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Understanding and Addressing Food Addiction: A Science-Based Approach to Policy, Practice and Research


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Public health concerns about the escalating obesity epidemic and its far-reaching health consequences, coupled with a growing understanding of the shared features of addiction across its myriad forms, have prompted some scientists to explore the possibility that certain eating behaviors might best be explained through the lens of addiction.

The interest in applying an addiction framework to understanding certain eating behaviors and food-related disorders has grown in recent years. This is a result of a large body of research highlighting the considerable overlap in the characterizing symptoms, risk factors and underlying neurobiological characteristics between substance addiction and what can be thought of as food addiction. It also arises from an attempt to explore how certain types of addictive-like eating might account for pathology that cannot be explained within the context of the currently recognized eating disorders of anorexia nervosa, bulimia nervosa and binge eating disorder. The growing interest in food addiction is also partially a result of an increasing awareness that lessons learned with regard to policy, prevention and clinical practice in relation to addictive substances might fruitfully be applied to the realm of food addiction.

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Understanding and Addressing Food Addiction: A Science-Based Approach to Policy, Practice and Research

  1. 1. Understanding And Addressing Food Addiction A Science-Based Approach to Policy, Practice and Research February 2016
  2. 2. Why Explore Disordered Eating Within an Addiction Framework? • To help understand the escalating obesity epidemic. • Clear shared features – risk factors, symptoms, neurobiological characteristics. • Apply lessons learned from addiction field to policy, prevention, clinical practice. 2
  3. 3. How is Food Addiction Defined? • A clinically significant physical and psychological dependence on high fat, high sugar, highly palatable foods. • Eating-related symptoms resembling those typically endorsed by individuals with substance use disorders, such as strong cravings and patterns of compulsive use. • Not a recognized disorder in the DSM-5. • Typically assessed via the Yale Food Addiction Scale (YFAS), which measures behavioral indicators of addictive eating, modeled after DSM-IV substance dependence criteria. 3
  4. 4. What are the Characterizing Symptoms? Endorsing 3 or more of the following symptoms and demonstrating clinically significant impairment or distress within the past 12 months: • Substance/food taken in larger amount and for longer period than intended • Persistent desire or repeated unsuccessful attempts to quit • Much time/activity spent to obtain, use, or recover • Important social, occupational, or recreational activities given up or reduced • Use continues despite knowledge of adverse consequences • Tolerance (marked increase in amount, marked decrease in effect) • Withdrawal 4
  5. 5. Obesity vs. Food Addiction • Although food addiction symptoms are more likely to be found in those who are overweight or obese, obesity and food addiction are distinct concepts. • Most obese people in the general population do not have food addiction and individuals with food addiction are not necessarily overweight or obese. • Unlike food addiction, substance addiction is found at relatively lower rates among obese individuals. • Little evidence that obesity itself is a form of addiction. 5
  6. 6. Anorexia, Bulimia, and Binge Eating Disorder vs. Food Addiction • Individuals with these clinical eating disorders may demonstrate addiction-like qualities, like obsessions, compulsions, impulsivity. • Individuals with eating disorders are up to 5 times more likely to have a substance use disorder; individuals with a substance use disorder are up to 11 times more likely to have an eating disorder. • Still, unlike food addiction, the diagnostic criteria for these eating disorders barely overlap with those for substance addiction. 6
  7. 7. Overlap between Substance Addiction and Disordered Eating Criteria Substance Use Disorders Food Addiction Binge Eating Disorder Bulimia Nervosa Anorexia Nervosa Substance often taken in larger amounts or over longer period than intended XX XX XX Persistent desire or unsuccessful efforts to cut down or control use XX ** Great deal of time spent in activities necessary to obtain the substance or recover from its effects X Craving, or a strong desire to use the substance ** ** Recurrent use resulting in a failure to fulfill major role obligations at work, school or home X Continued use despite persistent or recurrent social or interpersonal consequences X Important activities given up or reduced because of use X Recurrent use in situations in which it is physically hazardous X Continued use despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by use XX Tolerance X Withdrawal X ‘XX’ indicates that the symptom corresponding to the diagnostic criteria has been observed in studies of humans. ‘X’ indicates that there is preliminary evidence for this symptom in animal studies or in less rigorous human studies. ‘**’ indicates that this is not an official diagnostic criteria but is clearly evident in those with the disorder. 7
  8. 8. Eating Disorders vs. Addictive Disorders • The focus in eating disorders is primarily on the thoughts and feelings that the individual has about food and their own bodies (body image, shape & weight concerns, excessive value placed on these issues). • The focus in addictive disorders is primarily on the addictive powers of the substance/food itself. – The substance ‘hijacks’ the brain and its reward neurocircuitry. 8
