Learn about the causes and consequences of food addiction and find support to overcome it. Explore reliable information on Meri Sehat.

Food Addiction

Humza Khizer

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Overview

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not include a food addiction diagnosis.

Some healthcare professionals use the term to refer to cravings, binge eating behaviors, and an apparent lack of control when a person is around food1. While DSM-5 does define Feeding and Eating Disorders e.g. Binge Eating Disorder, however,&nbsp; there is an ongoing debate regarding the consideration of food addiction as an &lsquo;addiction&rsquo; or not. This is because addiction is usually related to psychoactive substances like cocaine, nicotine, and alcohol that present with symptoms of tolerance and withdrawal effects2. 
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Scientific research has shown that food addiction uses the same brain regions as drug addiction3. Their symptoms are similar as well and they affect the production of the same neurotransmitters in the process3. For instance, junk food like candy causes dopamine to trigger the reward centers of the brain.

Even though the symptoms and the consequences may not be as severe as drug addiction, food addiction is nevertheless a serious issue and requires treatment for the individual to lead a healthy lifestyle. 
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The WHO reported that 13% of adults worldwide were obese in 2016, while 39% were overweight14. The NHS spent &pound;6.1 billion on overweight and obesity-related ill-health in 2014-15 and economic expenses associated with overweight and obesity in the UK are projected to go up to &pound;37.2 billion by 205015. 
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518 participants participated in research on addictive eating at the University of Michigan 4. The results were evaluated using the Yale Food Addiction Scale (YFAS).

A list of 35 items, both processed and unprocessed, was given to each participant. On a scale from 1 (not at all addictive) to 7(extremely addictive), the subjects had to rate each of the 35 foods in terms of how likely they would affect them. 
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In this study, 7&ndash;10% of the individuals had a confirmed diagnosis of severe food addiction, i.e., they showed 3 or more symptoms plus clinically significant impairment or distress.

In addition, 92% of subjects displayed a persistent desire or repeated unsuccessful attempts to quit 4.

It should be no surprise that processed foods &ndash; pizza, chocolate, chips, and cookies &ndash; dominated the list of addictive foods. These foods typically had high levels of sugar, fat, or both. On the contrary, a majority of the unprocessed foods &ndash; cucumbers, carrots, beans, and apples &ndash; were said to be the least addictive. 
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Signs and Symptoms

Following is a list of 8 typical warning signs and symptoms of food addiction: 
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<h5>1. Having Cravings Despite Being Full</h5>

A craving is when you experience an urge to eat anything even though you have just finished a meal and you&rsquo;re full.

Cravings are a common phenomenon and are not as worrisome as an addiction. However, if they occur frequently and it&rsquo;s difficult to fulfill or ignore them, they may signify another underlying condition. 
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They can also be a problem when you know that you&rsquo;ve eaten a meal and that your body&rsquo;s not energy- or nutrient-deprived, it&rsquo;s just your brain seeking something that increases dopamine level. 
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<h5>&nbsp;2. Eating More Than Intended</h5>

There&rsquo;s no such thing as a single slice of cake for some individuals. It will start as one slice of cake, yes, but it will quickly and unintentionally, multiply into half a cake. It&rsquo;s kind of mindless eating. There&rsquo;s no moderation and no portion control because that&rsquo;s ineffective. 
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<h5>3. Eating Till You Feel Overstuffed</h5>

An individual with a food addiction cannot stop eating once they give in to a craving. They eat until the urge is satisfied. They may subsequently realize that they have consumed so much that they feel full. 
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<h5>4. Feeling Bad Afterwards, But Repeating It</h5>

You feel guilty when you cave into a need, particularly when you&rsquo;ve been trying to control or avoid eating junk. You may experience guilt even as you&rsquo;re stuffing your mouth with food because somewhere in the back of your mind you realize that this is improper behavior. The guilt does nothing to stop you, though. 
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<h5>5. Making Up Excuses</h5>

You have the power to decide what are the trigger foods for you. Is it chips? Is it pies or cookies? That the more you eat, the more you&rsquo;ll want to eat. But, in the case of food addiction, you&rsquo;ll find that it&rsquo;s challenging to abide by these guidelines. You look for &ndash; and discover &ndash; ways to go around the limits and give in to cravings when they arise.

