This content originally appeared on Everyday Health. Republished with permission.
By Laura Williams
Medically Reviewed by Allison Young, MD of American College of Lifestyle Medicine
Can the word “addiction” — typically associated with drugs, alcohol, gambling, or other behaviors that done in excess can seriously damage someone’s health and well-being — apply to food or certain foods?
According to an article in the American Journal of Psychiatry, food addiction isn’t considered a clinical substance use disorder (alcohol use disorder and opioid use disorder are subtypes) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic guide used by mental health professionals.
But some psychologists and nutrition and behavioral health researchers who study the topic say maybe it should be.
“While it hasn’t been universally acknowledged as an official diagnosis, the term is used to describe eating behaviors that lack restraint and are [not stopped] despite adverse physical, emotional, or social effects,” explains John Dolores, PhD, a clinical psychologist and the COO of Bespoke Treatment, a mental health practice based in Los Angeles.
There’s growing evidence to back up not only these claims, but also showing that specific foods do result in physiological processes in the brain that occur in other types of addictive behavior.
What Is Food Addiction?
According to the Yale Journal of Biology and Medicine, the word “addiction” was first used in the context of food (in a reference to chocolate) in 1890. In 1956, the researcher Theron Randolph, MD, used the term “food addiction” in the Quarterly Journal of Studies on Alcohol to describe “a specific adaptation to one or more regularly consumed foods to which a person is highly sensitive [which] produces a common pattern of symptoms descriptively similar to those of other addictive processes.”
More recently the term “food addiction” has become associated with addictive symptoms in response to highly rewarding foods (think candy, ice cream, potato chips, and pizza), says Ashley Gearhardt, PhD, a researcher and an assistant professor of psychology at the food and addiction science and treatment lab at the University of Michigan in Ann Arbor.
She and her colleagues developed the Yale Food Addiction Scale (YFAS) in 2009 to measure signs of addictive-like eating behavior. Its 25 questions are designed to determine whether certain highly processed foods (chocolate, ice cream, potato chips, and pizza, among others) trigger addictive behaviors in certain people — behaviors that map to the DSM-5’s diagnostic criteria for other types of substance dependence. It’s been shown to be effective in peer-reviewed research, and the latest version was published in the journal Psychology of Addictive Behavior.
If you regularly experience a loss of control when you eat, intense cravings, or feelings of sadness when you try to stop that behavior, or if you find it difficult to stop eating when you feel full (even if there are negative consequences), you’re more likely to meet the YFAS criteria for food addiction.
One study from Dr. Gearhardt’s group with a sample of 500 adults found that more than 14 percent met the criteria for addiction to highly rewarding foods. A meta-analysis of 272 studies in the March 2022 European Eating Disorders Review found that the overall prevalence of food addiction could be as high as 20 percent.
People predisposed to addiction, as well as those who struggle with weight or weight-related problems, tend to be more likely to behave in ways that align with this definition of food addiction, as do people with low self-esteem, anxiety, and depression, explains Dr. Dolores. Research published in Frontiers in Psychiatry in 2021 backs this up.
But that certainly doesn’t mean that everyone in those groups has those behaviors, Dolores says. And it doesn’t mean that others outside those groups won’t have those behaviors, too. “Food addiction can impact anyone, regardless of age, sex, or financial status,” he says.
The Science of Food-Related Addictive Behavior
Here it’s worth pointing out that evidence, published in Archives of General Psychiatry, did show that highly rewarding foods (ones with large amounts of sugar, fat, and salt) trigger the brain’s reward circuitry (namely dopamine neurotransmitters) in ways similar to other addictive substances, like drugs and alcohol.
“When the reward system is activated, the brain experiences a dopamine rush, pushing people to consume more, creating an unhealthy cycle,” Dolores explains.
This dopamine reward system isn’t activated with the consumption of all foods, however. Gearhardt (who was a coauthor on the Archives research) adds that like addictive drugs — which are man-made and specifically designed to stimulate dopamine release — foods that result in addictive responses are also highly processed. They tend to be man-made and chemically designed to taste as delicious as possible (which, in turn, activates the dopamine reward system).
Other research looked at brain scans after participants ate various foods and found that the combination of fat and carbohydrates in food led to greater activation of the brain reward circuitry than foods with either fat or carbohydrates alone.
“It really is highly processed foods that deliver unnaturally high levels of refined carbohydrates (like sugar) and/or fat that trigger addictive patterns of intake,” Gearhardt says.
She coauthored a paper published in November 2022 making the case that highly processed foods meet the criteria to be labeled as addictive substances using the standards historically used to deem tobacco products addictive.
It’s worth pointing out that when it comes to food addiction, Gearhardt and others focus on these highly processed foods. Naturally occurring and minimally processed foods (like fruits, vegetables, fish, or eggs) are highly unlikely to trigger addictive behaviors.
Should Food Addiction Be a Clinical Disorder?
Gearhardt says yes, the previously mentioned paper lays out the evidence that certain foods meet the same criteria that classify tobacco as an addictive substance: It causes compulsive use, has mood altering effects on the brain, and reinforces certain behavior.
