Food Addiction – Myth or Reality?

Can a person be addicted to food? The answer is under active investigation. While overeating and addiction have a lot of similarities, they also differ in many key ways.
Food Addiction

The complex process of eating is regulated by physiological, psychological and neurobiological mechanisms.1 In order to include food in the list of addictive substances or eating as an addiction under the classic definition, a specific chemical that causes changes in the body’s reward system and addiction would have to be identified.

Several have been proposed but none have been validated. It has been suggested instead that an adverse relationship with food might be classified as a “behavioral addiction” that brings pleasure and enjoyment and relieves internal discomfort but also cannot be controlled and is continued despite negative consequences.1

Food and the Body’s Reward System
Eating palatable foods affects the same reward systems in the brain as substance abuse does. Often sparked by emotional stress, boredom, or a negative mood, eating or overeating palatable foods activates opioid and endocannabinoid reward hotspots in the nucleus accumbens (NAc) and ventral pallidum areas of the brain and increases dopamine activation.2 This activity is stronger among individuals whose food previously has been restricted. Continued eating of palatable foods decreases dopamine activity in the NAc; this can spark overeating in a drive for a more robust and rewarding dopamine response.

The hormones leptin and ghrelin interact with the brain’s reward system. The fat cell hormone leptin normally signals fullness and dampens the perception of food rewards, signaling satiety. However, obesity-related leptin resistance appears to remove this check on the food reward system. In one study on 21 obese subjects and 23 controls, food cue-induced brain activation was positively associated with both plasma leptin concentration and BMI.3 The gut hormone ghrelin is thought to stimulate the brain’s reward center for food, as well as for alcohol and drugs of abuse.

Evaluation of Addictive Food Behaviors
The Yale Food Addiction Scale (YFAS) is the first tool developed to identify individuals with addictive tendencies towards food. Researchers are using the YFAS to correlate addictive food behaviors with other obesity-related characteristics and behaviors. Among obese individuals with binge eating disorder who took the YFAS, the 57% classified by the scale as food-addicted also had higher levels of depression, negative affect, emotion dysregulation, eating disorder psychopathology, and lower self-esteem.

YFAS scores were significant predictors of binge eating frequency above and beyond other predictive measures.4 A study of more than 600 patients found correlations between YFAS score and all food craving traits except anticipation of positive reinforcement, meaning that those with addictive behaviors demonstrate food cravings but do not necessarily expect that eating will make them feel better.5 Other research observed that obese individuals who met the diagnostic criteria for food addiction were more likely to have binge eating disorder and depression, impulsive behavior and emotional reactivity, and food cravings than their age- and weight-equivalent counterparts.

The Bottom Line
Although the effects on the brain reward center of overeating resemble those of substance abuse, data currently do not support the classification of particular food(s) as addictive. However, the process of eating may be an addictive behavior in some individuals and specific foods may trigger eating that is hard to control. Treatment should include identifying the individual emotions and situations associated with cravings and eating triggers and developing environmental, support, motivational, and other non-food strategies for dealing with them.

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FOOTNOTES

1Albayrak O, Wölfle SM, Hebebrand J. Does food addiction exist? A phenomenological discussion based on the psychiatric classification of substance-related disorders and addiction. Obes Facts. 2012 Apr 19;5(2):165-179. [Epub ahead of print].

2Berridge KC, Ho CY, Richard JM, DiFeliceantonio AG. The tempted brain eats: pleasure and desire circuits in obesity and eating disorders Brain Res. 2010 Sep 2;1350:43-64.

3Grosshans M, Vollmert C, Vollstädt-Klein S, et al. Association of leptin with food cue-induced activation in human reward pathways Arch Gen Psychiatry. 2012 May;69(5):529-37.

4Gearhardt AN, White MA, Masheb RM, Morgan PT, Crosby RD Grilo CM. An examination of the food addiction construct in obese patients with binge eating disorder Int J Eat Disord. 2012 Jul; 45(5):657-63.

5Meule A, Kübler A. Food cravings in food addiction: The distinct role of positive reinforcement Eat Behav. 2012 Aug; 13(3):252-5.