This kind of thinking is quite similar to that of a person who is trying to stop smoking. That is, they believe they are a non-smoker if they don&#39;t purchase a cigarette pack for themselves; they might, however, smoke from a friend&#39;s pack of cigarettes. 
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<h5>6. Repeated Failures At Setting Rules</h5>

You frequently make guidelines for yourselves, like allowing yourself one cheat meal during the day or one cheat day a week. However, you have trouble with self-control and often disregard these same rules. 
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<h5>&nbsp;7. Hiding Eating From Others</h5>

You have a history of making rules and failing at maintaining them so you start avoiding people while eating junk food. For instance, you prefer having that soft drink when nobody else is home or you devour cakes late in the evening once everybody has gone to bed. 
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<h5>8. Unable To Quit Despite Physical Problems</h5>

Short-term consequences of eating junk food include gaining weight, breakouts, foul breath, exhaustion, and compromised dental health.

<a href="https://merisehat.pk/disease/obesity">Obesity</a>, heart disease, <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">type 2 diabetes</a>, <a href="https://merisehat.pk/disease/dementia">dementia</a>, <a href="https://merisehat.pk/disease/alzheimers-disease">Alzheimer&#39;s disease</a>, and even some types of cancer can result from a lifetime of junk food eating.

If you have experienced any of these issues as a result of consuming unhealthy foods yet are unable to alter your behavior, then you probably require assistance. 
 
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Causes

Your brain&rsquo;s reward center fosters survival-related behavior. This covers instinctive actions like eating4. When you eat, the brain recognizes that you are acting appropriately and releases feel-good chemicals into the reward system. These feel-good molecules act as incentives to repeat that activity. Dopamine, a neurotransmitter, is one of these molecules. The brain looks for actions that cause the reward system&#39;s dopamine to emerge.

The issue with unhealthy food is that they induce greater pleasure compared to unprocessed foods. E.g., you find eating ice cream more enjoyable than eating an apple. 
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Diagnosis

The Yale Food Addiction Scale (YFAS) is commonly used as a &quot;diagnostic&quot; measure to recognize food addiction5. The YFAS is a questionnaire that closely resembles the substance use disorders (SUD) criteria in the Diagnostic and Statistical Manual of Mental Disorders. The scale demonstrates good convergent, discriminant, and incremental validity along with strong internal reliability5.

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The original YFAS scale included 25 self-reported questions in dichotomous and Likert-type formats. A modified version, the YFAS 2.0, was published to ensure it was consistent with the recent changes in the SUD section of the DSM-5 as well as to improve the psychometric properties of the original scale.

The Yale Food Addiction Scale for Children (YFAS-C), and subsequently the Dimensional Yale Food Addiction Scale for Children 2.0, were developed for use in the younger populations.

The DSM-5&rsquo;s criteria for SUD are listed below6: 
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<ol>
	<li>A substance is used in greater quantities or for longer than intended.</li>
	<li>Repeatedly trying to stop or cut down on the consumption of the substance, but failing to do so.</li>
	<li>Spending a lot of time trying to obtain, use, or recover from the effect of substance abuse.</li>
	<li>Feeling the urge to use the substance.</li>
	<li>Unable to focus or perform as you used to do at home, work, or school due to substance abuse.</li>
	<li>Continuing to use the substance despite experiencing difficulty in maintaining relationships due to substance use.</li>
	<li>Giving up important social, occupational, or recreational activities due to substance use.</li>
	<li>Continue using the substance despite being aware of its harmful or dangerous consequences.</li>
	<li>Continue using the substance knowing that it either caused or worsened an already existing psychological or physical issue.</li>
	<li>Developing a tolerance for the substance and increasing use to get the same pleasure.</li>
	<li>Experiencing withdrawal symptoms, which are alleviated once you use the substance. 
	&nbsp;</li>
</ol>

This 11-point criterion can be grouped into four categories: risky use, impaired control, physical dependence, and impaired control. When a person exhibits at least three of the symptoms mentioned above and tests positive for clinically substantial impairment or discomfort, they are considered to have a food addiction. 
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Treatment

Despite not being included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the fact that food addiction resembles other addictions means it&rsquo;s frequently treated using similar therapies and support that improve self-regulation, curbs cravings, and helps deal with distressing emotions like anxiety.

Since addiction is categorized as a chronic disease, the treatment options mentioned can be used. They can be personalized according to the severity of addiction, availability of support systems, and the presence of comorbidities in individual cases to ensure a sustained model of intervention: 
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<h5>1. 12-Step Programs</h5>

Finding a suitable 12-step program is one strategy for dealing with food addiction. A 12-step program is meeting other individuals who have a food addiction, too. Each person is assigned a sponsor who works with them to develop healthy eating habits.

