Is It a Valid Diagnosis?

Overeaters Anonymous follows a similar 12-step program as Narcotics and Alcoholics Anonymous, but unlike substance use disorder, food addiction is not listed in the DSM-5 manual, a diagnostic tool published by the American Psychiatric Association (APA).

When it comes to agreeing on a definition, it’s worth considering how those actually affected by food addiction feel about the term.

Addiction or addiction-like?

“In my experience, some affected people find the term ‘food addiction” validating, empowering, and useful for their recovery,” says Anne Marie O’Melia, MS, MD, FAAD, and chief medical and clinical officer at the Eating Recovery Center.

Still, she worries that the lack of consensus and clear definitions can fuel rigid, all-or-nothing thinking. Her take? Food addiction isn’t the best term, but it’s fair to say that food can prompt addiction-like behavior.

By contrast, licensed psychotherapist Teralyn Sell, Ph.D. says it’s fair to call a spade a spade.

“If you can’t stop yourself from eating something, overeat, find yourself being secretive about eating something, or even have a withdrawal, such as you feel sick or have blood sugar imbalance, that is an addiction,” she says.

Cali Estes, Ph.D., MCAP, MAC, ICADC, says food can definitely be addictive, pointing to a 2018 review on brain activity and food that’s similar to that seen in people addicted to drugs or alcohol.

Meaningful benchmarks

Still, even some of the terms Estes and Sell suggest are up for debate.

Without true screening guidance, it’s impossible to standardize the behaviors, symptoms, and neural activity present with food addiction.

However, the Yale Food Addiction Scale was created in 2009 to match the criteria for Substance Abuse in the DSM-5, and has been validated as a tool for identifying eating patterns which resemble alcohol and drug addictions. The scale was updated in 2016.

Part of the controversy around the term “food addiction” is that people feel it makes light of drug addiction.

For nearly two decades, the U.S. has grappled with an opioid crisis. In 2021, opioid-related deaths rose from 70,029 in 2020 to 80,816, according to CDC data. Overall, drug overdose deaths went up 15 percent.

Research from 2020 found only modest similarities between the lived experiences of people with addictive-like eating behaviors and those who fit the DSM-5 criteria for substance use disorder.

However, a 2018 systemic review suggested that addictive-food symptoms better fit the diagnostic criteria for substance use disorder rather than a behavioral disorder.

Again, it’s controversial — and loaded.

Sell has empathy for individuals who experience or have lost someone to drug addiction, and she admits there are significant differences.

However, she says the topic warrants research and discussion—and individuals deserve treatment options and help.

“While food addiction is unlikely to cause the amount of life-destroying consequences or impacts on loved ones like that of drug or alcohol addiction, food addictions…cannot be overlooked as problematic for individuals or as a societal issue,” Sell says.

Though it may not have a home in the DSM-5, food addiction has become a hot topic. While the appropriateness of the term is disputed, it still appears frequently in research.

According to a 2022 study of 194 college students, food addiction has gained increased research attention over the last decade.

The researchers note that a strong urge to eat too many highly-palatable foods is a hallmark sign of food addiction, and suggested a link between food addiction and college students’ weight dissatisfaction, eating habits, and food choices.

A 2019 scoping review acknowledged the controversy around the term. Still, authors called for more awareness of food addiction, the role of the food industry, and potential policy interventions that may help curb the issue.

A 2018 systemic review acknowledged food addiction as a valid diagnostic term, especially as it relates to foods high in added sweeteners and refined ingredients. Additionally, the study noted several symptoms characteristic of food addiction.

These included:

• neurological changes
• impaired control
• preoccupation
• chronicity
• relapse
• social impairment
• risky use

The study authors noted that the substance component of addiction, referring to highly-palatable food, was more relevant than the behavior of eating. This indicates that the actual makeup of the food rather than the familiar pattern of eating is at play in food addiction behaviors.

“We propose that the food addiction construct merits serious attention in regard to its presentation, prevention, and treatment in humans,” noted the authors.

Still, there are some who disagree.

According to 2021 research, study authors suggest that the concept of food addiction distracts from and doesn’t help reduce obesity rates. They argue that using the same diagnostic criteria for substance use disorders is too simplistic for several reasons.

These include:

• Several somatic and mental disorders must be excluded.
• Food addiction needs to be distinguished from the physiological need to consume enough calories to maintain a high body weight.
• Intentional weight loss can induce eating behaviors mimicking food addiction.
• The concept lacks validation, especially in light of the high prevalence of “food addiction” in patients with anorexia nervosa.
• It hasn’t led to novel and successful treatments for overeating and obesity.

