Food addiction

A food addiction or eating addiction is a behavioral addiction that is characterized by the compulsive consumption of palatable (e.g., high fat and high sugar) foods which markedly activate the reward system in humans and other animals despite adverse consequences.[5][6]

Addiction and dependence glossary[1][2][3][4]
  • addiction – a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences
  • addictive behavior – a behavior that is both rewarding and reinforcing
  • addictive drug – a drug that is both rewarding and reinforcing
  • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
  • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
  • drug withdrawal – symptoms that occur upon cessation of repeated drug use
  • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens)
  • psychological dependence – dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia)
  • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
  • rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach
  • sensitization – an amplified response to a stimulus resulting from repeated exposure to it
  • substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress
  • tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

Psychological dependence has also been observed with the occurrence of withdrawal symptoms when consumption of these foods stops by replacement with foods low in sugar and fat.[5] Because this addictive behavior is not biological, one cannot develop a trait that codes for an eating disorder, so professionals address this by providing behavior therapy[7] and by asking a series of questions called the YFAS questionnaire, a diagnostic criteria of substance dependence.[8]

Sugary and high-fat food have both been shown to increase the expression of ΔFosB, an addiction biomarker, in the D1-type medium spiny neurons of the nucleus accumbens;[5] however, there is very little research on the synaptic plasticity from compulsive food consumption, a phenomenon which is known to be caused by ΔFosB overexpression.[5]

Description

"Food addiction" refers to compulsive overeaters who engage in frequent episodes of uncontrolled eating (binge eating). The term binge eating means eating an unhealthy amount of food while feeling that one's sense of control has been lost.[9] At first, the food addiction comes in the form of cravings, so a person is naturally caught unaware when suddenly they find that they cannot cope without the craving.[10] The person’s behavior then begins to shift when the need for more food is not met, in that when the urge is met, binge eating, obesity and bulimia can result as a consequence. To show this, a study done by Sara Parylak and her peers in the physiology and behavior journal reveals that animal models given free access to food became more emotionally withdrawn after the food was taken away from them due to the anxiogenic-like stimuli pestering them for more food.[11] This kind of behavior shows that food addiction is not only a self control problem, but that it goes deeper than that, it is the body controlling a person to the point where the individual has no say on what goes into their bodies despite of all the consequences that can come from overeating.People who engage in binge eating may feel frenzied, and consume a large number of calories before stopping. Food binges may be followed by feelings of guilt and depression;[12] for example, some will cancel their plans for the next day because they "feel fat." Binge eating also has implications on physical health, due to excessive intake of fats and sugars, which can cause numerous health problems.

Unlike individuals with bulimia nervosa, compulsive overeaters do not attempt to compensate for their bingeing with purging behaviors, such as fasting, laxative use, or vomiting. When compulsive overeaters overeat through binge eating and experience feelings of guilt after their binges, they can be said to have binge eating disorder (BED).[9]

In addition to binge eating, compulsive overeaters may also engage in "grazing" behavior, during which they continuously eat throughout the day.[9] These actions result in an excessive overall number of calories consumed, even if the quantities eaten at any one time may be small.

During binges, compulsive overeaters may consume between 5,000 and 15,000 food calories daily (far more than is healthy), resulting in a temporary release from psychological stress through an addictive high not unlike that experienced through drug abuse.[12] Compulsive overeaters tend to show brain changes similar to those of drug addicts, a result of excessive consumption of highly processed foods.[13]

For the compulsive overeater, ingesting trigger foods causes the release of the chemical messengers serotonin and dopamine in the brain.[12] This could be another indicator that neurobiological factors contribute to the addictive process. Conversely, abstaining from addictive food and food eating processes causes withdrawal symptoms for those with eating disorders.[12] The resulting decreased levels of serotonin in the individual may trigger higher levels of depression and anxiety.[14]

Eventually, compulsive overeaters continuously think about food. Food is the main thing on their minds; when deprived of it, the person may engage in actions similar to those of hard drug addicts, including an uncontrollable search for the substance, and in devious behaviour, such as stealing or lying.[15][16][17]

Paul Kenny of Mount Sinai Hospital has found that rats who are offered food rich in both fat and sugar, such as cheesecake, at first nibble at it but once they get used to it they binge on it and become very overweight. In the experiment, rats offered diets that were just sugary or just fatty did not binge and did not gain much weight. When the cheesecake was taken away, the rats addicted to it were no longer interested in healthy food and seemed to prefer to starve themselves. Kenny is investigating parallels with human behavior.[18]

