Inspirational Q&A #6: Is Food Addiction a real thing?

August 6, 2019

Inspirational Q&A #6: Is Food Addiction a real thing?

Is Food Addiction a real thing?

I just received a very cool question from Dr.Devos a.k.a. The Lifting Dermatologist. Actually, there are 3 questions in one – is Food Addiction a real thing? What is binge eating? And what is the cause of it? I believe that these are great and topical questions and it makes sense to answer them exactly in the same sequence as they were asked.

Is Food Addiction a real thing?

It really depends on how you define “real thing” – if we are talking about official recognition as a “condition” or disorder, then the answer is no – there is no such diagnosis in DSM (Diagnostic and Statistical Manual) or in ICD (International Classification of Diseases). In North America, we use DSM-5, with its addictions section focused mostly on substances though recently we had gambling disorder added. We also have eating disorders such as anorexia nervosa, bulimia nervosa and others, including binge eating disorder (more on that later). You can see that we still haven’t quite captured food addiction as a separate disorder or diagnostic category as it’s quite difficult to do – we need to consume food to live and it’s hard to differentiate between normal food intake and addictive eating1.

At the same time, as a psychiatrist who contributed to DSM-5 and had been working in addictions for many years, I can say that the concept of food addiction is quite real. As a matter of fact, I often regard overeating as food addiction, and I will explain why. First, all addictions are revolving around the concept of gratification – we do enjoy food and we tend to crave it, there are lots of cultural food-related “rituals” involving hunting, gathering, cooking, presenting, and tasting food. Second, all kinds of addictive behaviours are biologically rooted in certain circuitry in our brain – nucleus accumbens / reward pathway to be very specific. All substances of abuse manage to hijack this pathway to give us pleasure and food is one of the major stimuli for this pathway as it was important for us from evolutionary standpoint to enjoy certain things necessary for survival of the species – food, water, shelter, sex etc. I must note that there is a critical difference between food and substances of abuse – food doesn’t have to “hijack” this pathway. It’s a naturally occurring survival mechanism and therefore it makes it difficult to separate food intake and food addiction. Finally, if we look at the formal diagnostic criteria for substance use disorders, which are by the way identical for all substances of abuse, we can see how uncontrolled food intake can meet the criteria for addiction – the four main categories of criteria are as follows:

Impaired control – we tend to lose control over quantity of food we consume, meal frequency, we go on various diets to reduce food consumption and experience cravings for food in general or some specific food items.
Social impairment – effectively, consumption of the drug of choice (food in this case) can result in failure to fulfill major role obligations, abandonment of hobbies and other recreational activities, which get substituted by food intake. It happens quite often in modern society and we even have a term “foodie” for people who are extremely focused on food.
Risky use – this one might be less obvious, but turns out to be surprisingly more solid. We know that overeating and consumption of specific foods is associated with increased risk of cardiovascular disease, obesity, premature mortality and has multiple medical sequelae in general i.e. excessive food intake represents a valid health risk.
Pharmacological criteria – there are two of them, specifically, tolerance and withdrawal. These criteria were created for substances and it’s hard to apply them to food. Actually, not even every substance has a well-defined withdrawal syndrome. We can still work around carbohydrate intake and operationalize tolerance and withdrawal criteria for food as insulin resistance and type 2 diabetes mellitus as tolerance and episodes of hypoglycemia in those who are taking sugar-lowering medications and thus are relying on carbohydrates in their diet and stop consuming them abruptly.

So, as you can see, from the formal diagnostic standpoint we can see how food can be addictive and how excessive, uncontrolled food intake can be conceptualized as food addiction. Interestingly enough, a person who is “addicted” to food will likely look like somebody with binge eating disorder, which is the second part of the question.

What is binge eating?

We do have a new addition to the DSM-5’s eating disorders section, which is called binge eating disorder and is characterized by regular binge eating episodes or “binges”, which lead to significant impairment in functioning. These binges are defined as episodes of consumption of unusually large quantities of food, usually in a rapid manner, past the point of feeling full and satiated. Food is often consumed alone as the person might feel embarrassed by the binge and might result if feeling guilty, disgusted or depressed. This kind of behaviour becomes binge eating disorder when these binges are regular and result in significant distress and impairment in functioning.

What is the cause of it?

Like almost everything in psychiatry, binge eating has multifactorial etiology – there are biological, medical, psychological, and sociocultural factors leading to the development of binge eating. There are individual genetically predetermined variations of metabolic pathways that may make some individuals respond differently to certain kinds of foods / nutrients. Some people might have some endocrinological disorders that would determine their responses to food and the way our bodies handle various nutrients – diabetes, thyroid problems, Cushing disease etc. just to name a few. Also, having certain psychiatric conditions like Prader-Willi syndrome for example is also associated with binge eating as well as stress, trauma and some of psychiatric medications as a side effect. Psychologically, through classical (Pavlovian) or operant (Skinnerian) conditioning, food intake might be associated with different situations such as celebrating something with a cake, having some comfort food when you are stressed, or, say, feeling good when restricting your food intake if you feel that your need to lose weight. Food intake can be dictated by social and cultural factors – binge eating will likely look differently in France and in Japan as different cultures have different nutrient intake patterns to begin with as well as different socially accepted food intake norms. Finally, certain social, recreational activities and sports are associated with either food restriction or overeating e.g. being a ballerina is a known risk factor for development of eating disorder. A good illustration of that would be the study that showed that introduction of TV to Fiji was associated with a significant change in prevalence of body dysmorphia and eating disorders2.

I don’t want to dwell too much on this study and make my blog too medical, but I hope that I managed to cover the topic of food addiction and binge eating well enough. If you feel like you have more questions on this topic or you’d like to know more about specific details, please do not hesitate to contact me either on this site, or on YouTube channel. Also, subscribe to my newsletter so that I can let you know every time I post something new.