Curr Psychiatry Rep (2015) 17:19 DOI 10.1007/s11920-015-0563-3 EATING DISORDERS (C GRILO, SECTION EDITOR) Current Considerations Regarding Food Addiction Erica M. Schulte & Michelle A. Joyner & Marc N. Potenza & Carlos M. Grilo & Ashley N. Gearhardt # Springer Science+Business Media New York 2015 Abstract BFood addiction^ is an emerging area, and behavior- diction require abstinence. Addiction interventions that focus on al and biological overlaps have been observed between eating moderation or controlled use may lead to novel approaches to and addictive disorders. Potential misconceptions about apply- treating eating-related problems. Finally, addiction-related poli- ing an addiction framework to problematic eating behavior may cies that focus on environmental (instead of educational) targets inhibit scientific progress. Critiques of Bfood addiction^ that may have a larger public health impact in reducing overeating. focus on descriptive differences between overeating and illicit drugs are similar to early criticisms of the addictiveness of to- Keywords Food addiction . Obesity . Addiction . Substance bacco. Although food is necessary for survival, the highly proc- dependence essed foods associated with addictive-like eating may provide little health benefit. Individual differences are important in de- termining who develops an addiction. If certain foods are addic- tive, the identification of possible risk factors for Bfood Introduction: Misconceptions About Food Addiction addiction^ is an important next step. Not all treatments for ad- The concept of Bfood addiction^ is an area of growing scien- Erica M. Schulte and Michelle A. Joyner shared first authorship tific interest and ongoing debate. Animal models suggest that rats given highly palatable foods (e.g., icing, bacon, cheese- A special thank you to Dr. Timothy D. Brewerton for taking the time to cake) or intermittent access to sugar will display neurobiolog- review this manuscript. ical and behavioral indicators similar to those observed in This article is part of the Topical Collection on Eating Disorders models of drug addiction [1, 2]. In humans, overlapping neu- : : E. M. Schulte M. A. Joyner A. N. Gearhardt (*) robiological systems (e.g., mesolimbic dopamine system) ap- Department of Psychology, University of Michigan, 2268 East Hall, pear activated by both drugs of abuse and highly palatable 530 Church Street, Ann Arbor, MI 48109, USA foods [3•]. Individuals with addiction or eating-related prob- e-mail: [email protected] lems (e.g., obesity, binge eating disorder) exhibit similar pat- E. M. Schulte terns of neural reactivity to drug or food cues, respectively [4•, e-mail: [email protected] 5]. Higher scores on the Yale Food Addiction Scale (YFAS) M. A. Joyner [6], which applies the diagnostic criteria for substance depen- e-mail: [email protected] dence to the consumption of highly palatable foods, are asso- M. N. Potenza ciated with increased body mass index (BMI), more frequent Departments of Psychiatry, Child Study and Neurobiology, Yale binge eating, greater impulsivity, and stronger cravings for University School of Medicine, CMHC Room S-104, 34 Park St, fatty, processed foods [7]. Patterns of neural response and New Haven, CT 06519, USA e-mail: [email protected] genetic profiles implicated in addiction have also been related to higher YFAS scores [8, 9]. Although these findings are C. M. Grilo important and provide support for food addiction as a clinical- Department of Psychiatry, Yale University School of Medicine and ly relevant concept, more scientific inquiry is needed before Department of Psychology, 301 Cedar Street (2nd fl), New Haven, CT 06519, USA the “food addiction” concept can be either accepted or rejected e-mail: [email protected] and applied routinely in clinical settings. A major obstacle to 19 Page 2 of 8 Curr Psychiatry Rep (2015) 17:19 evaluating whether an addictive process contributes to prob- addiction) include diminished control over participation in lematic eating may involve potential misconceptions about the behavior, a diminished ability or willingness to quit, con- what an addiction perspective means when applied to eating tinued participation despite negative consequences, and appe- behavior. In the current paper, we will address many of these titive urges or cravings [16, 17]. There is evidence that over- notions and highlight important gaps that should be addressed consumption of highly palatable foods can result in these same to empirically evaluate whether an addictive process contrib- outcomes [18, 19]. For example, diminished control and con- utes to problematic eating behavior. tinued consumption despite negative consequences are key defining characteristics of binge-eating episodes [20, 21], in- cluding