Food addiction

Behavioral addiction characterized by compulsory indulgence over foods

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A food or eating addiction is any behavioral addiction that is primarily characterized by the compulsive consumption of palatable (e.g., high fat and high sugar) food items which markedly activate the reward system in humans and other animals despite adverse consequences.[1][2]

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.[1] 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[3] and by asking a series of questions called the YFAS (Yale Food Addiction Scale) questionnaire, a diagnostic criteria of substance dependence.[4]

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;[1] 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.[1]

## Contents

* 1 Description
* 2 Signs and symptoms
* 3 Effects
* 4 Management
* 5 Prognosis
* 6 Epidemiology
* 7 Summary of addiction-related plasticity
* 8 See also
* 9 References
* 10 Further reading
* 11 External links

## Description[edit | edit source]

"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.[5] 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.[6] 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in the physiology and behavior journal reveals that animal models given free access to food became more emotionally withdrawn after the food was taken away from them due to the anxiogenic-like stimuli pestering them for more food.[7] This kind of behavior shows that food addiction is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 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;[8] 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).[5]

In addition to binge eating, compulsive overeaters may also engage in "grazing" behavior, during which they continuously eat throughout the day.[5] 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.[8] Compulsive overeaters tend to show brain changes similar to those of drug addicts, a result of excessive consumption of highly processed food (most likely consisting of high amounts of saturated fat, which is more energy-rich).[9]

## Signs and symptoms[edit | edit source]

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 experiencing 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.[8][10]

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, 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.[11]

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 able 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 overrule and the rules are abandoned. 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.[12][11]

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.[12][11]

In extreme cases food addiction can result in suicidal thoughts.[12]

## Effects[edit | edit source]

Obesity has been attributed to eating behavior or fast food, personality issues, depression, genetics but also social and environmental conditions such as walkability and access to diverse foods. The lack of access to diverse foods could also be caused by food deserts. Moreover, some other effects of obesity could also lead to increased risk for type 2 diabetes,[13] cardiovascular diseases and certain cancers.[14] One supplementary explanation for the epidemic of obesity overall might be food addiction.[15]

## Management[edit | edit source]

See also: Jaw wiring

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.[16][17]

Lisdexamfetamine is an FDA-approved appetite suppressant drug that is indicated (i.e., used clinically) for the treatment of binge eating disorder.[18] 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 antidepressants, such as mianserin, trazodone and bupropion.[19][20] Anti-obesity medications[21] have also proven very effective. Studies suggest that anti-obesity drugs, or moderate appetite suppressants, may be key to controlling binge eating.[22]

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[jargon] obstacles need to be resolved.[23] 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."[24] 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.[25]

As well, several twelve-step programs exist to help members recover from compulsive overeating and food addiction,[8] 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.[26]

## Prognosis[edit | edit source]

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[27] which leads to treatment resistance the longer gone untreated. Due to poor mental health and lack of control and environmental factors,[28] 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.[29] 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[edit | edit source]

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%.[1]

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.[30]

## Summary of addiction-related plasticity[edit | edit source]

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 | ↑ | ↑ | ↑ | ↑ | ↑ | ↑ | [1]
Behavioral plasticity
Escalation of intake  | Yes | Yes | Yes |  |  |  | [1]
Psychostimulant
cross-sensitization | Yes | Not applicable | Yes | Yes | Attenuated | Attenuated | [1]
Psychostimulant
self-administration | ↑ | ↑ | ↓ |  | ↓ | ↓ | [1]
Psychostimulant
conditioned place preference | ↑ | ↑ | ↓ | ↑ | ↓ | ↑ | [1]
Reinstatement of drug-seeking behavior | ↑ | ↑ |  |  | ↓ | ↓ | [1]
Neurochemical plasticity
CREB phosphorylation
in the nucleus accumbens | ↓ | ↓ | ↓ |  | ↓ | ↓ | [1]
Sensitized dopamine response
in the nucleus accumbens | No | Yes | No | Yes |  |  | [1]
Altered striatal dopamine signaling | ↓DRD2, ↑DRD3 | ↑DRD1, ↓DRD2, ↑DRD3 | ↑DRD1, ↓DRD2, ↑DRD3 |  | ↑DRD2 | ↑DRD2 | [1]
Altered striatal opioid signaling | No change or
↑μ-opioid receptors | ↑μ-opioid receptors
↑κ-opioid receptors | ↑μ-opioid receptors | ↑μ-opioid receptors | No change | No change | [1]
Changes in striatal opioid peptides | ↑dynorphin
No change: enkephalin | ↑dynorphin | ↓enkephalin |  | ↑dynorphin | ↑dynorphin | [1]
Mesocorticolimbic synaptic plasticity
Number of dendrites in the nucleus accumbens | ↓ | ↑ |  | ↑ |  |  | [1]
Dendritic spine density in
the nucleus accumbens | ↓ | ↑ |  | ↑ |  |  | [1]

