What is Food Addiction?

OA believes that compulsive overeating is a threefold disease: physical, emotional and spiritual. We regard it as an addiction which, like alcoholism and drug abuse, can be arrested but not cured.

Overeating Anonymous

Many colleagues believe food addiction is not the correct way to approach binge eating, but I disagree based on both my professional and personal experience. I think there is a lot of shame in assuming that binge eating is an addiction because food is regarded in general as a human primary need and a socially accepted experience. Therefore, it is hard for most people to grasp the idea that food can be misused and associated with addictive behaviors. It is easier to see that food can be a problem when it comes to obesity, anorexia, or bulimia, but not when you address binge eating through the lens of addiction.

I believe, however, that we are doing a disservice to people who deal with this sort of experience if we don’t treat it like an addiction. In the Psychiatry community, binge eating is not considered an addiction but there are five criteria sets to diagnose binge eating that resemble dependency issues to some extent. For instance, the first criterion regards the amount of food consumed in an uncontrolled manner and within a specific time frame (see summary table at the end of this post). According to the “addiction model”, cravings or urges to engage in a specific behavior are usually paired with a loss of control over that same behavior.

The second binge eating diagnosis criterion posits that at least three of the following aspects must be true: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of being embarrassed by how much one is eating, and feeling disgusted with oneself, depressed, or very guilty after eating. These aspects reflect, once again, many of the characteristics of addiction.

The third criterion deals with the presence of distress regarding binge eating. The fourth criterion states that binge eating occurs when someone has an episode at least once a week for a period of three months. The final criterion refers to the absence of regular use of unhealthy compensatory behaviors such as purging or over-exercising. When dealing with binge eating, there is an attempt to control food intake which is frustrated over and over again due to cravings and the reinforcement of the feedback loop once these are fulfilled.

Criteria summary table

Criterion 1
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

– Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances

– The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
Criterion 2
Binge-eating episodes are associated with three (or more) of the following:
– Eating much more rapidly than normal
– Eating until feeling uncomfortably full
– Eating large amounts of food when not feeling physically hungry
– Eating alone because of being embarrassed by how much one is eating
– Feeling disgusted with oneself, depressed, or very guilty after overeating
Criterion 3
Marked distress regarding binge eating is present
Criterion 4
The binge eating occurs, on average at least 1 day a week for 3 months
Criterion 5
The binge eating is not associated with the regular use of inappropriate compensatory behavior (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa.
DSM-5 Binge Eating Criteria for Diagnosis

In the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), addiction has been included and its defining aspects are no longer specific to substance abuse, including non-substance abuse disorders as well. These aspects include spending a great deal of time getting and using a substance, attempts to quit the unhealthy behavior, and continued use despite negative consequences. Recent studies also corroborate this view by showing that addictive behaviors seem to emerge as an attempt to reactivate and stimulate areas of the brain that are involved in feeling pleasure.

This reinforces the idea that food addiction, like many other types of addiction, is a neuropsychological issue. Food addiction may be triggered by an individual need to seek pleasure or avoid pain and, in the process, be reinforced by neurobiological pathways that regulate the electrical stimulation of specific areas of the brain that are responsible for pleasure. The mesolimbic pathway, for instance, is very important when looking at how reward and pleasure are processed in the brain, as it is responsible for the transport of dopamine, a neurotransmitter that modulates our mood, motivation, and other higher cognitive functions.

Many binge-eaters only seek help when physical and mental exhaustion becomes greater than the urge to obtain further stimulation and compensation through food. This derails one of the arguments presented in the book “Overcoming Binge Eating”, written by Dr. Christopher G. Fairburn, who suggests that binge eating should not be treated as an addiction based on the fact that binge eaters have the drive to avoid the behavior. I would say binge eaters are preoccupied with the behavior but do not have an intrinsic drive to avoid it because the feedback loop gives them some relief even if just temporarily.

Concluding Thoughts

Although I respect my colleagues and other professionals who don’t agree that the term food addiction can or should be applied to binge eating, my professional and personal opinion is that dealing with binge eating from an addiction standpoint can be empowering and fruitful. Letting people know that their behavior is likely a disguised attempt to obtain psychological and physical relief from tension accumulated can be life-changing in the way we move through behavioral change stages. Learning how sugared and processed foods can trigger our brain’s reward system also allows us to look at food and its nutritional value from a different stance. It’s much easier to stop binge eating when we know why we do it and why we tend to lose control over high-calorie foods such as chocolate, processed cheeses, and candy.

Other blogs you may like to read:

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Anyone who knows me knows that I love Mediterranean food and appreciate the myriad of scientific studies that demonstrate its benefits. In this blog post, I will share what the scientific community has to say about osteoarthritis (OA) and the Mediterranean diet (MDiet).

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