Food addiction: is it a real thing?
A while ago, one of my nutrition clients and I were chatting about food and eating habits. I asked them to explain to me, in their own terms, what eating day to day was like for them. Let’s call them “Sam”.
Describing her day’s eating sounded as though Sam ate what we can colloquially consider to be ‘healthy’: veg, dairy, whole foods, and a moderate amount. Then came evening and she said
‘I don’t know what happens at 8pm because I have an uncontrollable urge to eat chocolate! I can binge on bars and bars of the stuff! I am addicted to sugar!’
I asked her to explain what that feeling was like for her. She explained to me that by evening time she still feels like she could eat, despite ‘knowing’ that she doesn’t need to, and specifically wants to eat chocolate. She said when she starts eating its hard to stop and whilst she’s eating chocolate feels exhilarated, happy. Afterwards she said, she feels guilt, shame, regret. She also said, that during the day she craves bread, potatoes, and hadn’t eaten a pizza or burger for years. She said that ‘carb’s make her fat,’ that j’ust looking at cake causes bloat’, and she ‘manages’ her intake of these items with the kind of due diligence required by MI5.
‘Hmm’ I said. ‘Hmm’.
‘Addicted’. That was the word she used.
The topic of food addiction is sensitive and highly controversial, but one that is not going away. The concept of food addiction is implicated in craving, bingeing and having higher body fat. The concept of food addiction is also controversial: there is no consensus on whether or not there is enough evidence for it’s existence in the scientific community.
What does ‘addiction’ mean?
Addiction as a term is commonplace in society and used to describe these scenarios despite a lack of consensus on a clinical definition, but feelings of being addicted to some food items is a real issue for some people. Lets explore what addiction means.
Addiction is defined by the American Psychiatric Association as ‘…a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems.’
Recently, the DSM IV included a new category Non-Substance-Related Disorders, within the newly-named Substance-Related and Addictive Disorders section of the manual. Despite food not being included in this section, the American Society of Addiction Medicine (ASAM) have chosen to include food addiction in their list of possible disorders.
In order to be diagnosed with addiction, a person must demonstrate they meet two or more of the diagnostic criteria in the DSM. The criteria parent categories are: impaired control, social impairment, risky use and pharmacological criteria. Within these, there are sub-criteria that can commonly describe how a person might feel when they are in the throws of eating something delicious: cravings, continuing the ‘use’ of the substance despite negative physical or psychological symptoms, experiencing negative symptoms as a result of ‘use’.
Yale university has developed the Yale Food Addiction Scale yet despite extensive research on both human and animal participants, there is no significant evidence to suggest that food addiction is true disorder.
So if we’re not addicted, why do we binge on all the things?
What research has shown, is that the perception of being addicted to food seems to follow restriction of said food. In psychology it’s well known that deprivation drives motivation, so when we diet we are technically depriving ourselves. Addictive sensations can also be associated with addictive personality traits, but frequently and significantly, the addictive symptoms seem to follow the strict control of the intake of the food items, or the food items being in short supply.
Notions of addiction are interesting when we explore the evidence that dieting (a practice of restricting energy intake) creates a biological and psychological environment that literally ramps up hunger signals and drives fat storage. When we diet, we deprive the body of the energy it requires to sustain the current body fat levels. It is a state of managed starvation that over time, should create (if we treat humans as input output machines) a decrease in mass. Unfortunately restriction of energy can also create trigger an increase in the neurotransmitter neuropeptide Y, that increases appetite and fat storage. Hence why we diet, lose a few pounds, and then ‘reward’ ourselves with cake only to regain more.
We are told by diet culture (I’ll chat more about diet culture in another post) that scale weight is important, that dress size defines our worth and that body fat is bad. We are also told that there are ‘good’ and ‘bad’ foods, ‘treats’ and ‘cheat meals’. This kind of language subscribed morality to our foods. We get to feel saintly if we eat what we commonly agree are ‘good’ foods, and feel conversely ‘bad’ if we eat the foods that are ‘guilty’ pleasures.
It is easy to imagine how, in the culture of food morality and dieting, that also stigmatises a larger body, we are literally primed to see palatable foods as substances to be regarded suspiciously and with caution. We seem to imbibe from our parents, our society, friends etc that to sustain ur worth we must carefully manage our behaviour around chocolate, cake and burgers for fear of becoming a fat person. The worst fate that could behold a human: to have ‘let yourself go’ and grown fat.
It’s common sense that if we are told to restrict something, we’ll want it. Imagine a child in a room full of age appropriate toys, and a mobile phone. Tell the child ‘don’t touch the phone’. What do they immediately want to play with? Adults are no different, and for varying reasons, the mechanisms that we rely on to sustain the restriction of tasty foods, like willpower, are exhaustive. Sooner or later, we’ll run out of resources, break and eat all the things.
