Food Addiction
By Rich Weil M.Ed., CDE
Transformation Weight Control
transformationweightcontrol.com
“Any one of us could be an addict at any time. Addiction is not fundamentally a moral failing — it’s not a disease of weak-willed losers. When you look at the biology, the only model of addiction that makes sense is a disease-based model, and the only attitude towards addicts that makes sense is one of compassion.” David Linden
Nothing catches the essence of addiction more than these words by David Linden. It captures the depression, guilt, shame, and isolation of addiction. About 35 years ago I started thinking about food and eating as an addiction because after listening to my clients and patients who struggled with their weight, food cravings, overeating, lack of appetite regulation, and obsessing about food, it sounded just like it. The compulsions and obsessing over food they described, the intensity and vividness of the cravings, the inability to stop eating even though it caused psychic and physical pain. It all sounded just like addiction.
Then, in the late 1980’s, I read the book “Relapse Prevention” by Alan Marlatt and Judith Gordon. At the time, Dr. Marlatt was the world’s leading authority on alcohol addiction. He literally wrote the book on it! As I read it, it started to confirm what I believed to be true, that there is such a thing as food addiction, because everywhere he mentioned alcohol, I could easily have substituted the word “food”. I made notes throughout the book. I even remember where I started reading it, on a park bench in Washington Square Park in New York City, near where I lived. I think I’ve used the phrase, “rocked my world” once in my life, and reading his book did indeed rock my world. From then on, I started teaching my clients about food addiction, and it resonated strongly. However, when I would mention it to clinicians and researchers in the obesity/weight control field, it was difficult to sell the idea and, for decades, even to the present day, some will argue that food is not addictive, one of the arguments being that you can’t get addicted to something essential for life. I ignore these scholarly arguments as a waste of time. My reaction is that individuals who argue against food as an addiction have not worked with the population of people with obesity like I have for all these years, and although everyone understands the negative consequences of overeating, it doesn’t mean they can stop. And by the way, not everyone who has food addiction has obesity, they may just have an eating addiction.
Some years later, scientists and psychologists started studying food and addiction, and the idea caught on. Dr. Marcia Pelchat, in 2002, in the journal Physiology and Behavior, published this paper with the colorful title, identifying the link between food and addiction.
And then there are two of the most prolific researchers on food and addiction, Drs. Norma Volkow and Gene-Jack Wang. Dr Volkow is the Director of the National Institute on Drug Abuse at the National Institutes of Health, and Dr. Wang is senior clinician and the clinical director of the Laboratory of Neuroimaging at the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. Dr. Volkow has published almost a thousand peer-reviewed articles, written 113 book chapters, manuscripts and articles, and edited four books on neuroscience and brain imaging for mental and substance use disorders. Dr. Wang is no slouch either! His research focuses on PET Scan and MRI imaging of the neuro-psychiatric mechanisms and manifestations of alcoholism, drug addiction, ADHD, obesity and eating disorder in humans. He was the first to report the similarity of human brain circuits disruption in drug addiction and in obesity. He has published 281 original articles, 45 review articles, and 18 book chapters. If you do a search for either of them in Google, Google Scholar, or PubMed, you will get a sense of the breadth of their research, a significant amount in the area of food as a substance of abuse. Then search for “food addiction” in the same search engines and you will find endless articles on food addiction by many scientists and psychologists. I expound on the credentials and accomplishments of Drs. Volkow and Wang to emphasize that they are two serious scientists studying the very serious issue of food addiction.
Drs. Volkow and Wang published this article in 2004:
Then in 2009, the psychologist Ashley Gearhardt Ph.D., developed the Yale Food Addiction Scale (YFAS), published many articles on the subject, and argued for the idea that food addiction does exist. The YFAS is designed to show if individuals have behavior patterns similar to persons who are addicted to other substances of abuse, such as cocaine. In a 2021 meta-analysis (a review of many studies), Praxedes et al, published in the journal European Eating Disorders Review, used the YFAS and found that 20 percent of adults are addicted to food. In our program, we used the YFAS and found that 41% of our participants showed many patterns of behavior similar to persons with addiction to other substances of abuse. Below are two of the many articles published by Dr. Gearhardt.
