Q: A colleague and I have an ongoing debate about food addiction. He claims that the true definition should be eating addiction, and that food addiction is not a true eating disorder but in reality is similar to substance abuse. Is he right? (L.H., Merced, CA)
A: That is an excellent but unsettled question. The concept of food addiction, or food-related behavior, was first described in 1956 by Randolph, and has received increasing attention, but its true definition is still controversial. “Food addiction” suggests that an individual may have addictive-like responses to food similar to those seen in classic substance abuse. This can be associated with obesity and disordered eating. As defined by the DSM-5, this may more appropriately be described as a substance-related disorder, more closely identified as an eating addiction. Others have proposed that food addiction is an addictive disorder rather than an eating disorder. Thus, BED is proposed to be a psycho-behavioral disorder while food addiction is a biologically based disorder (Appetite. 2009; 52:430).Methods of assessment, such as the Yale Food Addiction Scale now exist, but the appropriate classification schemes and treatments (and even whether any such addiction would be to food or eating) remain uncertain.
A recent paper by Carolin Hauck and colleagues, originally presented at the Nutrition Society Winter meeting and published in Proceedings of the Nutrition Society (2020; 79:103), argues that addictive-like eating may manifest through repeated consumption of highly palatable, highly processed complex foods, typically foods containing large amounts of energy, sugar and/or fat. Evidence thus far suggests this pattern of eating is similar to behavior seen in behavioral or substance dependence. The authors suggest that food addiction does not seem to fit in with established eating disorders. Instead, food addiction may represent a distinct pattern of disordered eating or may be a subtype of an already existing eating disorder, such as BED. Future studies are needed to clarify causes, point to treatment, and to describe the impact on individuals with these eating patterns.