I was asked "Should the concept of food addiction be discussed or addressed within eating disorder treatment? Why or why not?"
After listening to the Food Psych podcast episode where Christy Harrison MPH, RD, CDN interviews Marci Evans MS, CEDRD, cPT I was able to come up with an appropriate response to this question.
Her podcasts always start out with her asking her guest "tell me about your relationship with food growing up" and that's definitely something to consider because our relationship with food generally develops at such a young age and is heavily influenced by the way we see our parents eat, how we are told/taught to eat, how meals are conducted in the household, how we see our friends at school eat and what they have to eat compared to what we have to eat. We don’t even realize we have an actual 'relationship' with food until we rely heavily on it for emotional support.
The desire to eat highly palatable food is largely driven by a primitive physiological response. Highly palatable foods are higher in carbohydrates and fats which can provide the body with more energy and quickly. The brain will fight against dieting and food control or food restriction by igniting reward centers that motivate us to seek out highly palatable foods. The more we restrict food, the more our brains signal food consumption, the harder it becomes for us to stay on our ‘diet’ and the worse the binge may be once we finally give in. "The consumption of palatable foods, which have more intense flavors than standard foods, sends information to the reward center in the nucleus accumbens, which triggers dopamine and serotonin release. The reward center has connections with neurons in the hypothalamus that act on appetite control" (source). Meaning, when you eat highly palatable foods, the dopamine hit delays satiety signals and can lead to higher consumption of food regardless of true hunger. Because of the connection between palatable foods, the brains reward centers, and increased oral intake, it can be hypothesized that excessive weight gain/obesity and drug addiction share common neural mechanisms.
This is when many people will begin to believe that they are truly addicted to food and there is a feeling of addiction present when someone restricts.
"A major psychiatry reference text, the Diagnostic and Statistical Manual of Mental Disorders (DSM), doesn’t include food addiction. However, some researchers have taken DSM criteria for diagnosing drug addiction (technically, “substance use disorder”) and adapted them for assessment of food addiction." (source). The outcome: The Yale Food Addiction Scale that incorporates 7 features:
If you exhibit 3 of the 7 features and experience significant distress around food, you can be classified as having a food addiction.
All seven features classifying 'food addiction' have one key underlying trigger... FOOD RESTRICTION. Without food restriction, one could argue that the majority (if not all) of these features wouldn't even be present.
Let's discuss the research briefly...
Food addiction has been largely researched and studied in rodent models which lends a lot of limitations because human’s practice more free will, aren’t cage bound, and not confined to ridged routines for the most part. This means the results from these studies are not entirely translatable to humans because environment plays a key role in food-seeking behavior.
As discussed earlier, the systems in the brain that are stimulated and triggered in drug addicts are the same systems that motivate us to seek natural rewards like sex and food. So, in theory, anything that stimulates these systems in the brain could lead to an addiction. "However, studies in animals report that food doesn’t stimulate them nearly as much as highly addictive drugs of abuse, and this is part of the reason why the food addiction concept is controversial." (source).
To answer the main question this blog proposes, I don't think it's really even a food addiction problem, I think it's a problem with food restriction. And "The DSM-V committee that focused on addiction declined to add “food addiction” as a recognized mental illness stated that there is not definitive evidence for its addiction." (source).
The messaging of food addiction resonates with so many people because it’s a fear-based message that states you cannot be trusted around food and therefore, you must abstain from certain foods. However, this places further restriction on those that may already be suffering with disordered eating behaviors.
I believe that food restriction creates the addiction, and less food diversity coupled with a diet high in ultra-processed foods creates an 'addiction' mindset as well. Without food restriction and with more diet diversity, there is no scarcity, and with no scarcity comes food freedom and with that, comes less psychological distress around food and food choices.
Restriction can cause us to hyper-focus on the very things we are forbidding and ultimately, we can associate these forbidden foods with negativity and morality --> 'If I eat this then I'm bad'. So, if we place morality on foods and believe that we become out of control around certain foods, this further perpetuates restriction of those foods.
This makes treatment for food addiction so much harder because we need food to survive but someone who is addicted to heroin definitely doesn’t need that to survive. So, people with food addiction must continue to expose themselves to and consume the very thing they claim they are addicted to in hopes of not ‘relapsing’ and finding their version of recovery and a healthy relationship with food.
I believe that food addiction and food restriction should be explained and discussed with patients and clients. This can help people better understand the neurological and biological responses and motives towards food. In understanding this, people can then recognize patterns and habits they have around their food choices and learn to bend their own food rules and give themselves more permission and grace when it comes to improving their relationship with food.
Healing your relationship with food should not be centered around food control and body modification, it’s about body acceptance. People need to heal from the physical and psychological deprivation. “You can’t have eating disorder recovery and weight management” at the same time, says Christy Harrison.
Those with disordered eating need to give themselves permission to eat in order to restore nutrients, balance hormones, and eliminate the food obsession developed after restriction and dieting. The feeling of food addiction can and will dissipate overtime.
Food is meant to be pleasurable, nourishing and life-sustaining.
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