Then there is this article in Bloomberg, also published in 2011:
Source: https://www.bloomberg.com/news/articles/2011-11-02/fatty-foods-addictive-as-cocaine-in-growing-body-of-science
BRAIN IMAGING AND FOOD ADDICTION
The image below captures the brain lighting up in regions of the brain interested in food. The next time you feel like your brain is lighting up because you’re thinking about food, you’re not imagining it. It is indeed lighting up in regions of the brain that create food cravings and likely stimulate what’s called the “reward pathway” in the brain, responsible for how rewarding and motivational food is for you. The reward and motivation pathway in the brain consists of the regions of the brain known as the ventral tegmental area and the nucleus accumbens. Interestingly, daily snacking on highly processed foods, or foods high in fat and sugar, rewire the brain’s reward circuits, increasing food cravings and making some foods more palatable than they already are, and I’m not talking broccoli. Most rats will choose sugar instead of cocaine, and similar observations have been made in humans, where highly processed and high fat/high sugar foods are overeaten to the point of vomiting, diarrhea, and what we call in our program, a “food hangover”.
I want to tell you that the lighting up of your brain while you look at food, think about food, or taste or smell certain foods, is NOT in your imagination. It is the neurobiology of your brain at work, and it overworks in some people more than in others. Overweight and having obesity is not your fault. It’s not a lack of self-discipline or willpower, nor a character flaw. The brain circuits of some individuals for food, appetite, and a decrease in appetite regulation, is in overdrive. Neurotransmitters that send aberrant appetite signals through the brain, hormonal imbalances, and dysregulation of appetite regulation are just some of the problems. Again, THIS IS NOT YOUR FAULT. You did not choose for this to happen, nor do you intentionally make it happen.
This next image is more complicated scientifically (notice the authors), but I will simplify as best I can. Dopamine is the “pleasure neurotransmitter” in the brain, produced by the region known as the ventral tegmental area (VTA), sending dopamine through reward circuits to the nucleus accumbens (one of the brain structures involved in drug dependency and food). The VTA secretes dopamine at high rates when you think, taste, smell, talk about, or see food in front of you or in your mind’s eye. Dopamine travels from the VTA to dopamine receptors in the brain that are responsible for giving you pleasure, sometimes known as the hedonic (pleasure) region of the brain. Vision of food is the strongest cue for food cravings, more than the other senses. “Out of sight, out of mind”, applies here as a way to control or prevent food cravings.
What you see in the images below are PET scans of the brain in persons addicted to alcohol, food (BMI>30), and cocaine, compared to individuals without these dependencies. The receptors are stained red by injecting a special dye into the body that attaches to and lights up the dopamine receptors. In this image you see that fewer dopamine receptors are visible in the substance abuse individuals compared to the non-addicted individuals. We call this down-regulation of the receptors in addicted individuals. As a result of fewer down-regulated dopamine receptors, individuals with addiction consume more of the substance to “get their fix”.
This scenario describes addiction as simply, perfectly, and clearly as possible. That is, you need your fix by consuming more substance because your dopamine and dopamine receptors don’t work as well as in non-addicted individuals. Again, THIS IS NOT YOUR FAULT. It is not a lack of will power, self-discipline, or a character flaw. Genetics, epigenetics, hormonal imbalances, neurotransmitter receptor down-regulation, excess food supply, highly processed foods, learned behaviors, and much more biology and psychology, causes this.
In Transformation Weight Control, and all the programs prior to this one that I have been involved with, we teach this to empower individuals to understand that it’s not their fault, and then we go to work teaching behavior, psychological, and physical strategies to help overcome it. We’re good at it, and it works. I’m not suggesting it’s easy, but individuals gain control over addictions all the time. And by the way, GLP-1 receptor agonists, the weight control medications taking the country by storm, work on the reward pathway in the brain so that you experience fewer cravings and obsessing about food. As our patients report it, there is less “food noise” in their head. What a relief it is to finally have help that is effective.
Don’t despair. As I said, individuals overcome addictions all the time. I recommend the following books:
“Relapse Prevention Counseling Workbook: Practical Exercises for Managing High-Risk Situations” by Terence T. Gorski;
2. “Relapse Prevention, Second Edition: Maintenance Strategies in the Treatment of Addictive Behaviors 2nd Edition” by Alan Marlatt, and Judith Gordon.
3. “From the First Bite: A Complete Guide to Recovery from Food Addiction” by Kay Sheppard.4. There’s also a little book I recommend called “Food for Thought: Daily Meditations for Overeaters (Hazelden Meditations)”, a lovely little book that has a brief paragraph or two for every day of the year to help you stay focused and get through the day. It’s described as “Daily readings for compulsive overeaters who seek to understand the role of food in their lives, supporting a life of physical, emotional, and spiritual balance.”
5. I also recommend this article published in Scientific American: https://www.scientificamerican.com/article/food-can-be-literally-addictive-new-evidence-suggests/
That’s all I’ve got for now. I hope this information has empowered some of you to understand that if you feel addicted to food, you’re not alone, and IT IS NOT YOUR FAULT. I leave it to you to decide if you think there’s such a thing as food addiction, and I welcome your comments.
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