Food addiction

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A food addiction or eating addiction is any behavioral addiction characterized primarily by the compulsive consumption of palatable and hyperpalatable food items. Such foods often have high sugar, fat, and salt contents (HFSS), and markedly activate the reward system in humans and other animals. Those with eating addictions often overconsume such foods despite the adverse consequences (such as excess weight gain, diabetes, and heart disease) associated with their overconsumption. [1] [2]

Contents

Psychological dependence has also been observed, with the occurrence of withdrawal symptoms when substituting foods low in sugar and fat. [1] A person cannot develop a trait that codes for an eating disorder. Professionals address psychological dependence by providing behavior therapy [3] and through administering the YFAS (Yale Food Addiction Scale) questionnaire, a diagnostic criteria of substance dependence. [4]

High-sugar and high-fat foods have been shown to increase the expression of ΔFosB, an addiction biomarker, in the D1-type medium spiny neurons of the nucleus accumbens; [1] however, there is very little research on the synaptic plasticity from compulsive food consumption, a phenomenon which is known to be caused by ΔFosB overexpression. [1]

Description

Food addiction often refers to compulsive overeating; some who suffer from the condition engage in frequent episodes of uncontrollable eating (binge eating). The word was first used in a research-based publication the Quarterly Journal of Studies on Alcohol by American doctor Theron Randolph in 1956. [5] It was continued to use throughout the late 1900s with more cases reported of the condition. In the 21st century, food addiction are often associated with eating disorders. [5] The term binge eating is defined as eating an unhealthy amount of food while feeling that one's sense of control has been lost. [6] Food addiction initially presents in the form of cravings, which cause a feeling that one cannot cope without the food in question. [7] As the disorder progresses, behavior is modified in order to satisfy the urge for the food. These behavioral changes can result in binge eating disorder, obesity, and bulimia nervosa. A study in Physiology & Behavior by Parylak et al. suggests that animal models given free access to food become more emotionally withdrawn once the food is unavailable due to the anxiogenic stimulus for more food that results. [8] This behavior may suggest that food addiction is not only a problem of self-control, but that it is furthermore the body providing a stimulus so powerful as to numb the individual to the negative consequences of overeating.

People who engage in binge eating may feel frenzied, and consume a large number of calories before stopping. Food binges may be followed by feelings of guilt and depression; [9] for example, one might cancel their plans for the next day because one "feels fat." Binge eating also has implications on physical health, due to excessive intake of fats and sugars, which can cause numerous health problems. [10]

Unlike individuals with bulimia nervosa, persons with compulsive overeating do not attempt to compensate for their bingeing with purging behaviors, such as fasting, laxative use, or vomiting. When a person suffering from compulsive overeating through binge eating experiences feelings of guilt after their binges, that person can be said to have binge eating disorder (BED). [6]

In addition to binge eating, compulsive overeaters may also engage in "grazing" behavior, during which they continuously eat throughout the day. [6] These actions result in an excessive overall number of calories consumed, even if the quantities eaten at any one time may be small.

During binges, compulsive overeaters may consume between 5,000 and 15,000 food calories daily (far more than is healthy), resulting in a temporary release from psychological stress through an addictive high not unlike that experienced through drug abuse. [9] Compulsive overeaters tend to show brain changes similar to those of drug addicts, a result of excessive consumption of highly processed food (most likely consisting of high amounts of saturated fat, which is more energy-rich). [11] Unlike smoking, drugs, or alcoholism, people with food cravings are not under a type of substance use disorder. Food addiction is more commonly associated with a behavioral addiction to a form of processed food that is not generally healthy. [10]

Signs and symptoms

A food addiction features compulsive overeating, such as binge eating behavior, as its core and only defining feature. There are several potential signs that a person may be experiencing compulsive overeating. Common behaviors of compulsive overeaters include eating alone, consuming food quickly, gaining weight rapidly, and eating to the point of stomach discomfort. Other signs include significantly decreased mobility and withdrawal from activities due to weight gain. Emotional indicators can include feelings of guilt, a sense of loss of control, depression and mood swings. [9] [12]

Hiding consumption is an emotional indicator of other symptoms that could be a result of having a food addiction. Hiding consumption of food includes behaviors such as eating in secret, eating late at night, eating in a vehicle, and hiding certain foods until ready to consume in private. Other signs of hiding consumption are avoiding social interactions to eat the specific foods that are craved. [4] Other emotional indicators are inner guilt, which may consist of rationalizing why the food would be beneficial to consume, as well as feeling guilty shortly after consuming the food. [13]