Is this addiction? Or are we all just fucking hungry?
Why is chocolate and cake so super tasty?
Humans are hard wired biologically, to prefer the taste of energy dense foods. Tasty foods, like burgers, pizza, chocolate and cakes, are high sugar and fat. Sugar is a simple carbohydrate, which is like four stroke for the human body. It takes a very simple process to convert sugar into a substrate the body need for energy, and our runs most efficiently on it. Each molecule of carbohydrate hold 4 calories, and 4 x its weight in water, and so for every gram we eat, we’ll hold significantly more than that in water. Fat on the other hand, holds little water, but it has 9 calories per gram. Having more than double the calories of carbohydrate makes it super tasty.
Back in the day, when we were cave people, we existed in an environment of feast and famine. We ate well when food was around and during food scarcity, we relied upon our body fat to survive. Those of us cave dwellers who held onto higher levels of fat would have survived longer, and women would have outlived men due to genetically higher levels of body fat. Us women need the extra fat for nurturing our babies, and other hormonal processes.
During times of famine, the mechanisms in our body that drive hunger, do so to illicit food seeking behaviour. Without these hunger signals, we’d never leave the cave to look for fuel and eventually, the human race would die out.
Dieting tries to sidestep these biological mechanisms, outwit them and diet culture actually celebrates how successful a person has starved themselves: ‘Wow! Have you lost weight? You look amazing!’ Bodybuilding sub culture goes even further than that, and celebrates just how muscular a person can get, and the subsequent big ‘reveal’ of the muscles through various fat loss methods.
In bodybuilding there are tales from many competitors of finishing a show, only to dive head first into a binge fest, that can last months. The consequences are usually that the body regains previous fat levels, and more, and that the ‘competitor’ then feels they must go back into ‘cutting’ (the term for body building dieting). This practice is accepted, encouraged, well researched, intellectualised and celebrated when achieved to extreme levels.
Female competitors experience a loss of menstruation as a side effect of dieting, a phenomenon known as the ‘female athlete triad’. Healthy hormonal balance in both men and women, is dependent upon adequate body fat levels. There’s a reason why some male bodybuilders experience low testosterone levels.
When we diet, our clever brains drive us to seek the most energy dense foods in oder to restore homeostasis. Its a psychological (I haven’t had that so I want it) and physiological (elevated ghrelin levels – our hunger hormone) state of need. This, is not addiction: its survival.
Let yourself go. Not literally, as in don’t wash, but metaphorically. Take a deep breath and ask yourself ‘what do I actually want to eat?’ It’s clear from research that holding on tightly to our values and beliefs about food and eating, doesn’t serve us very well.
Besides, if we look at one species: lets choose lions. Every lion is different. Some lions are fatter, some are leaner. Some have big scruffy heads, whereas some are like groomed puffballs. Each lion displays different behavioural traits: some lioness will be dutiful parents, whereas others can be lackadaisical and prone to losing a cub or two.
My point is, within the human species there are supposed to be individual differences. Some of us who would have survived the famine, have evolved to store naturally higher levels of body fat. Some of us, have lower body fat, longer long bones, thicker thighs, bigger noses and better sight. It’s normal and rather than celebrate this, we are conditioned by diet culture to cultivate similarity: clone like images of perceived beauty that the media peddles.
It takes real courage to step out of the diet culture wheel. It’s a stepwise process, and one that is 2 steps forward, 6 steps back sometimes. Body positivity is a non linear journey that takes vulnerability and warrior like fearlessness. It’s not easy, and I haven’t mastered it. I still rip myself apart in moments of doubt, but I then take a step back. I look at myself really, and practice saying good things about myself, things separate from the body. Things of real worth that improve my life and the lives of others around me.
Because as a human, I am infinitely more powerful when I am present, and offering my true version of myself to others, in all my wobbly thighed, cellulite glory, rather than being occupied on how I feel others perceive my backside.
So, my take home message, would be: love yourself. If you can identify what you need and commit to giving yourself that unconditionally, you might feel full enough to not want to eat all the things, all the time. Besides, no one ever said ‘ I wish I ate less cake’.
Corwin RL, Grigson PS. Symposium Overview—Food Addiction: Fact or Fiction? The Journal of Nutrition. 2009;139(3):617-619. doi:10.3945/jn.108.097691.
Gearhardt, Ashley & Corbin, William & Brownell, Kelly. (2013). Yale Food Addiction Scale.
Gordon EL, Ariel-Donges AH, Bauman V, Merlo LJ. What Is the Evidence for “Food Addiction?” A Systematic Review. Nutrients. 2018;10(4):477. doi:10.3390/nu10040477.