What is Food Addiction?
- Food addiction is a behavioral addiction with a neurobiological basis that fulfills a formal definition of disease.
- It is considerable to an addiction of an obsession, and without fulfilling this obsession prolific mental health ailments incur, giving us what is common in most diagnoses known as co-morbidity.
- Eating disorders are the most lethal form of mental illness or addictive behavior out there. People who become depressed from eating disorders are creating eating disorders to beat things like depression. It’s a vicious cycle where mortality rates are high.
- Patients who have food addictions exhibit a loss of control, tolerance, withdrawal symptoms, and continued use despite dangerous outcomes. (Shriner and Gold 2013)
Common Types of Eating Disorders
-Anorexia Nervosa is an eating disorder characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with activities in their lives. (http://www.mayoclinic.org)
-Bulimia Nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating. (https://www.nationaleatingdisorders.org)
-Binge Eating Disorder is an eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. (https://www.nationaleatingdisorders.org)
- Only 25% of participants who are obese meet the diagnostic criteria for food addiction according to the Yale Food Addiction Scale. (YFAS; Avena et al. 2013)
- Food Addiction, although increasingly supported in the scientific literature in the fields of psychology and medicine, remains a hypothesis because it has not been declared a diagnosis in the DSM-5. (American Psychological Association 2013)
- Types of triggers range from numbers, measuring tape, mirrors, sizes of clothing, toilets, specific food, scales and weight measuring devices, nutrition facts on or off of labels, specific brands of food, grocery shopping, pictures of others with eating disorders, and the list goes on.
- Research suggests that with overeating of palatable foods, dopamine receptors are down-regulated and exhibit reduced sensitivity and reward. (Gold 2011). This feeling is exacerbated during the night time when our reward system requires more and more to “feed” a craving. This is when most are known to go into things like “late night munchies” or “food comas,” but most commonly referred to as binge eating.
- It is believed that food addiction stems from the stimulation of both dopamine and opioid receptors. (Shriner and Gold 2013). Similar to a drug user getting a high after a hit, the same feeling is achieved when an overeater puts an eclaire to their lips and instantly feels better. “Instantaneous release” is the pivotal reward system to an abuser, whether it be drugs or food, it’s all the same!
- The Yale Food Addiction Scale is currently the most accurate measurement available to evaluate for food addiction.
- The Yale Food Addiction Scale contains 25 self-reported questions in which subjects are asked to reflect on eating habits within the past 12 months. The questions fall under seven specific substance dependence criteria as defined by the DSM-IV, as well as clinically significant impairment.
Patient History: Questions to ask when evaluating a person for food addiction
-Does your patient
Have control over his/her eating?
Eat more than he/she intended?
Drink excessive soda and sugary drinks?
Feel addicted to fast food?
Think about eating fatty or sugary foods multiple times a day?
Gain weight despite attempts to cut down
Gain weight despite numerous health and life consequences?
Signs and Symptoms of Food Addictions
Do you think you cannot control your intake of food, especially junk food or high sugar foods?
Have you tried different diets or weight loss programs, but none has worked permanently?
Have you found yourself vomiting, using laxatives, diuretics, or exercising a lot to avoid a weight gain after you have eaten a lot?
Do you find yourself feeling depressed, hopeless, sad or ashamed about your eating or your weight?
Do you find yourself eating when you are upset or reward yourself with food when you do something good?
Have you ever noticed after eating sugar, flour, or wheat that you become more irritable?
Do you eat in private so no one will see you?
Do you avoid social interactions because you feel you do not look good enough or do not have the proper fitting clothes to wear?
Do you steal other people’s food?
Are you more interested in what food is served at social gatherings than looking forward to the company of the people attending?
Treatment and Recovery
- Research has shown that pharmacological treatment, in combination with therapy and reduction of palatable food intake, is effective in the population with food addiction.
- This is most commonly known as “Psychotherapy” and is the leading form of treatment within eating disorder clinics, coupled with long term--not short term--intensive outpatient therapy.
- Therapy for eating disorders usually last months upon months, maybe even years, compared to an addiction outpatient therapy that may only last 3 to 6 weeks.
- The reason outpatient therapy lasts in the long term months or years for eating disorders is because unlike drugs, you cannot just quit eating.
- A key objective for including psychotherapy is to get the afflicted on the proper SSRI (most common) or anti-craving or anti-psychotic (not for psychotic reasoning) medicine. A drug abuser may stop completely and have a dopamine or serotonin rebalancing. But, with never actually being able to give up eating or going to overeating, the serotonin and dopamine may always be out of circle for the user. This is why incorporating SSRI’s and psychotherapy with long term treatment is severely crucial to recovery.
- Experts argue that recovery from food addiction may be more complicated than recovery from other kinds of addictions. Alcoholics, for example, can ultimately abstain from drinking alcohol. But people who are addicted to food still need to eat.
- So the question arises, how do you encorporate foods back into your daily living, without going too much or too little?
- The proper techniques for grocery shopping may ultimately need to be learned. Proper food selection, how much, when to eat it, are all things that the person suffering must contemplate, among many other ailments and set-backs.
- Bariatric surgery is often seen as an effective and available option to treat obese individuals with a BMI of greater than 40, however, because of the neurological, psychological and emotional complexity of food addiction, this option and pharmacological options should never be used as a sole treatment option for food-addicted patients and should not be the first choice of physicians. (Werdell 2009)
- Those who do suffer from overeating and get bariatric surgery often go into obsessions of overeating again, even with a stomach of roughly 3-4 oz, versus the previous normal capacity of 15-20 ounces of stomach. You see many start to put weight back on after bariatric treatment because of the wrong food selection and continually stretching the stomach, again.
- With such small stomachs, those who do overeat after bariatric surgery often go through binging and purging cycles, like a bulimic would, just to get the dopamine release that an overeater would. Once again divulging into the cycle of comorbidity.
- Some of the biggest forms of treatment lie in Canada. Some of the biggest programs for these types of treatment are as follows:
- BANA- Bulimia and Anorexia Nervosa Association
- Has clinics all over Canada and stemming into the US.
- NEDA- National Eating Disorder Association
FDA Approved Pharmaceuticals
- Qsymia - Qsymia contains a combination of phentermine and topiramate in an extended-release capsule. Phentermine is an appetite suppressant similar to an amphetamine. Topiramate is a seizure medication, also called an anticonvulsant.
- Belviq - Belviq contains a chemical called lorcaserin which affects chemicals in the brain that deal with appetite regulation.
- Wellbutrin- Wellbutrin is the most common form of SSRI used in eating disorder treatment because of it’s ability to curb apetities back to “normal” standards. It’s also used to give a boost of energy to help with depression, or level out certain types of generalized anxiety disorders that are coupled with eating disorders.
- Overeaters Anonymous
- Food Addicts Anonymous
- 12 step programs
Ascher, M.S. Levounis P. (2015). The Behavioral Addictions. Arlington, V.A: American Psychiatric Publishing.