## See also[edit | edit source]

* Binge eating disorder
* Binge eating
* Bulimia nervosa
* Eating disorder
* Eating disorder not otherwise specified
* Food Addicts in Recovery Anonymous
* Food Addicts Anonymous
* Gluttony
* Hyperalimentation – overnutrition
* Overeaters Anonymous
* Overeating
* Polyphagia – excessive hunger
* SMART Recovery
* Sugar industry

## References[edit | edit source]

1. ^ a b c d e f g h i j k l m n o p q r Olsen CM (December 2011). "Natural rewards, neuroplasticity, and non-drug addictions". Neuropharmacology. 61 (7): 1109–22. doi:10.1016/j.neuropharm.2011.03.010. PMC 3139704. PMID 21459101. "Functional neuroimaging studies in humans have shown that gambling (Breiter et al, 2001), shopping (Knutson et al, 2007), orgasm (Komisaruk et al, 2004), playing video games (Koepp et al, 1998; Hoeft et al, 2008) and the sight of appetizing food (Wang et al, 2004a) activate many of the same brain regions (i.e., the mesocorticolimbic system and extended amygdala) as drugs of abuse (Volkow et al, 2004). ... As described for food reward, sexual experience can also lead to activation of plasticity-related signaling cascades. ... In some people, there is a transition from “normal” to compulsive engagement in natural rewards (such as food or sex), a condition that some have termed behavioral or non-drug addictions (Holden, 2001; Grant et al., 2006a). ... the transcription factor delta FosB is increased during access to high fat diet (Teegarden and Bale, 2007) or sucrose (Wallace et al, 2008). ...To date, there is very little data directly measuring the effects of food on synaptic plasticity in addiction-related neurocircuitry. ... Following removal of sugar or fat access, withdrawal symptoms including anxiety- and depressive-like behaviors emerge (Colantuoni et al, 2002; Teegarden and Bale, 2007). After this period of “abstinence”, operant testing reveals “craving” and “seeking” behavior for sugar (Avena et al, 2005) or fat (Ward et al, 2007), as well as “incubation of craving” (Grimm et al, 2001; Lu et al, 2004; Grimm et al, 2005), and “relapse” (Nair et al, 2009b) following abstinence from sugar. In fact, when given a re-exposure to sugar after a period of abstinence, animals consume a much greater amount of sugar than during previous sessions (Avena et al., 2005).""Table 1"
2. ^ Hebebrand J, Albayrak Ö, Adan R, Antel J, Dieguez C, de Jong J, Leng G, Menzies J, Mercer JG, Murphy M, van der Plasse G, Dickson SL (November 2014). ""Eating addiction", rather than "food addiction", better captures addictive-like eating behavior" (PDF). Neuroscience and Biobehavioral Reviews. 47: 295–306. doi:10.1016/j.neubiorev.2014.08.016. PMID 25205078. "
• Evidence for addiction to specific macronutrients is lacking in humans.
• 'Eating addiction' describes a behavioral addiction. ...
We concur with Hone-Blanchet and Fecteau (2014) that it is premature to conclude validity of the food addiction phenotype in humans from the current behavioral and neurobiological evidence gained in rodent models. ... To conclude, the society as a whole should be aware of the differences between addiction in the context of substance use versus an addictive behavior. As we pointed out in this review, there is very little evidence to indicate that humans can develop a 'Glucose/Sucrose/Fructose Use Disorder' as a diagnosis within the DSM-5 category Substance Use Disorders. We do, however, view both rodent and human data as consistent with the existence of addictive eating behavior."
3. ^ Ho KS, Nichaman MZ, Taylor WC, Lee ES, Foreyt JP (November 1995). "Binge eating disorder, retention, and dropout in an adult obesity program". The International Journal of Eating Disorders. 18 (3): 291–4. doi:10.1002/1098-108X(199511)18:3<291::AID-EAT2260180312>3.0.CO;2-Y. PMID 8556026.
4. ^ Hebebrand J, Albayrak Ö, Adan R, Antel J, Dieguez C, de Jong J, Leng G, Menzies J, Mercer JG, Murphy M, van der Plasse G, Dickson SL (November 2014). ""Eating addiction", rather than "food addiction", better captures addictive-like eating behavior". Neuroscience and Biobehavioral Reviews. 47: 295–306. doi:10.1016/j.neubiorev.2014.08.016. PMID 25205078.
5. ^ a b c Saunders R (January 2004). ""Grazing": a high-risk behavior". Obesity Surgery. 14 (1): 98–102. doi:10.1381/096089204772787374. PMID 14980042. S2CID 20130904.
6. ^ Corsica JA, Pelchat ML (March 2010). "Food addiction: true or false?". Current Opinion in Gastroenterology. 26 (2): 165–9. doi:10.1097/mog.0b013e328336528d. PMID 20042860. S2CID 9253083.
