Food Addiction: How restriction plays a role …

Linking Dietary Restriction and Food Addiction

May 14, 2025 Eating Disorders Training

This is part 2 in the series of articles on Food Addiction and tackles the interplay between Dietary Restriction and Food Addiction.

If you missed the first installment, I strongly encourage you to pause andread part one, What is Food Addiction and How is it Diagnosed?

I describe how food addiction is being defined and diagnosed and offer a couple of prompts to consider in preparation for today’s topic: The interplay between dietary restriction and food addiction.

I am going to be using a number of acronyms:
FA = Food Addiction
UPFA = Ultra-Processed Food Addiction
UPFs = Ultra-Processed Foods
ED = Eating Disorder
YFAS = Yale Food Addiction Scale

The Interplay between Dietary Restriction and Food Addiction.

Neurobiology, Famine, and Food Salience

Decades of research demonstrate the unique ways starvation shaped our neurobiological responses to food. Due to the threat of famine, our brains evolved to seek out and derive pleasure from calorie-dense food. Gearhardt and Schulte (2021) wrote a thorough article summarizing the unique brain and body systems which work together to promote the prioritization of attaining foods efficiently. Thus, amplifying food salience in the context of deprivation is a feature, not a bug! Heightened salience makes it harder for us to ignore or resist food cues. Phew! This is a very good thing.

Dietary Restriction and Ultra-Processed Food Addiction

Many people, including me, have pointed to the role that dietary restriction plays in creating an experience and appearance of “addiction” to food. Remember the data I provided in my last newsletter? If we take the Yale Food Addiction Scale as a legitimate way to diagnose a “food addiction”, folks with EDs score much (MUCH!) higher rates than the average US population (14-15% vs. as high as 97%). Given the central role that restriction plays in most EDs, it seems logical that the YFAS is overly diagnosing an “addiction” in ED populations since it is not designed to discriminate between symptoms of “addiction” with dietary restriction.

Note: It is beyond the scope of this series to elaborate in detail, but I do want to mention that some researchers are looking at the possibility of phenotypes. This might include Individuals who meet criteria for a food addiction, but not an ED; individuals with an ED who display “addiction-like” eating due to the role of dietary restriction; individuals who present with both an ED and a FA where dietary restriction is not a core feature.

We must continue to be curious and critical readers of the food addition research.

Neurobiology

Historically, critics of the FA theory (including myself) would pretty much rest their case on the restriction argument alone. But research has evolved over the past 15 years and it’s my opinion that this argument on its own doesn’t cut it.

Newer research is showing that UPFs do demonstrate amplified reward responses in the brain, suggesting they have a higher reward potential. This does not occur in the same way with minimally processed foods. However, it’s not just salience that drives proponents of the FA theory to compare UPFs with other addictive substances. Brain imaging studies on UPFs demonstrate amplified responses among brain regions responsible for liking, wanting, motivation, and reward appraisal (Gearhardt & DeFeliceantonio, 2023; Krupa et al., 2024; Schulte et al., 2021).

Amplified reward responses alone do not signal an FA. Rather, scientists look at long-term changes in the functional connectivity of brain regions. Newer research does show that individuals who meet diagnostic criteria for an FA share several mechanisms with individuals who have a substance use disorder. They are primarily related to reward dysfunction (particularly dopamine), emotion regulation, executive function, and impulsivity (Gearhardt & DeFeliceantonio, 2022; Ratković et al., 2023; Schulte et al., 2021; Wiss & Avena, 2020).

While the research has a very long way to go, proponents of the UPFA theory believe there is clear evidence that among individuals with a diagnosed FA, there are meaningful neurobiological changes (alongside behavioral symptoms and subjective experiences). However, much controversy and debate remains about if and what specific food substances create a FA.

So if we are to put this super simply, we could say – gosh, when we take a person’s experience and couple it with brain imaging, it sure seems like something is happening with these highly processed foods in some people’s bodies and brains! (Please bear in mind that the researchers have a long way to go here. UPFs cover a massive array of foods.)

What Other Factors Should We Consider?

As we’ve discussed, dietary restriction can create an appearance of “FA.” And there are a number of factors that also impact the brain, creating vulnerability to the appearance or experience of addiction-like processing. I find David Wiss and Timothy Brewerton’s 2020 article, “Separating the Signal from the Noise” very helpful in describing the clinical steps to evaluate a variety of factors with nuance and care.