Managing food addiction is more challenging if there&rsquo;s no social support. Finding people who are willing to assist, especially if they have had similar experiences, is helpful for healing. Additionally, 12-step programs are generally accessible and cost nothing. 
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<h5>2. Cognitive Behavioral Therapy</h5>

Cognitive behavioral therapy (CBT), a psychological strategy, has shown considerable promise in treating a variety of eating disorders, including bulimia as well as binge eating disorder7. These disorders exhibit symptoms identical to food addiction.

A psychologist who deals with eating disorders can be consulted as well to assist you in breaking the cycle of compulsive overeating. They achieve this by helping you identify and then change negative thought patterns. They also introduce you to new coping mechanisms in case you come across trigger foods or develop a sudden urge for processed foods again.

You can take CBT in a group session or individually, whichever is more convenient. 
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<h5>3. Psychiatrists And Drug Therapy</h5>

There are no medications to manage food addiction.

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However, the FDA has approved a combination of bupropion and naltrexone to help people lose weight. Bupropion is dopamine while naltrexone is an opioid antagonist, and they both work together to manage your food cravings by suppressing the parts of the brain responsible for appetite and the reward system. It&rsquo;s always recommended along with lifestyle changes, including lowering calorie intake and following an exercise routine8.

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Also, medication for anxiety or depression is sometimes prescribed to reduce the symptoms of anxiety and depression that can trigger a feeding disorder. They do not treat food addiction itself.

Note: Always consult a psychiatrist who can outline the various possibilities and offer advice based on your specific situation. 
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<h5>4. Nutritional Counseling</h5>

Consult a nutritionist who can help you develop a healthy approach to eating and planning your meals. 
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Food addiction is a complex issue that requires professional help to deal with. If untreated, food addiction can result in serious physical and psychological issues.

Short-term complications include physical effects, like upset stomach, extreme nausea and vomiting, and heartburn, and psychological or emotional distress, like feeling ashamed or disgusted with themselves.

Long-term complications include: 
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<ul>
	<li>Weight gain and <a href="https://merisehat.pk/disease/obesity">obesity</a></li>
	<li><a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Type 2 diabetes</a></li>
	<li><a href="https://merisehat.pk/disease/hypertension-57">High blood pressure</a></li>
	<li>High cholesterol</li>
	<li>Depression</li>
	<li><a href="https://merisehat.pk/disease/coronary-artery-disease">Coronary heart disease</a></li>
	<li><a href="https://merisehat.pk/disease/sleep-apnea-91">Sleep apnea</a></li>
	<li><a href="https://merisehat.pk/disease/stroke">Stroke</a></li>
	<li>Reproductive problems</li>
	<li><a href="https://merisehat.pk/disease/osteoarthritis-64627">Osteoarthritis</a></li>
	<li>Gallstones</li>
	<li>Cancer 
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Food addiction can affect anyone. Risk factors for food addiction are similar to that of other eating disorders, like bulimia nervosa, anorexia nervosa, and binge eating disorder, which involve a range of psychological, biological, and sociocultural issues. 
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<h5>Biological</h5>

<ul>
	<li>A close relative suffering from an eating disorder</li>
	<li>Having a close family who has a mental illness</li>
	<li>History of dieting</li>
	<li>Negative balance of energy</li>
	<li>Type 1 Diabetes 
	&nbsp;</li>
</ul>

<h5>&nbsp;Psychological</h5>

<ul>
	<li>Perfectionism</li>
	<li>High body image dissatisfaction</li>
	<li>History of anxiety disorders</li>
	<li>Rigid behavior 
	&nbsp;</li>
</ul>

<h5>Social</h5>

<ul>
	<li>Weight stigma</li>
	<li>Bullying</li>
	<li>Thin-ideal internalization</li>
	<li>Acculturation</li>
	<li>Limited socialization and isolation</li>
	<li>History of any trauma10 
	&nbsp;</li>
</ul>
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Like other addictions e.g. alcohol addiction or drug addiction, food addiction can be managed with help and support. There are also some strategies listed below that can work as preventive measures:&nbsp; 
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<ol>
	<li>Use smaller plates to ensure you eat smaller amounts throughout the day</li>
	<li>Reduce sweet intake; replace processed sweeteners with healthier alternatives</li>
	<li>Exercise regularly to address physiological imbalances</li>
	<li>Think about seeking therapy or assistance from a group for people with food addiction</li>
	<li>Avoid triggers like olfactory stimuli (passing a bakery commuting to work) and visual stimuli (e.g., commercials) that create an urge to consume more food</li>
	<li>Improve emotional control</li>
	<li>Allow some time to lapse before you give in to your craving, like letting 2-5 days pass by which time your food craving is likely to subside</li>
	<li>Eat only when you feel hungry or starved</li>
	<li>Avoid caffeine</li>
	<li>Drink plenty of water</li>
	<li>Eat home-cooked meals</li>
	<li>Eat mindfully, i.e., sit down at proper times and focus on the food only while eating 
	&nbsp;</li>
</ol>

