A group of doctors and scientists is getting behind the controversial idea that people can be addicted to certain trigger foods, in the same way as drugs and alcohol. The team says this addiction should be treated with abstinence, which goes against mainstream medical advice.
Is it possible to be “addicted” to eating unhealthy food? Yes, says a group of doctors and scientists who are going against mainstream medical advice to declare a provocative new way to think about overeating.
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| Certain “trigger foods” may be hard for some people to avoid Wirestock, Inc./Alamy |
The idea isn’t entirely new, as a few researchers have been arguing for years that some people overeat so much that their relationship with food should be seen as an addiction. But because it seems different to other kinds of addictions, such as when people are dependent on alcohol or take drugs such as heroin, many researchers and organisations are resistant to the concept. “An addiction is a dependence on something you don’t need,” says Duane Mellor, a spokesperson for the British Dietetic Association.
Obviously, we all need to eat. But those who argue for the idea of food addiction point to research in rats that found when they are allowed to drink sweetened water, it triggers the release of a reward-signalling brain chemical called dopamine, in a similar way to if the rodents are allowed to self-administer cocaine.
With food addiction, though, it is unclear exactly what in our food should be classified as addictive. People may binge on cakes and chocolate, but they may also do so with savoury snacks, like peanuts or fried food. Some advocates of low-carbohydrate diets – such as Jen Unwin, a psychologist in Southport in the UK – say carbohydrate cravings can be triggered by anything that contains the nutrient, including ostensibly healthy starchy foods like bread and pasta.
While there is no single widely agreed definition of addiction, most bodies, such as the World Health Organization, consider people’s behaviour and how it affects their lives. Someone may be considered addicted to smoking cannabis, for instance, if they crave the substance when they abstain, if they are unable to stop or if they continue to smoke it despite it harming their health.
Researchers use a questionnaire called the Yale Food Addiction Scale to measure these kinds of effects in relation to food, asking people how often they do things like eating to the point that they feel ill. Using this scale, some studies have estimated that as many as 14 per cent of adults have food addiction, with higher estimates reached in surveys of people with obesity or those who tend to have eating binges, but the concept remains contentious.
To try to improve understanding of the idea among medical professionals and the public, 40 doctors and researchers have spent the past year developing a consensus statement, defining the condition and summarising the supporting evidence. They unveiled it at the International Food Addiction Consensus Conference in London on 17 May.
One development is that the group believes the condition should be reframed as addiction to ultra-processed foods specifically. “When people talk about their problematic foods, they’re not talking about steak and broccoli,” says Unwin, who worked with the group. “It’s always cakes, donuts, pizzas.”
In their statement, the doctors and researchers say people with ultra-processed food addiction “use food in a way similar to drugs of abuse, obsess about food and/or engage in eating behaviours that become compulsive and often continue despite harmful medical and biopsychosocial consequences”.
But combining the concept of food addiction with that of ultra-processed foods could bring further problems, as the idea that ultra-processed food is a distinct and uniquely harmful category is also contested by many scientists.
While it is uncontroversial that some kinds of processed foods like crisps and cakes promote weight gain, the big question is whether they do so because they were made in factories or because they are high in fat, salt and sugar. That matters because if people try to avoid all processed foods, that precludes things that most doctors would say are good for us, like wholemeal bread or pasta, baked beans and many types of premade sauces and meals.
It also presents a dilemma for dieters, as many commercial diet foods, such as low-sugar jelly, are seen as helpful for weight loss yet fall firmly into the processed food category, says David Wiss, a dietitian in Los Angeles who helped formulate the consensus statement. “I think we’re going to run into some pushback there.”
Putting aside the ultra-processed food question, if food addiction really does exist, it has implications for how those affected try to manage their overeating. It suggests that they would benefit from completely abstaining from what they find to be their “trigger foods”, like how people who are addicted to alcohol are advised to cut it out entirely, says Unwin.
That goes against common healthy eating advice, which is that completely banning certain foods can enhance their appeal, says Mellor. In this model, it is better to let yourself have occasional treat foods, but to stop eating them once you feel full, he says. “Abstaining is the opposite of intuitive eating.”
While there is no hard evidence on whether abstention or moderation is better, a recent study by Wiss, Unwin and their colleagues lends some support for abstention. This tracked people attending clinics for food addiction, which provided group and individual therapy sessions along with advice to cut out all their trigger foods and adopt a low-carb whole food diet. A report from 2022 found that after three months, this approach helped people reduce their food binging and lose weight. Longer-term results were reported at the conference this week, finding that after one year, the participants continued to reduce their food addiction scores, as measured by the Yale questionnaire.
Results for weight loss at one year weren’t yet available, however. And a more rigorous test would be to compare abstention with a more traditional moderation approach in a randomised trial. Unwin says most of the participants had tried and failed with the moderation approach for decades. But a trial should be the next step, says Wiss.
For now, it remains to be seen whether the food addiction advocates will convince the rest of the medical world. Gunter Kuhnle at the University of Reading, UK, says the campaign would be more convincing if they had included the views of a wider group of nutrition experts, not just those who believe in food addiction. “That might have helped to give it more credibility,” he says.
Mellor says the idea of food addiction may be helpful for some people. “If you recognise you have got a problem with certain foods in your diet and you feel compelled to eat them, abstinence is a way of managing that,” he says. “But I’m not sure the call to eliminate all sugar or eliminate all carbs is the right answer for everyone.”