chosen method involved assessing its association with key characteristics of addiction in relation to food: (a) neurobiological changes, (b) preoccupation with the substance, (c) impaired control, (d) social impairments, (e) risky use, (f) tolerance/withdrawal, (g) chronicity of the condition, and (h) relapse [1,10,17].
What Is the Evidence for “Food Addiction?
Gordon, E. L., Ariel-Donges, A. H., Bauman, V., & Merlo, L. J.
Data collection, review, reporting, and discussion were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement [35,36]. The literature search was carried out in PubMed and PsychINFO databases using varying combinations of the following keywords: food addiction, addiction, process addiction, binge eating, hedonic eating, compulsive overeating, compulsive eating, eating behavior, food, eat, feeding behavior/psychology, food preferences, food habits, hyperphagia, eating disorders, obesity, overeat*. Meshterms were used in the PubMed search. Filters were used in both databases according to the study’s predetermined inclusion and exclusion criteria. Given that the “study type” filters on PubMed only identified articles in print, a second search was done using the same search terms without filters in order to identify recent articles published online before print. Additional studies were identified through review of the references listed in the identified articles. Due to the proliferative nature of research on food addiction, two searches were done: the first was completed on 29 June 2016, and the second was completed on 8 January 2018. Protocols were followed for both searches exactly as described above, with the exception that the second search included only articles published since 30 June 2016.
The 52 identified studies (35 articles) were qualitatively assessed to determine the extent to which their findings indicated the following addiction characteristics in relation to food: brain reward dysfunction, preoccupation, risky use, impaired control, tolerance/withdrawal, social impairment, chronicity, and relapse. Each pre-defined criterion was supported by at least one study. Brain reward dysfunction and impaired control were supported by the largest number of studies (n = 21 and n = 12, respectively); whereas risky use was supported by the fewest (n = 1).
The results of the current systematic review generally support the validity of food addiction as a diagnostic construct, particularly as it relates to foods high in added sweeteners and refined ingredients. The majority of studies in the current review reported evidence for symptoms related to neurological changes and impaired control, with fewer studies evaluating preoccupation, chronicity, relapse, social impairment, and risky use. Behavioral and substance-related aspects of food addiction appear to be intertwined, but we suggest that the substance (highly-palatable food) component may be more salient to the diagnostic classification of this phenomenon than the behavior (eating). We propose that the food addiction construct merits serious attention in regard to its presentation, prevention, and treatment in humans.
food addiction; eating behavior; process addiction; systematic review
Gordon, E. L., Ariel-Donges, A. H., Bauman, V., & Merlo, L. J. (2018). What Is the Evidence for "Food Addiction?" A Systematic Review. Nutrients, 10(4), 477. https://doi.org/10.3390/nu10040477