The idea of food addiction has gained traction in public consciousness, paralleling talk of the modern food environment and its highly palatable foods. But can we really become addicted to food in the same way we might become addicted to tobacco, alcohol or cocaine? It’s a controversial question that presents a few conundrums. One, unlike alcohol or drugs we depend on food to live. Two, what people experience as food addiction doesn’t match up to the science.
“Currently there is no evidence base for food, and more specifically sugar, as a substance that is actually chemically addictive,” says Boston-based registered dietitian Marci Evans, MS, CEDRD, LDN. However, she says this doesn’t discount people’s feelings of food addiction. “This idea of, ‘If I don’t bring it into my house, I’m OK, but the moment I start, I can’t stop,’ those qualities are very real for some people.”
Yale Food Addiction Scale. Much of the research on food addiction comes out of Yale University, including brain scans showing that in people who report food addiction, eating addictive foods triggers brain responses that look very similar to responses to alcohol or hard drugs. But there’s a problem with that. Alcohol and drugs hijack the neurological pathways that were designed to release dopamine—the “pleasure hormone”—in response to natural rewards like foods, not the other way around.
“Just because sugar and cocaine share the same neuropathways does not equate to sugar being addictive, or harmful,” says San Diego-based registered dietitian Tiffany Haug, MS, RDN. She points out that breast feeding your child, looking at a loved one’s face and listening to music also activate those pleasure pathways—yet no one worries about them being addictive.
The Yale Food Addiction Scale has set criteria for diagnosing food addiction that include persistent eating despite negative consequences to physical or emotional health, persistent desire for food, unsuccessful attempts to cut down, and impairment of functioning—to daily routines, relationships or health—because of overeating. It also includes criteria for tolerance and withdrawal symptoms—controversial because they are poorly defined. “The primary problem is that the Yale Food Addiction Scale is diagnosing addiction based on someone’s felt or subjective experience,” Evans says, “rather than actually diagnosing something that we see happening on a neurobiological level.”
The problem with abstinence. Abstaining from “addictive” foods is a common treatment tool, but Evans says this may contribute to the problem. “Many people translate ‘food addiction’ as ‘I can never have these foods. I’m an addict, and therefore I can’t be trusted. My body has a mind of its own, and I have to be abstinent,’” Evans says, pointing out that the only studies that show true addictive-like or compulsive behavior are with rodents that have been intermittently deprived of sugar. This means that when we abstain from a food, we are potentially setting ourselves up to eat in a way that feels compulsive when we do have that food. Why? Because we get a bigger burst of dopamine than when we would if we regularly ate that food.
Haug gives the example of someone who abstains from chocolate for two years then relents to have a brownie at their child’s birthday party. “There is going to be that surge of dopamine, which feels really good,” she says. “This may increase their likelihood of eating half the pan of brownies instead of a more moderate amount because it tastes amazing to them—maybe even better than they remember prior to cutting it out of their diet.”
Adding in the “Last Supper mentality” of “I don’t know when I will let myself have chocolate again, so I better enjoy it now,” can make the person feel out of control around the brownies—and vowing to never eat them again, Haug says. “But what we often forget and lose sight of is that this all began with cutting the food out in the first place. Restricting always proceeds the overeating.”
Perhaps not surprisingly, commonly reported “addictive” foods contain sugar, caffeine, or fat—think milkshakes, chocolate, soda, pizza or French fries, not broccoli and salmon. “The more attractive a food is, the more it’s been labeled as ‘bad,’ the more someone tries to avoid it, the more likely when someone ‘loses their willpower’ the experience will feel out of control,” Evans says.
Getting help and finding balance. There are many reasons someone might overeat in a way that feels out of control, including having a diagnosable eating disorder, such as binge eating disorder or bulimia nervosa, which need expert treatment.
Evans says simply discovering that restriction and abstinence can lead to binging and feelings of being out of control about food isn’t enough. Trying to break the cycle by suddenly granting permission to eat the “forbidden” food may make things worse. “Without unlearning a lot of the unhelpful thoughts and judgments and without developing skills to manage all that food, what ends up happening is a lot of binging, and then this sort of proof that, ‘See, I can’t be trusted.’ It reinforces the past experience,” she says.
—Carrie Dennett, MPH, RDN