Signs and symptoms

A food addiction features compulsive overeating, such as binge eating behavior, as its core and only defining feature. There are several potential signs that a person may be suffering from compulsive overeating. Common behaviors of compulsive overeaters include eating alone, consuming food quickly, and gaining weight rapidly, and eating to the point of feeling sick to the stomach. Other signs include significantly decreased mobility and the withdrawal from activities due to weight gain. Emotional indicators can include feelings of guilt, a sense of loss of control, depression and mood swings.[12][19]

Hiding consumption is an emotional indicator of other symptoms that could be a result of having a food addiction. Hiding consumption of food includes eating in secret; late at night while everybody else is asleep, in the car, and hiding certain foods until ready to consume in private. Other signs of hiding consumption are avoiding social interactions to eat the specific foods that are craved. Other emotional indicators are inner guilt; which includes making up excuses to why the palatable food would be beneficial to consume, and then feeling guilty about it shortly after consuming.[20]

Sense of loss of control is indicated in many ways which includes, going out of the way to obtain specific foods, spending unnecessary amounts of money on foods to satisfy cravings. Difficulty concentrating on things such as a job or career can indicate sense of loss of control by not being to organize thoughts leading to a decrease in efficiency. Other ways to indicate the sense of loss of control, are craving food despite being full. One may set rules to try to eat healthy but the cravings over rule and the rules are failed to be followed. One big indicator of loss of control due to food addiction is even though one knows they have a medical problem caused by the craved foods, they cannot stop consuming the foods, which can be detrimental to their health.[21][20]

Food addiction has some physical signs and symptoms. Decreased energy; not being able to be as active as in the past, not being able to be as active as others around, also a decrease in efficiency due to the lack of energy. Having trouble sleeping; being tired all the time such as fatigue, oversleeping, or the complete opposite and not being able to sleep such as insomnia. Other physical signs and symptoms are restlessness, irritability, digestive disorders, and headaches.[21][20]

In extreme cases food addiction can result in suicidal thoughts.[21]

Effects

A food addiction, especially long-term, can result in negative consequences to all aspects of a person’s life, creating damaging and chronic symptoms.[20]

Physical consequences

The short-term physical effect associated with dopamine and endogenous opiate release in the brain reward center is low level euphoria, a decrease in both anxiety and emotional pain also known as a “food coma.” The long-term physical effects may vary. The health consequences can be severe.

If a food addict has obesity, it can be associated with the following:

  • Diabetes
  • High blood pressure
  • High cholesterol and triglycerides
  • Osteoarthritis in the knees
  • Fungal infections in skin folds that are hard to clean
  • Congestive heart failure
  • Shortness of breath
  • Coronary artery disease
  • Death

Obesity has been attributed to eating behavior or fast food, personality issues, depression, addiction and genetics. One proposed explanation of epidemic obesity is food addiction.[22]

Psychological consequences

The psychological and mental effects can prove intense and plague an individual for years. These can include hopelessness, powerlessness, isolation, shame, depression, self-loathing, guilt, suicidal thoughts, suicide attempts and self-injurious behaviors.[20]

Relational consequences

Food addiction impacts relationships, especially those within the family. This is because the person with the addiction is vastly more involved with food than with people. Food becomes their safest, most important and meaningful relationship. Other connections to friends and family take a back seat. This often leads to a deep sense of isolation from others.[23]

Management

Compulsive overeating is treatable with nutritional assistance and medication. Psychotherapy may also be required, but recent research has proven this to be useful only as a complementary resource, with short-term effectiveness in middle to severe cases.[24][25]

Lisdexamfetamine is an FDA-approved appetite suppressant drug that is indicated (i.e., used clinically) for the treatment of binge eating disorder.[26] The antidepressant fluoxetine is a medication that is approved by the Food and Drug Administration for the treatment of an eating disorder, specifically bulimia nervosa. This medication has been prescribed off-label for the treatment of binge eating disorder. Off-label medications, such as other selective serotonin reuptake inhibitors (SSRIs), have shown some efficacy, as have several atypical agents, such as mianserin, trazodone and bupropion.[27][28] Anti-obesity medications[29] have also proven very effective. Studies suggest that anti-obesity drugs, or moderate appetite suppressants, may be key to controlling binge eating.[30]

Many eating disorders are thought to be behavioral patterns that stem from emotional struggles; for the individual to develop lasting improvement and a healthy relationship with food, these affective obstacles need to be resolved.[31] Individuals can overcome compulsive overeating through treatment, which should include talk therapy and medical and nutritional counseling. Such counseling has been recently sanctioned by the American Dental Association in their journal article cover-story for the first time in history in 2012: Given "the continued increase in obesity in the United States and the willingness of dentists to assist in prevention and interventional effort, experts in obesity intervention in conjunction with dental educators should develop models of intervention within the scope of dental practice."[32] Moreover, dental appliances such as conventional jaw wiring and orthodontic wiring for controlling compulsive overeating have been shown to be efficient ways in terms of weight control in properly selected obese patients and usually no serious complications could be encountered through the treatment course.[33]

As well, several twelve-step programs exist to help members recover from compulsive overeating and food addiction,[12] such as Overeaters Anonymous.