We can also add some more recent articles describing increased incidence of “food addiction” in people who perceive they have experience weight stigma and fear of weight stigma (Huang et al., 2022; Huang et al., 2024; Meadows and Higgs, 2020; O’Brien et al., 2016; Papatsaraki et al., 2024). Factors to consider include:

  • History of trauma and presence of PTSD
  • History of early life adversity
  • Tendency towards impulsive behaviors
  • Negative body image and its role in dietary restraint
  • History or current food insecurity
  • Presence and degree of malnutrition
  • Chronic stress due to stigmatization (e.g. weight, racism, transphobia, acculturative stress) Dennis, et al 2024​

With all of these complexities at play, we must continue to be curious about what is being revealed by all of this research. A profound limitation of brain imaging studies is the lack of context. Yes, it is compelling to see that a lot is happening in the brain scans when a person eats Doritos vs carrots (I’m making this up, I don’t know what foods they use in these studies).

Is it the ingredients of the Doritos? Is it the ingredients of the Doritos in concert with other factors like lived experience, genetic legacy, gut microbiome, diet culture, etc, etc?

Listed below, I include a handful of citations that have informed my study, which you may want to dig into yourself. In the next article in this series, I’ll offer a few thoughts on changes that have occurred in the FA research landscape over the past 20 or so years.

I don’t pretend to be an expert in this space, nor do I believe that my interpretation of the research is the only “right” way. But I do hope this brief series inspires you to critically engage with this material.

Thanks for being here with me!

marci evans RD boston MA

 

 

 

 

This article is Part 2 in our 5-part series on Food Addiction. Explore more from the series:

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Citations:

  • Dennis, K., Barrera, S., Bishop, N., Nguyen, C., & Brewerton, T. D. (2024). Food Addiction Screening, Diagnosis and Treatment: A Protocol for Residential Treatment of Eating Disorders, Substance Use Disorders and Trauma-Related Psychiatric Comorbidity. Nutrients, 16(13), 2019–2019. https://doi.org/10.3390/nu16132019​
  • Gearhardt, A. N., & Schulte, E. M. (2021). Is Food Addictive? A Review of the Science. Annual Review of Nutrition, 41(1), 387–410. https://doi.org/10.1146/annurev-nutr-110420-111710​
  • Gearhardt, A. N., & DiFeliceantonio, A. G. (2022). Highly processed foods can be considered addictive substances based on established scientific criteria. Addiction, 118(4). https://doi.org/10.1111/add.16065​
  • Huang, P.-C., Latner, J. D., Bevan, N., Griffiths, M. D., Chen, J.-S., Huang, C. H., O’Brien, K. S., & Lin, C.-Y. (2024). Internalized weight stigma and psychological distress mediate the association of perceived weight stigma with food addiction among young adults: A cross-sectional study. Journal of Eating Disorders, 12(1). https://doi.org/10.1186/s40337-024-01112-x​
  • Huang, P.-C., Lee, C., Griffiths, M. D., O’Brien, K., Lin, Y.-C., Gan, W. Y., Poon, W. C., Hung, C., Lee, K.-H., & Lin, C. (2022). Sequentially mediated effects of weight-related self-stigma and psychological distress in the association between perceived weight stigma and food addiction among Taiwanese university students: A cross-sectional study. Journal of Eating Disorders, 10(1). https://doi.org/10.1186/s40337-022-00701-y​
  • Meadows, A., & Higgs, S. (2020). Internalized weight stigma and the progression of food addiction over time. Body Image, 34, 67–71. https://doi.org/10.1016/j.bodyim.2020.05.002​
  • O’Brien, K. S., Latner, J. D., Puhl, R. M., Vartanian, L. R., Giles, C., Griva, K., & Carter, A. (2016). The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite, 102, 70–76. https://doi.org/10.1016/j.appet.2016.02.032​
  • Papatsaraki, A., Pappa, D., Koreli, A., Kourti, F.-E., Manthou, P., Chasaki, K., Koutelekos, I., Margari, N., Theodoratou, M., & Dafogianni, C. (2024). Investigation of Internalized Weight-Related Stigma: Progression to Dietary Addiction and the Role of Stress. Curēus, 16(2). https://doi.org/10.7759/cureus.55007​
  • Ratković, D., Knežević, V., Dickov, A., Fedrigolli, E., & Čomić, M. (2023). Comparison of binge-eating disorder and food addiction. Journal of International Medical Research, 51(4), 030006052311710-030006052311710. https://doi.org/10.1177/03000605231171016​
  • Schulte, E. M., Chao, A. M., & Allison, K. C. (2021). Advances in the Neurobiology of Food Addiction. Current Behavioral Neuroscience Reports, 8(4), 103–112. https://doi.org/10.1007/s40473-021-00234-9​
  • Wiss, D., & Brewerton, T. (2020). Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint. Nutrients, 12(10), 2937. https://doi.org/10.3390/nu12102937
  • Wiss, D. A., Avena, N., & Gold, M. (2020). Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications. Nutrients, 12(11), 3521. https://doi.org/10.3390/nu12113521​