In an attempt to determine whether food addiction is the correct term, some scientists have looked at the brain.

“It may be that, for some people, consuming high levels of processed, highly palatable food…sets off a change in the same reward pathways that are impacted in the brain when developing an addiction to a drug,” says O’Melia.

In these cases, foods light up the cue-reward centers of the brain and stimulate neurotransmitter activity, such as dopamine and endorphins.

Similarly, a 2020 study lists dopamine release as a parallel between individuals with food addiction and tobacco use disorder, and a 2021 study of 150 participants indicates that individuals with food addiction have altered functions of the reward circuit of the brain.

Research from 2021 suggests that highly processed foods are better at triggering reward-related neural systems than less processed foods, comparing those foods with addictive substances.

A small 2017 study of 10 healthy males suggests that feeding consistently set off a release of cerebral opioids even without the subjective pleasure often linked to eating.

A 2011 study suggested that imaging studies showed individuals who are obese may have impaired dopaminergic pathways, which are associated with reward sensitivity, conditioning, and control.

O’Melia says that the research is still in its infancy and the psychology of food addiction is still up for debate.

Sample sizes have often been small, but research may explain why people develop addictive-like behaviors around highly processed or sugary foods like pizza or sweets but not broccoli.

Societal constructs can make a person more likely to consume processed food.

A small 2020 study of 37 parents of sixth graders from historically marginalized communities indicated that, though “less-processed” foods were perceived as healthier, processed foods were associated with convenience. Parents outside of the U.S. were more likely to link “processed” with positive traits, indicating a need for more education and consistent definition.

Research from 2021 indicated that historically marginalized groups had to drive further to access healthy foods.

A 2018 study indicated Black people were more likely to consume hyper-processed food and had higher hypertension rates than white people.

“Food disparities and food deserts are a real problem across America,” Sell says. “If there is legitimately no access to healthy food options or food in general, you’ll choose or be given processed foods due to longer shelf lives.”

As Sell said, though people may dispute whether “food addiction” is the correct term, individuals may have food habits they want to change. And they deserve compassion and help. Experts share that overcoming compulsive food habits will look different for everyone but may include:

• self-compassion
• customized treatment that does not center around weight loss and will-power
• identification of trigger foods
• nutritional counseling
• medication

Sell suggests avoiding “should” statements and being kind to yourself.

“Shoulding is negative because it brings about feelings of guilt and shame for not accomplishing what had wanted,” Sell says. “This can bring about the shame cycle, which can lead to indulging in the addiction.”

O’Melia says it’s essential to find providers who take the same approach.

“Too often, obesity is treated as a personal failure and treatment plans for loss of control eating,” O’Melia says.

Further, not all people with addiction-like behaviors around food are obese. Customized care is critical, and O’Melia says it should include an individualized assessment and action plan that considers:

• biological, psychological, and social contributors to symptoms
• cultural factors that have shaped food and body valuations
• a plan to develop skills around self-acceptance and emotional regulation

Unlike people with drug addiction, people cannot abstain from food. And O’Melia says total elimination often fails.

“For compulsive eating challenges, it is often helpful to identify “trigger” foods that create vulnerabilities for loss of control eating,” O’Melia says.

Rather than nixing these foods altogether, patients can work with providers like therapists and nutritional counselors to develop plans around these foods.

“We plan for vulnerable situations or more challenging foods,” she says. “We never go too long without eating. We plan and prepare balanced, tasty meals and snacks. We plan for the social aspects of meals and prioritize supportive relationships and connection.”

Research from 2020 indicated that Tele-CBT could provide short-term benefits for reducing food addiction symptoms.

If addictive food behaviors are exhibited in conjunction with bulimia, O’Melia says Prozac can be prescribed and is FDA-approved. Research indicates that bupropion may assist with the treatment of obesity with or without Type 2 diabetes.

O’Melia says any treatment should also include care for any underlying conditions, including diabetes, hypertension, and mood disorders.

Want to know more about the controversial topic of food addiction? Get the facts below.

How common is ‘food addiction?’

Research indicates that food addiction affects a significant number of people.

According to a 2021 review of 196,211 human subjects, food addiction affected up to 20 percent of individuals included. Factors like being female, older than 35, and having a high BMI correlated with higher risk for food addiction.

Another 2021 review of 272 studies confirmed the 20 percent prevalence rate, noting that rates were higher in those with a clinical diagnosis of binge eating.

Research from 2014 suggests that 40 percent of people seeking bariatric surgery, also known as weight-loss surgery, experience food addiction.