Sense of loss of control may be indicated in many ways, such as expending more effort than usual to obtain specific foods, or spending unnecessary amounts of money on foods to satisfy cravings. This sense of loss of control may impede function during work due to disorganized thoughts, leading to a decrease in efficiency. Another indication is craving food despite being full. One may set rules to try to eat healthy, but find themselves frustrated when they are overruled by their cravings. A large indicator of loss of control due to food addiction is knowing one has a medical problem caused by their behaviors, but not being able to stop consuming the foods, further compromising one's health. [14] [13]

Food addiction has some physical signs and symptoms, including decreased energy; decreased ability for activity compared to the past or compared to others; decreased mental efficiency due to the lack of nutritive energy; fatigue; hypersomnia; and insomnia. Other physical signs and symptoms are restlessness, irritability, digestive disorders, and headaches. [14] [13]

In extreme cases food addiction can result in suicidal thoughts. [14]

Effects

Obesity has been attributed to eating behavior or fast food, personality issues, depression, genetics, and also social and environmental conditions such as walkability and access to diverse foods. A lack of access to diverse foods could be caused by food deserts. Other effects of obesity could be an increased risk for type 2 diabetes, [15] cardiovascular diseases, and certain cancers. [15] Food addiction might be one supplementary explanation for the epidemic of obesity overall. [16]

Management

Compulsive overeating is treatable with nutritional assistance and medication. Psychotherapy may also be required, but recent research has shown this to be useful only as a complementary resource, with short-term effectiveness in moderate to severe cases. [17] [18]

Lisdexamfetamine is an FDA-approved appetite suppressant drug that is indicated (i.e., used clinically) for the treatment of binge eating disorder. [19] The antidepressant fluoxetine is a medication that is approved by the Food and Drug Administration for the treatment of an eating disorder, specifically bulimia nervosa. This medication has been prescribed off-label for the treatment of binge eating disorder. Off-label medications, such as other selective serotonin reuptake inhibitors (SSRIs), have shown some efficacy, as have several atypical antidepressants, such as mianserin, trazodone and bupropion. [20] [21] Anti-obesity medications [22] have also proven very effective. Studies suggest that anti-obesity drugs, or moderate appetite suppressants, may be key to controlling binge eating. [23]

Many eating disorders are thought to be behavioral patterns that stem from emotional struggles; for the individual to develop lasting improvement and a healthy relationship with food, these behavioral obstacles need to be resolved. [24]

Treatment can include talk therapy and medical and nutritional counseling.

The American Dental Association has sanctioned these suggestions, stating:

Given the continued increase in obesity in the United States and the willingness of dentists to assist in prevention and interventional effort, experts in obesity intervention in conjunction with dental educators should develop models of intervention within the scope of dental practice.

— Journal of the American Dental Association [25]

Moreover, dental appliances such as conventional jaw wiring and orthodontic wiring have been shown to be efficient methods of weight control in obese patients, with a low incidence of serious complications. [26]

Several twelve-step programs exist to help members recover from compulsive overeating and food addiction, [9] such as Overeaters Anonymous.

The Ontario Health Insurance Plan has announced a new program designed to assist individuals struggling with food addiction. [27]

Prognosis

Left untreated, food addiction can lead to chronic conditions and eventually death.

In an individual diagnosed with an eating disorder such as BED, the chances for relapse are high. Those with a food addiction were most likely overweight in childhood, [28] which may lead to treatment resistance depending on the amount of time gone untreated. Due to poor mental health and lack of control and environmental factors, [29] overeaters may relapse into their old habits even after completing various treatments. BED patients often report and acknowledge using substances daily as a coping mechanism.

However, with treatment and follow-ups, there is a 50% chance of recovery. [30] Success in overcoming this disorder rests on following treatment directions and a properly supportive environment in which to recover.

There is a higher chance of successful treatment in teenage populations, in which denial is less ingrained than adults.

Epidemiology

A review on behavioral addictions estimated the lifetime prevalence (i.e., the proportion of individuals in the population that developed the disorder during their lifetime) for food addiction in the United States as 2.8%. [1]

As obesity continues to grow into a worldwide problem, solutions such as a sugar tax have been suggested. A sugar tax is set to be introduced in Ireland to minimise the consumption of harmful foods and drinks. [31]