relapse to prior eating patterns and nearly inevitable Lessons Learned From Tobacco weight regain [22]. These similarities are not sufficient to con- clude that highly palatable foods can be addictive or have The term addiction may raise the image of a person Baddicted^ addictive properties, but if Bfood addiction^ is a valid concept, to an illicit drug who is experiencing intoxication or with- the presence of these characteristics is necessary. Criticisms of drawal, contributing little to society, engaging in illegal activ- the “food addiction” concept that focus mainly on the way that ities, and at-risk of overdose. Yet, this view of addiction does problematic overeating may look different from addiction to not accurately reflect most addictions nor does it resonate with substances like alcohol and opiates may be at best distracting arguably the most common and deadly addiction in our soci- and at worst a repetition of mistakes from the history of how ety—tobacco addiction. Cigarette smoking is a leading cause tobacco was considered [23]. of preventable death in the USA [10]. Yet, tobacco smoking Concerns about diminishing the meaning of addiction have does not lead to noticeable intoxication, has a mild physical also been raised in the debate about “food addiction” [24]. Yet, (although not psychological) withdrawal, is legal, readily ac- like with tobacco, excessive consumption of calorie-dense, cessible, and causes little impairment in one’s daily life (e.g., highly processed foods is an important factor relating to pre- work, caring for oneself, raising children). For decades, critics ventable death in the USA [10]. Overconsumption of these of the addictiveness of nicotine (the ingredient identified as foods may not lead to overdoses, life-threatening withdrawal, habit-forming or addictive in tobacco) pointed to these differ- or illegal behaviors, but may lead to premature deaths. Akin to ences between tobacco and other drugs (e.g., alcohol, opiates) tobacco, minimizing the significance of potentially addictive as evidence that cigarettes could not be addictive [11]. For foods (or food additives) may miss the substantial public example, the British opiate-addiction researcher, Sir Hum- health consequences of a legal, cheap, advertised, available, phrey Rolleston was quoted as saying, BThat smoking pro- and potentially addictive substance. duces a craving for more when an attempt is made to give it up… is undoubted, but it can seldom be accurately described as overpowering, and the effects of its withdrawal, though Can You Be Addicted to Something You Need to Survive? there may be definite restlessness and instability, cannot be compared with the physical distress caused by withdrawal in Another possible critique of the concept of Bfood addiction^ is morphine addicts. To regard tobacco as a drug of addiction is that food is necessary for survival and therefore cannot be all very well in a humorous sense, but it is hardly accurate addictive. This seemingly accurate criticism is not without [12].^ Critics also suggested that applying the term addiction flaws. First, people can become addicted to something even to a legal substance that had little risk of severe intoxication, if it contains components necessary for survival. For example, withdrawal, or overdose would reduce the meaningfulness of water is completely necessary for us to survive. Humans are at the addiction label [13]. Such perspectives delayed the recog- risk of dying from dehydration within 3 days of going without nition of tobacco as an addictive substance, which hindered water [25]. There is no evidence of an addictive process de- the development of more effective treatment and prevention veloping to water even though thirsty people may find drink- approaches. ing water very rewarding [26]. In contrast, the addition of an Many critiques of the concept of Bfood addiction^ highlight addictive ingredient to water is sufficient to give it an addic- descriptive differences as the case with tobacco and addiction tive potential. For example, beer can be up to 97 % water, but noted above [14, 15]. Overconsumption of highly processed it is addictive due to the presence of ethanol. Thus, a substance foods does not lead to intoxication, a life-threatening with- once necessary for survival (e.g., water) can become addictive drawal syndrome, or the threat of overdose. Food is easily with the addition of certain ingredients. accessible, socially permissible, and legal. However, we have Similar to water, food consumption is necessary for our learned from tobacco that millions can become Baddicted^ to a survival. Nutrient-rich foods, such as fruits, vegetables, and substance with these characteristics. Core components of ad- lean meats, are essential