7. ^ Parylak SL, Koob GF, Zorrilla EP (July 2011). "The dark side of food addiction". Physiology & Behavior. 104 (1): 149–56. doi:10.1016/j.physbeh.2011.04.063. PMC 3304465. PMID 21557958.
8. ^ a b c d Goldberg J (August 21, 2014). "Food Addiction". WebMD. WebMD. Retrieved October 27, 2014.
9. ^ Nolen-Hoeksema S (2014). (ab)normal Psychology. New York, NY: McGraw-Hill Education. p. 348\. ISBN 9781308211503.
10. ^ "Food Addiction Signs and Treatments". WebMD. Retrieved 2017-02-28.
11. ^ a b c "What Are The Effects of Food Addiction". Authority Nutrition. 2013-02-18. Retrieved 2017-02-28.
12. ^ a b c "About Food Addiction: Signs, Symptoms, Causes & Articles For Treatment Help". www.eatingdisorderhope.com. Retrieved 2017-02-28.
13. ^ Adams, Rachel C.; Sedgmond, Jemma; Maizey, Leah; Chambers, Christopher D.; Lawrence, Natalia S. (2019-09-04). "Food Addiction: Implications for the Diagnosis and Treatment of Overeating". Nutrients. 11 (9): 2086. doi:10.3390/nu11092086. ISSN 2072-6643. PMC 6770567. PMID 31487791.
14. ^ Adams, Rachel C.; Sedgmond, Jemma; Maizey, Leah; Chambers, Christopher D.; Lawrence, Natalia S. (2019-09-04). "Food Addiction: Implications for the Diagnosis and Treatment of Overeating". Nutrients. 11 (9): 2086. doi:10.3390/nu11092086. ISSN 2072-6643. PMC 6770567. PMID 31487791.
15. ^ Liu Y, von Deneen KM, Kobeissy FH, Gold MS (June 2010). "Food addiction and obesity: evidence from bench to bedside". Journal of Psychoactive Drugs. 42 (2): 133–45. doi:10.1080/02791072.2010.10400686. PMID 20648909. S2CID 5694810.
16. ^ "Binge-eating disorder Treatment at Mayo Clinic - Diseases and Conditions". Mayo Clinic. 2012-04-03. Retrieved 2014-02-01.
17. ^ Johnson BA, Ait-Daoud N, Wang XQ, Penberthy JK, Javors MA, Seneviratne C, Liu L (December 2013). "Topiramate for the treatment of cocaine addiction: a randomized clinical trial". JAMA Psychiatry. 70 (12): 1338–46. doi:10.1001/jamapsychiatry.2013.2295. PMID 24132249.
18. ^ "Vyvanse Prescribing Information" (PDF). United States Food and Drug Administration. Shire US Inc. January 2015. Retrieved 24 February 2015.
19. ^ White MA, Grilo CM (April 2013). "Bupropion for overweight women with binge-eating disorder: a randomized, double-blind, placebo-controlled trial". The Journal of Clinical Psychiatry. 74 (4): 400–6. doi:10.4088/JCP.12m08071. PMC 4021866. PMID 23656848.
20. ^ Calandra C, Russo RG, Luca M (June 2012). "Bupropion versus sertraline in the treatment of depressive patients with binge eating disorder: retrospective cohort study". The Psychiatric Quarterly. 83 (2): 177–85. doi:10.1007/s11126-011-9192-0. PMID 21927936. S2CID 27991416.
21. ^ "Obesity Treatment at Mayo Clinic - Diseases and Conditions". Mayo Clinic. 2013-06-07. Retrieved 2014-02-01.
22. ^ McElroy SL, Guerdjikova AI, Mori N, O'Melia AM (2012). "Pharmacological management of binge eating disorder: current and emerging treatment options". Therapeutics and Clinical Risk Management. 8: 219–41. doi:10.2147/TCRM.S25574. PMC 3363296. PMID 22654518.
23. ^ "Factors That May Contribute to Eating Disorders". NEDA. Retrieved October 27, 2014.
24. ^ Curran AE, Caplan DJ, Lee JY, Paynter L, Gizlice Z, Champagne C, Ammerman AS, Agans R (November 2010). "Dentists' attitudes about their role in addressing obesity in patients: a national survey". Journal of the American Dental Association. 141 (11): 1307–16. doi:10.14219/jada.archive.2010.0075. PMID 21037188.
25. ^ Al-Dhubhani MK, Al-Tarawneh AM (July 2015). "The Role of Dentistry in Treatment of Obesity—Review". Saudi Journal of Dental Research. 6 (2): 152–6. doi:10.1016/j.sjdr.2014.11.005.
26. ^ "New program to help people struggling with food addiction". News-Medical-Life Sciences. June 6, 2018. Retrieved June 21, 2018.
27. ^ Halmi, Katherine A (2013-11-07). "Perplexities of treatment resistance in eating disorders". BMC Psychiatry. 13 (1): 292. doi:10.1186/1471-244x-13-292. ISSN 1471-244X. PMC 3829659. PMID 24199597.
28. ^ Lu, Henry; Mannan, Haider; Hay, Phillipa; Lu, Henry Kewen; Mannan, Haider; Hay, Phillipa (2017-07-18). "Exploring Relationships between Recurrent Binge Eating and Illicit Substance Use in a Non-Clinical Sample of Women over Two Years". Behavioral Sciences. 7 (3): 46. doi:10.3390/bs7030046. PMC 5618054. PMID 28718830.
29. ^ Treasure, Janet; Stein, Daniel; Maguire, Sarah (2014-09-29). "Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence". Early Intervention in Psychiatry. 9 (3): 173–184. doi:10.1111/eip.12170. ISSN 1751-7885. PMID 25263388. S2CID 44847818.
30. ^ "Sweet taste of success for soft drinks sector". The Irish Times. 14 October 2016.