Form of neuroplasticity
or behavioral plasticity 		Type of reinforcer Sources
OpiatesPsychostimulantsHigh fat or sugar food Sexual intercourse Physical exercise
(aerobic) 		Environmental
enrichment
ΔFosB expression in
nucleus accumbens D1-type MSNs Tooltip medium spiny neurons		↑↑↑↑↑↑ [1]
Behavioral plasticity
Escalation of intakeYesYesYes [1]
Psychostimulant
cross-sensitization 		YesNot applicableYesYesAttenuatedAttenuated [1]
Psychostimulant
self-administration 		↑↑↓↓↓ [1]
Psychostimulant
conditioned place preference 		↑↑↓↑↓↑ [1]
Reinstatement of drug-seeking behavior ↑↑↓↓ [1]
Neurochemical plasticity
CREB Tooltip cAMP response element-binding protein phosphorylation
in the nucleus accumbens		↓↓↓↓↓ [1]
Sensitized dopamine response
in the nucleus accumbens		NoYesNoYes [1]
Altered striatal dopamine signaling ↓DRD2, ↑DRD3 ↑DRD1, ↓DRD2, ↑DRD3 ↑DRD1, ↓DRD2, ↑DRD3 ↑DRD2 ↑DRD2 [1]
Altered striatal opioid signaling No change or
↑μ-opioid receptors 		↑μ-opioid receptors
↑κ-opioid receptors 		↑μ-opioid receptors ↑μ-opioid receptors No changeNo change [1]
Changes in striatal opioid peptides ↑dynorphin
No change: enkephalin 		↑dynorphin ↓enkephalin ↑dynorphin ↑dynorphin [1]
Mesocorticolimbic synaptic plasticity
Number of dendrites in the nucleus accumbens↓↑↑ [1]
Dendritic spine density in
the nucleus accumbens		↓↑↑ [1]

See also

Related Research Articles

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known simply as bulimia, is an eating disorder characterized by binge eating, followed by purging or fasting, as well as excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

<span class="mw-page-title-main">Appetite</span> Desire to eat food

Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Appetite has a relationship with every individual's behavior. Appetitive behaviour also known as approach behaviour, and consummatory behaviour, are the only processes that involve energy intake, whereas all other behaviours affect the release of energy. When stressed, appetite levels may increase and result in an increase of food intake. Decreased desire to eat is termed anorexia, while polyphagia is increased eating. Dysregulation of appetite contributes to ARFID, anorexia nervosa, bulimia nervosa, cachexia, overeating, and binge eating disorder.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

Overeating occurs when an individual consumes more calories in relation to the energy that is expended via physical activity or expelled via excretion, leading to weight gain and often obesity. Overeating is the defining characteristic of binge eating disorder.

<span class="mw-page-title-main">Chocolate addiction</span> Person who craves chocolate

Chocolate addiction is a compulsive desire to eat chocolate despite negative consequences.

Motivational salience is a cognitive process and a form of attention that motivates or propels an individual's behavior towards or away from a particular object, perceived event or outcome. Motivational salience regulates the intensity of behaviors that facilitate the attainment of a particular goal, the amount of time and energy that an individual is willing to expend to attain a particular goal, and the amount of risk that an individual is willing to accept while working to attain a particular goal.

Sexual addiction is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences. The concept is contentious; as of 2023, sexual addiction is not a clinical diagnosis in either the DSM or ICD medical classifications of diseases and medical disorders, which instead categorize such behaviors under labels such as compulsive sexual behavior.

A food craving is an intense desire to consume a specific food, and is different from normal hunger. It may or may not be related to specific hunger, the drive to consume particular nutrients that is well-studied in animals. In studies of food cravings, chocolate and chocolate confectioneries almost always top the list of foods people say they crave; this craving is referred to as chocoholism. The craving of non-food items as food is called pica.

An addictive behavior is a behavior, or a stimulus related to a behavior, that is both rewarding and reinforcing, and is associated with the development of an addiction. There are two main forms of addiction: substance use disorders and behavioral addiction. The parallels and distinctions between behavioral addictions and other compulsive behavior disorders like bulimia nervosa and obsessive-compulsive disorder (OCD) are still being researched by behavioral scientists.

<span class="mw-page-title-main">Compulsive behavior</span> Habit and impulse disorder

Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. Compulsive behaviors are a need to reduce apprehension caused by internal feelings a person wants to abstain from or control. A major cause of compulsive behavior is said to be obsessive–compulsive disorder (OCD). "The main idea of compulsive behavior is that the likely excessive activity is not connected to the purpose to which it appears directed." There are many different types of compulsive behaviors including shopping, hoarding, eating, gambling, trichotillomania and picking skin, itching, checking, counting, washing, sex, and more. Also, there are cultural examples of compulsive behavior.