  9. 9. Food & Substance Addiction: Shared Qualities • Ingestion of a product in an unhealthy/excessive manner • Loss of control over consumption • Continuing behavior despite negative consequences • Inability to cut down despite wanting to do so • Obsessive thoughts • Impulsivity, emotional reactivity • Feelings of distress, regret, depression, disgust • Tendency to relapse frequently without proper treatment 9
  10. 10. Addictive Qualities of Food Implicated in Food Addiction • Ingredients found in most highly palatable, highly processed, calorie-dense foods: sugar, fat, salt • Stimulate reward- and motivation-oriented regions of the brain • Concentrated dose, high potency, rapid rate of absorption • Promote craving • Reinforce continued consumption/use and tolerance • Elicit withdrawal symptoms 10
  11. 11. Shared Risk Factors • Genetics/biology/variations in brain structure and function (mostly associated with obesity/weight gain) • Psychology/personality traits (impulsivity, novelty seeking, a tendency toward ‘delay discounting,’ mood disorders, lower self-esteem, psychiatric illness, stress) • Early exposure to addictive substances (alcohol, illicit drugs, certain foods) and substance use/overeating/ unhealthy eating in family or social groups • Easy availability/accessibility of addictive substances/ foods 11
  12. 12. Shared Neurobiological Characteristics • Repeated, intermittent access to hyper-palatable foods leads to classic addiction symptoms, including withdrawal when the food is no longer available, tolerance or the dampening of reward with continued or repeated consumption, and craving. • Neurons in brain regions where the reward is processed have been found to have receptors for appetite-related brain chemicals; these chemicals may play a role in alcohol and other drug addiction. • The brain chemical most closely associated with rewarding stimuli and strongly implicated in addictive disorders is dopamine. 12
  13. 13. Implications of Addiction Model for Policy, Practice, and Research Improve Public Awareness: • Educate the public about the risk factors for food addiction, binge eating, and obesity. • Policies to ensure public is informed about food contents (e.g., ingredient labeling, calorie counts, salt content). • Education and prevention with new or expectant parents, children, educators (who make important choices about food availability and quality in schools), health professionals (who can educate and motivate patients to make healthy food choices and get help when needed). 13
  14. 14. Implications of Addiction Model for Policy, Practice, and Research Reduce Accessibility and Appeal of Addictive Food Components: • Increase financial incentives to food manufacturers and retailers to produce and sell more healthy foods. • Limit financial incentives to food manufacturers for producing foods high in corn starch, fructose, cheese, animal products, and other inexpensive and mass-produced ingredients. • Require sustainable and humane farming practices. • Institute zoning restrictions to limit fast food retailers in low- income neighborhoods and near schools. 14
  15. 15. Implications of Addiction Model for Policy, Practice, and Research Reduce Accessibility and Appeal of Addictive Food Components: • Levy taxes on high sugar beverages and other unhealthy foods to increase costs and reduce their desirabilty and accessibility. • Prohibit direct-to-consumer marketing of unhealthy foods to children. • Hold food industries financially accountable for health care costs associated with consumption of their products. • Limit the influence of the food industry on public policy, including the development of nutritional guidelines. 15
  16. 16. Implications of Addiction Model for Policy, Practice, and Research Incorporate Screening and Interventions into Health Care: • Identify individuals at risk early and provide evidence-based interventions to reduce risk and adverse health outcomes. • Certain medications effective in substance addiction treatment (e.g., naltrexone, bupropion, baclofen) may help control food intake and food addiction symptoms. • Certain psychotherapeutic interventions effective in substance addiction treatment (e.g., cognitive-behavioral therapy) may be effective in enhancing the sense of control over food intake. 16
  17. 17. Implications of Addiction Model for Policy, Practice, and Research Fund and Conduct Quality Research to Identify: • Valid and reliable diagnostic criteria for food addiction. • The prevalence of food addiction nationally and in at-risk populations. • The extent to which food addiction co-occurs with other eating disorders, other psychiatric disorders, and other manifestations of addiction, or increases their risk. • The specific food ingredients and processing approaches that may contribute to addictive eating in humans. • Risk and protective factors for food addiction. • Effective prevention and intervention approaches. 17
  18. 18. Conclusions For years, eating disorders and obesity were examined primarily through the lens of individual vulnerability, with prevention and interventions focused on changing how the individual interacts with his or her family and food environment. Lessons learned from substance addiction, specifically the power of certain addictive substances to directly affect an individual’s brain and behavior, have helped launch a new and potentially fruitful paradigm for understanding and addressing certain cases of obesity and eating disorders. As researchers and clinicians continue to explore the validity of the food addiction construct, its physiological mechanisms, and its potential applications to prevention, intervention, and treatment, the desire for a simple and powerful explanation and solution to our nation’s weight problem must be balanced with the need to explore these issues via a scientifically sound approach. 18
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