## Further reading[edit | edit source]

* 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.

## External links[edit | edit source]

* Media related to Food addiction at Wikimedia Commons

* v
* t
* e

Reinforcement disorders: Addiction and Dependence

Addiction|

| Drug|

* Alcohol
* Amphetamine
* Cocaine
* Methamphetamine
* Methylphenidate
* Nicotine
* Opioid

|

Behavioral|

* Financial
* Gambling
* Shopping
* Palatable food
* Sex-related
* Intercourse
* Pornography
* Internet-related
* Internet addiction disorder
* Internet sex addiction
* Video game addiction
* Digital media addictions

Cellular
mechanisms|

* Transcriptional
* ΔFosB
* c-Fos
* Cdk5
* CREB
* GluR2
* NF-κB

* Epigenetic
* G9a
* G9a-like protein
* HDAC1
* HDAC2
* HDAC3
* HDAC4
* HDAC5
* HDAC9
* HDAC10
* SIRT1
* SIRT2
* ...

Dependence|

| Concepts|

* Physical dependence
* Psychological dependence
* Withdrawal

|

Disorders|

* Drugs
* Alcoholism
* Amphetamine
* Barbiturate
* Benzodiazepine
* Caffeine
* Cannabis
* Cocaine
* Nicotine
* Opioid
* Non-drug stimuli
* Tanning dependence

Treatment
and
management|

| Detoxification|

* Alcohol detoxification
* Drug detoxification

|

Behavioral
therapies|

* Cognitive behavioral therapy
* Relapse prevention
* Contingency management
* Community reinforcement approach and family training
* Motivational enhancement therapy
* Motivational interviewing
* Motivational therapy
* Physical exercise

Treatment
programs|

* Drug rehab
* Residential treatment center
* Heroin-assisted treatment
* Intensive outpatient program
* Methadone maintenance
* Smoking cessation
* Nicotine replacement therapy
* Tobacco cessation clinics in India
* Twelve-step program

Support groups|

* Addiction recovery groups
* List of twelve-step groups

Harm reduction|

* Category:Harm reduction
* Drug checking
* Reagent testing
* Low-threshold treatment programs
* Managed alcohol program
* Moderation Management
* Needle exchange program
* Responsible drug use
* Stimulant maintenance
* Supervised injection site
* Tobacco harm reduction

See also|

* Addiction medicine
* Allen Carr
* Category:Addiction
* Category:Vaccines against drugs
* Discrimination against drug addicts
* Dopamine dysregulation syndrome
* Cognitive control
* Inhibitory control
* Motivational salience
* Incentive salience
* Sober companion

* Category

*[MSNs]: medium spiny neurons
*[CREB]: cAMP response element-binding protein
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