Overeaters Anonymous (OA) is a twelve-step program founded by Rozanne S. Its first meeting was held in Hollywood, California, USA on January 19, 1960, after Rozanne attended a Gamblers Anonymous meeting and realized that the Twelve Steps could potentially help her with her own addictive behaviors relating to food. OA has since grown, with groups in over 75 countries meeting in person, over the phone, and through the internet. OA is for people with problems related to food including, but not limited to, compulsive overeaters, those with binge eating disorder, bulimics and anorexics. Anyone with a problematic relationship with food is welcomed; OA's Third Tradition states that the only requirement for memberships is a desire to stop eating compulsively.

<span class="mw-page-title-main">Impulsivity</span> Tendency to act on a whim without considering consequences

In psychology, impulsivity is a tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences. Impulsive actions are typically "poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation that often result in undesirable consequences," which imperil long-term goals and strategies for success. Impulsivity can be classified as a multifactorial construct. A functional variety of impulsivity has also been suggested, which involves action without much forethought in appropriate situations that can and does result in desirable consequences. "When such actions have positive outcomes, they tend not to be seen as signs of impulsivity, but as indicators of boldness, quickness, spontaneity, courageousness, or unconventionality." Thus, the construct of impulsivity includes at least two independent components: first, acting without an appropriate amount of deliberation, which may or may not be functional; and second, choosing short-term gains over long-term ones.

Behavioral addiction, process addiction, or non-substance-related disorder is a form of addiction that involves a compulsion to engage in a rewarding non-substance-related behavior – sometimes called a natural reward – despite any negative consequences to the person's physical, mental, social or financial well-being. In the brain's reward system, a gene transcription factor known as ΔFosB has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations.

An addictive personality refers to a hypothesized set of personality traits that make an individual predisposed to developing addictions. This hypothesis states that there may be common personality traits observable in people suffering from addiction; however, the lack of a universally agreed upon definition has marked the research surrounding addictive personality. Addiction is a fairly broad term; it is most often associated with substance use disorders, but it can also be extended to cover a number of other compulsive behaviors, including sex, internet, television, gambling, food, and shopping. Within these categories of addiction a common diagnostic scale involves tolerance, withdrawal, and cravings. This is a fairly contentious topic, with many experts suggesting the term be retired due to a lack of cumulative evidence supporting the existence of addictive personality. It has been claimed that characteristics of personality attributed to addictive personality do not predict addiction, but rather can be the result of addiction. However, different personality traits have been linked to various types of addictive behaviors, suggesting that individual addictions may be associated with different personality profiles. The strongest consensus is that genetic factors play the largest role in determining a predisposition for addictive behaviors. Even then, however, genes play different roles in different types of addictions. Forty to seventy percent of the population variance in the expression of addictions can be explained by genetic factors.

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in addiction's development.

Exercise addiction is a state characterized by a compulsive engagement in any form of physical exercise, despite negative consequences. While regular exercise is generally a healthy activity, exercise addiction generally involves performing excessive amounts of exercise to the detriment of physical health, spending too much time exercising to the detriment of personal and professional life, and exercising regardless of physical injury. It may also involve a state of dependence upon regular exercise which involves the occurrence of severe withdrawal symptoms when the individual is unable to exercise. Differentiating between addictive and healthy exercise behaviors is difficult but there are key factors in determining which category a person may fall into. Exercise addiction shows a high comorbidity with eating disorders.

Drunkorexia is a colloquialism for anorexia or bulimia combined with an alcohol use disorder. The term is generally used to denote the utilization of extreme weight control methods to compensate for planned binge drinking. Research on the combination of an eating disorder and binge drinking has primarily focused on college-aged women, though the phenomenon has also been noted among young men. Studies suggest that individuals engage in this combination of self-imposed malnutrition and binge drinking to avoid weight gain from alcohol, to save money for purchasing alcohol, and to facilitate alcohol intoxication.

Emotional eating, also known as stress eating and emotional overeating, is defined as the "propensity to eat in response to positive and negative emotions". While the term commonly refers to eating as a means of coping with negative emotions, it sometimes include eating for positive emotions, such as overeating when celebrating an event or to enhance an already good mood.

<span class="mw-page-title-main">Hyperpalatable food</span> Food that triggers the brains reward system

Hyperpalatable food (HPF) combines high levels of fat, sugar, sodium, and/or carbohydrates to trigger the brain's reward system, encouraging excessive eating. The concept of hyperpalatability is foundational to ultra-processed foods, which are usually engineered to have enjoyable qualities of sweetness, saltiness, or richness. Hyperpalatable foods can stimulate the release of metabolic, stress, and appetite hormones that play a role in cravings and may interfere with the body's ability to regulate appetite and satiety.

References

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  31. ↑ "Sweet taste of success for soft drinks sector". The Irish Times. 14 October 2016.

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