These preventive measures help significantly in decreasing the incidence of obesity. However, it&rsquo;s pertinent to mention here that not all obese people have a food addiction or vice versa.11,12 
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Association Between Food Addiction And Time Perspective During Covid-19 Isolation16

The COVID-19 pandemic and its restrictions changed the lifestyle of the majority of people around the world. It had a significant impact on their thoughts, feelings, and actions, including their diet and eating habits. 
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The study demonstrated that the incidence rate of food addiction increased alarmingly during the COVID-19 isolation. Higher rates of food addiction symptoms were seen in those with past negative, present hedonistic, and present fatalistic time perspectives during the pandemic&#39;s first wave. Individuals with balanced and future time perspectives exhibited the lowest number of food addiction symptoms. 
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Key Points

<ul>
	<li>A variety of factors cause food addiction.</li>
	<li>Dieting, sadness, and body dissatisfaction are frequent precursors to developing an eating problem.</li>
	<li>Eating disorders can be controlled with medical assistance, peer and family support, and professional assistance.</li>
	<li>Food addiction is an example of a behavioral addiction.</li>
	<li>Food addiction and obesity are often confused to be two sides of the same coin; they&rsquo;re not. 
	&nbsp;</li>
</ul>

[1] Gunnars K. 8 common symptoms of food addiction. Healthline.

[2] Elizabeth Hartney BS. How to understand the phenomenon of food addiction. Verywell Mind.

[3] Gunnars K. How to overcome food addiction. Healthline.

[4] Bjarnadottir A. The 18 most addictive foods. Healthline.

[5] Khine MT, Ota A, Gearhardt AN, Fujisawa A, Morita M, Minagawa A, Li Y, Naito H, Yatsuya H. Validation of the Japanese Version of the Yale Food Addiction Scale 2.0 (J-YFAS 2.0). Nutrients. 2019 Mar 22;11(3):687. doi: 10.3390/nu11030687. PMID: 30909486; PMCID: PMC6471687.

[6] Elizabeth Hartney BS. The symptoms used to diagnose substance use disorders. Verywell Mind.

[7] Food addiction treatment: Know your options. WebMD.

[8] Wang GJ, Zhao J, Tomasi D, Kojori ES, Wang R, Wiers CE, Caparelli EC, Volkow ND. Effect of combined naltrexone and bupropion therapy on the brain's functional connectivity. Int J Obes (Lond). 2018 Nov;42(11):1890-1899. doi: 10.1038/s41366-018-0040-2. Epub 2018 Feb 23. PMID: 29535451; PMCID: PMC6107443.

[9] Food addiction. PsychGuides.

[10] Risk factors. National Eating Disorders Association.

[11] Food addiction: Symptoms and management. Medical News Today.

[12] Vasiliu O. Current Status of Evidence for a New Diagnosis: Food Addiction-A Literature Review. Front Psychiatry. 2022 Jan 10;12:824936. doi: 10.3389/fpsyt.2021.824936. PMID: 35082706; PMCID: PMC8784968.

[13] Borisenkov MF, Popov S V, Smirnov V V, Gubin DG, Petrov IM, Vasilkova TN, et al. Association between food addiction and time perspective during COVID-19 isolation. Eat Weight Disord Anorexia, Bulim Obes. 2022;27(5):1585–91.

[14] Obesity and overweight. World Health Organization.

[15] Health matters: Obesity and the Food Environment. GOV.UK.

[16] Borisenkov MF, Popov SV, Smirnov VV, Gubin DG, Petrov IM, Vasilkova TN, Solovieva SV, Martinson EA, Pecherkina AA, Dorogina OI, Symaniuk EE. Association between food addiction and time perspective during COVID-19 isolation. Eat Weight Disord. 2022 Jun;27(5):1585-1591. doi: 10.1007/s40519-021-01259-5. Epub 2022 Feb 18. PMID: 35178680; PMCID: PMC8853916.