As of 2018, the Ontario Health Insurance Plan has announced a new program designed to assist individuals struggling with food addiction.[34]

Prognosis

Once an eating disorder such as BED is developed there are two potential pathways that can occur for an individual.

Getting help is the first step to getting better but the chances for relapse are high. Those with a food addiction were most likely overweight in childhood[35] which leads to treatment resistance the longer gone untreated. Due to poor mental health and lack of control and environmental factors[36], overeaters relapse into their old habits even after completing various treatments. BED patients often report and acknowledge using substances daily as a coping mechanism.

However, there is a 50% of recovery at the end of treatment and follow-ups[37]. Overcoming a food addiction isn't easy but those who accomplish it possess enough confidence to change, go through required examinations but most importantly, they receive support and encouragement from their loved ones and environment.

Ultimately, there is no guaranteed prognosis for food addictions. More studies are currently being conducted in order to understand food addictions along with other eating disorders.

A food addiction can lead to chronic conditions and eventually death. Nevertheless, there is a higher chance of recovery when treated in early stages such as teenage years when the symptoms are more noticeable then adulthood where there is more denial on part of the individual.

Epidemiology

A review on behavioral addictions listed the estimated the lifetime prevalence (i.e., the proportion of individuals in the population that developed the disorder during their lifetime) for food addiction in the United States as 2.8%.[5]

The problem of obesity is becoming a worldwide problem. A sugar tax is set to be introduced in Ireland to minimise the consumption of harmful foods and drinks.[38]

Form of neuroplasticity
or behavioral plasticity		 Type of reinforcer Sources
Opiates Psychostimulants High fat or sugar food Sexual intercourse Physical exercise
(aerobic)		 Environmental
enrichment
ΔFosB expression in
nucleus accumbens D1-type MSNs		 ↑↑↑↑↑↑[5]
Behavioral plasticity
Escalation of intake YesYesYes[5]
Psychostimulant
cross-sensitization		 YesNot applicableYesYesAttenuatedAttenuated[5]
Psychostimulant
self-administration		 ↑↑↓↓↓[5]
Psychostimulant
conditioned place preference		 ↑↑↓↑↓↑[5]
Reinstatement of drug-seeking behavior ↑↑↓↓[5]
Neurochemical plasticity
CREB phosphorylation
in the nucleus accumbens		 ↓↓↓↓↓[5]
Sensitized dopamine response
in the nucleus accumbens		 NoYesNoYes[5]
Altered striatal dopamine signaling ↓DRD2, ↑DRD3↑DRD1, ↓DRD2, ↑DRD3↑DRD1, ↓DRD2, ↑DRD3↑DRD2↑DRD2[5]
Altered striatal opioid signaling No change or
↑μ-opioid receptors		↑μ-opioid receptors
↑κ-opioid receptors		↑μ-opioid receptors↑μ-opioid receptorsNo changeNo change[5]
Changes in striatal opioid peptides ↑dynorphin
No change: enkephalin		↑dynorphin↓enkephalin↑dynorphin↑dynorphin[5]
Mesocorticolimbic synaptic plasticity
Number of dendrites in the nucleus accumbens ↓↑↑[5]
Dendritic spine density in
the nucleus accumbens		 ↓↑↑[5]

See also

References
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    • Evidence for addiction to specific macronutrients is lacking in humans.
    • 'Eating addiction' describes a behavioral addiction. ...
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Further reading
  • Brownlee, Christen (2009). "Food fix: Neurobiology highlights similarities between obesity and drug addiction". Science News. 168 (10): 155–6. doi:10.1002/scin.5591681012. INIST:17072118.
  • "Eating Awareness Training" Molly Gregor, copyright 1983 "...reclaim (your) 'birthright', the right to eat without compulsion, obsession, or suffering. ...what the body wants, as much as it wants, whenever it wants." From the Preface by Thomas Lebherz, M.D.
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