“There is a group of us currently working on an application for it to be considered as a provisional diagnosis in the DSM because we believe the research has now reached a point to support it,” Gearhardt says.
Not all health professionals agree.
The analysis published in Frontiers in Psychiatry in 2021 mentioned above acknowledges the work of Gearhardt and others, but argues there’s still not enough research and evidence to define parameters of food addiction, not to mention clinical guidelines on how to diagnose it, treat it, and prevent it. While the YFAS is a well-validated instrument for identifying symptom severity, there are still no clinically validated diagnostic criteria that are well-defined and universally accepted, according to the paper.
There’s also significant overlap between symptoms of eating addiction, obesity, and eating disorders like binge eating disorder — and in cases where eating patterns are problematic, one of these other existing diagnoses might apply and might be more appropriate.
The bottom line from those arguing against making food addiction a clinical diagnosis is that more research on how to properly diagnose it, treat it, and prevent it is needed first. And until more studies are done to define the condition and treatment options, food addiction is left in a gray area where clinicians are aware of the potential diagnosis and are working with clients with the latest information available.
Can You Be Addicted to the Act of Eating?
Some researchers prefer the term “eating addiction,” arguing that the addictive symptoms are related to the act of eating or the behavior, rather than specific foods.
Gearhardt disagrees. “In our lab, it is overwhelmingly unnaturally highly rewarding foods that are being consumed addictively,” she says. “We don’t see people losing control of their intake of bananas, beans, or chicken breasts.”
The history of food addiction also doesn’t align with the idea of an eating addiction, as the negative effects of food overconsumption have really only become widely prevalent in the most recent generations. Gearhardt cowrote a review of the evidence for this, published in the journal Psychotherapy and Psychosomatics in 2022.
“We have had to eat for the entirety of human existence. Why did we only just start to see these huge uptakes in excessive overeating, obesity, and diet-related disease? I would argue it is because that’s when cheap, ultra-processed foods started to dominate the food environment, thus triggering widespread addictive patterns of eating,” Gearhardt says.
Overlap With Binge Eating Disorder
Here it’s relevant to consider binge eating disorder (BED), a mental health disorder in which you regularly have episodes of eating unusually large amounts of food in one sitting and feeling like you can’t stop — or as if your eating is controlling you.
Research shows that people with binge eating disorder are more likely to also meet criteria for food addiction than people with other eating disorders.
Food addiction (as defined by Gearhardt’s work) is marked by a loss of control when eating specific foods, feelings of guilt and shame, intense cravings, and an inability to stop the behavior despite negative consequences. And indeed, research suggests that the mechanisms of food overconsumption overlap in areas like reward dysfunction or impulsivity.
The difference, however, is that a binge episode involves a high volume of food, but not necessarily a specific food or an overwhelming drive to consume highly addictive foods. Someone with food addiction, on the other hand, is likely to experience a binge episode triggered by a craving for specific foods or types of foods, like the highly addictive foods identified by Gearhardt and her team.
Food addiction aligns with an addiction framework, whereas BED aligns with an eating disorder model that is tied to weight or size concern and dietary restraint.
So, yes, there are differences, but some experts say there’s also a lot of potential overlap between these two phenomena.
“There is an idea that it’s not the food that people are addicted to, but that they are in a restrict-binge cycle,” explains Aisling Crosson, a licensed professional clinical counselor and Health at Every Size therapist in private practice in Boulder, Colorado.
Effects on Weight Stigma
A clinical diagnosis of food addiction might increase the shame and stigma that exist around obesity and the fear of fat, which could further contribute to the development of restrict-binge cycles and BED, particularly in populations that may be more susceptible, Crosson says. It’s a reason she says food addiction shouldn’t be a separate clinical diagnosis.
A study published in Obesity in October 2021 involved experiments to determine if the use of either obesity-framing or addiction-framing models contributed to weight stigma among adults. The data showed that telling someone they have a food addiction may not actually serve to reduce feelings of stigma or guilt around weight, but could increase those feelings.
You Think You May Be Addicted to Food: Now What?
If you’re concerned you may be struggling with food addiction, Gearhardt encourages you to first talk to a doctor to determine if there are other underlying medical issues that could be playing a role, like a thyroid issue.
If there is no underlying medical issue, but you’re concerned about your eating habits or eating patterns when it comes to specific foods or scenarios, consider talking to a dietitian or therapist. All mental health care professionals licensed to diagnose clinical disorders should be able to identify and diagnose an eating disorder, but someone who specializes in eating disorder treatment might have more experience developing a treatment approach around your specific concerns, Dolores says.
Treatment for eating disorders can include cognitive behavioral therapy for eating disorders (CBT-E), other types of talk therapy (or psychotherapy), nutrition counseling, medications, and some integrative therapy approaches (like yoga, meditation, and acupuncture).
There are no formal treatment guidelines for eating addiction, as it is not currently a clinical disorder, but researchers have posited that similar psychotherapeutic approaches, as well as nonsurgical brain stimulation techniques, such as transcranial magnetic stimulation (TMS) — during which magnetic fields are used to stimulate nerve cells in the brain — could help.