People often joke that their favorite snack is “like crack” or jokingly call themselves “chocoholics.” But is it possible to really be addicted to food in the same way you can be addicted to substances like alcohol or nicotine?
As an addiction psychiatrist and researcher with experience in the treatment of eating disorders and obesity, I have followed research in this field for the past decades. I have written a textbook on food addiction, obesity, and overeating disorders, and, more recently, a self-help book for people with intense cravings and obsessions for certain foods.
While there is still some debate among psychologists and scientists, there is growing consensus that food addiction is a real phenomenon. Hundreds of studies confirmed that certain foods, often those high in sugar and ultra-processed, affect the brain and behavior of certain people in a similar way to other addictive substances such as nicotine.
Even so, many questions remain about which foods are addictive, which people are most susceptible to this addiction, and why. There are also questions about how this condition compares to other substance addictions and whether the same treatments could work for patients struggling with any type of addiction.
How does addiction work?
The neurobiological mechanisms of addiction have been outlined through decades of laboratory research using neuroimaging and cognitive neuroscience approaches.
Studies show that pre-existing genetic and environmental factors lead to the development of addiction. Regular consumption of an addictive substance causes a reconfiguration of several important brain systems, leading the person to crave it more and more.
This reconfiguration occurs in three key brain networks that correspond to key functional domains, often called the reward system, the stress response system, and the executive control system.
First, consuming an addictive substance causes the release of a chemical messenger called dopamine into the reward network, making the user feel good. The release of dopamine also facilitates a neurobiological process called conditioning, which is basically a neural learning process that results in the formation of habits.
As a result of the conditioning process, sensory cues associated with the substance begin to have an increasing influence on decision-making and behavior, often triggering a craving. For example, due to conditioning, seeing a needle may lead a person to abandon their commitment to stop using an injectable drug and return to using it.
Second, continued use of an addictive substance over time affects the brain’s emotional or stress response network. The user’s body and mind develop a tolerance, meaning they need increasing amounts of the substance to feel its effect. The neurochemicals involved in this process are different from those that mediate habit formation and include a chemical messenger called norepinephrine and internally produced opioids such as endorphins. If they stop using the substance, they experience withdrawal symptoms, which can range from irritability and nausea to paranoia and seizures.
At that point, negative reinforcement comes into play. This is the process by which a person returns to using a substance because they have learned that using it not only feels good, but also relieves negative emotions. During substance withdrawal, people feel deep emotional discomfort, including sadness and irritability. Negative reinforcement is the reason why someone trying to quit smoking, for example, will be at greater risk of relapse in the week after quitting and during times of stress, since they used to turn to cigarettes for relief before.
Third, excessive use of most addictive substances progressively damages the brain’s executive control network, the prefrontal cortex, and other key parts of the brain involved in impulse control and self-regulation. Over time, damage to these areas becomes increasingly difficult for the user to control their behavior in relation to these substances. This is why it is so difficult for long-term users of many addictive substances to quit smoking.
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What evidence is there that food is addictive?
Many studies over the past 25 years have shown that high-sugar and other highly pleasurable foods—often ultra-processed—act on these brain networks in ways similar to other addictive substances. The resulting changes in the brain fuel increased desire and overconsumption of the substance—in this case, highly rewarding foods.
Clinical studies have shown that people with an addictive relationship with food exhibit the hallmark signs of a substance use disorder.
Studies also indicate that, for some people, cravings for highly palatable foods go far beyond simply wanting a snack and are, in fact, signs of addictive behavior. One study found that cues associated with highly pleasurable foods activate the brain’s reward centers, and the degree of activation predicts weight gain. In other words, the more power the food cue has to capture a person’s attention, the more likely they are to succumb to cravings.
Multiple studies have also found that suddenly stopping a high-sugar diet can cause withdrawal symptoms, similar to what happens when quitting opioids or nicotine.
Excessive exposure to high-sugar foods has been found to reduce cognitive function and damage the prefrontal cortex and hippocampus, the parts of the brain that mediate executive control and memory.
In another study, when obese people were exposed to food and told to resist their cravings by ignoring it or thinking about something else, their prefrontal cortices became more activated compared to non-obese people. This indicates that the obese group found it more difficult to combat their cravings.
Finding safe treatments for patients with eating problems
Addiction recovery often centers on the idea that the fastest way to recover is to abstain from the problematic substance. But unlike nicotine or narcotics, food is something that everyone needs to survive, so quitting cold turkey is not an option.
Additionally, eating disorders such as bulimia nervosa and binge eating disorder often occur along with food addiction. Most psychologists and psychiatrists believe that these diseases have their origin in excessive dietary restriction.
For this reason, many eating disorder treatment professionals resist the idea of labeling some foods as addictive. They worry that encouraging abstinence from certain foods could trigger binge eating and extreme dieting to compensate.
A way forward
However, others argue that, with care, integrating food addiction approaches into eating disorder treatment is feasible and could save some people’s lives.
The growing consensus around this relationship is prompting researchers and those treating eating disorders to consider food addiction in their treatment models.
A similar approach might be what Dr. Kim Dennis, an addiction psychiatrist and eating disorder specialist, described to me. Consistent with traditional eating disorder treatment, the nutritionists at their residential clinic strongly advise their patients against calorie restriction. At the same time, consistent with traditional addiction treatment, they help their patients consider significantly reducing or completely abstaining from certain foods with which they have developed an addictive relationship.
Additional clinical studies are already underway. However, in the future, more studies are needed to help clinicians find the most effective treatments for people with an addictive relationship with food.
Groups of psychologists, psychiatrists, neuroscientists and mental health professionals are working to include “ultra-processed food consumption disorder,” also known as food addiction, in future editions of diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders and the World Health Organization’s International Classification of Diseases.
In addition to recognizing what those treating food addiction are already seeing in the field, this would help researchers obtain funding for additional studies on the treatment of food addiction. With more information about which treatments will work best for each person, sufferers will no longer have to suffer in silence and professionals will be better prepared to help them.
*Claire Wilcox is Adjunct Professor of Psychiatry, University of New Mexico
This text was originally published in The Conversation
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