Evolutions in the Food Addiction Research Landscape: Then and Now
In part 3 of this series, I am detailing some of the changes and advances in the field of “Food Addiction” over the past 20 or so years.
If you haven’t already, I strongly recommend the first two articles in this series:
Part one – What is Food Addiction and How is it Diagnosed?
Part two – Linking Dietary Restriction and Food Addiction
One of the reasons I am describing some of the changes in the scientific research is because I see colleagues I deeply respect utilizing dated arguments or partial understandings to critique and “debunk” food addiction.
Critiques of research, professional standards, and treatments are ESSENTIAL. Some of my most important growth as a clinician and changes I’ve made in clinical practice have often been a result of my colleagues’ critiques of the ED profession.
But for a critique to be strong, it must reflect the most current understanding of an issue rather than the knowledge we had from a decade previous. Because we are clinicians with busy practices and lives, it is extraordinarily difficult to be up to date on all issues impacting our clinical work at all times. I hope my work is helpful to you. My brief summary here is not complete, so if you have additions, corrections, or critiques of what I present here, please know that I am open and grateful to receive them. I have utilized the article “Advances in the Neurobiology of Food Addiction” by Erica Schulte, et al (and cited at the end) for the bulk of the content in the table below.
Evolutions in the Research on Addiction-Like Eating
In the past, I pointed to the many “amplified brain-based responses” we humans display in response to music, snuggling a baby, etc. and would declare “we don’t call those things addictive!” This is true. But it reflects an incomplete understanding of addiction science.
Proponents of the food addiction model are not looking at amplified reward responses to certain foods and calling it an addiction. Rather, they are looking to see if long-term exposure to certain foods creates both behavioral changes (as measured by the YFAS) alongside reward-based neurological changes comparable to what has been observed with addictive drugs/substances. They are looking for changes in functional connectivity of particular brain regions primarily associated with reward dysfunction (dopamine), emotion regulation, executive function, and impulsivity. And that all of these things ought to correlate with an individual’s subjective experience as measured by the YFAS.
Significant controversy and debate remain regarding if and what specific food substances create a “food addiction.”
Researchers who study addictive-like eating all agree that much of this research is in the very early stages and that there is an abundance of opportunities for future research, including identifying which specific foods may be addictive.
As clinicians, we ought to be asking ourselves:
- How much stock do we put in the YFAS? Given that we don’t have fMRIs to measure what’s happening in our clients’ brains, that’s the diagnostic tool we’ve got. Do we discount it since it produces such high rates of food addiction among individuals with ED and doesn’t screen for dietary restriction/restraint? Do we utilize it in conjunction with other clinical tools and questions as suggested by Wiss and Brewerton?
- What is the utility of brain imaging without context? How do a person’s lived experiences, identities, cultures, and belief systems shape what is being observed in a brain scan? How do we parse out what is driven by food ingredients vs. our client’s experiences of these foods?
- If a person is having a more “addictive” neurobiological response to food, what does this mean for our work with them? How might altering intake impact their relationship to and experience of what they are eating?
In the next articles, I’ll offer some of my own critiques, concerns, and questions about the food addiction paradigm. And will wrap up this series with specific thoughts about how this applies to the ED profession specifically.
Thanks for being here with me!
If you haven’t already, catch up on the other articles in this 5-part series on Food Addiction:
- Part 1: What is Food Addiction and How is it Diagnosed?
- Part 2: Linking Dietary Restriction and Food Addiction
- Part 4: Rethinking Food Addiction Research: Critiques, Concerns & Questions
- Part 5 – Bridging the Gap Between Food Addiction and Eating Disorder Treatment
Need more CPEUs this year?
If you’ve already completed one of my Online Training Courses, make sure to submit for your CPEU certificate. And if you’ve been meaning to register for more training, visit my online course library to find a course that fits your needs. These are self-paced and packed with CPEUs along with tools and resources to use with your clients too.
Citations:
- 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
- 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., & Avena, N. (2020). Food addiction, binge eating, and the role of dietary restraint: Converging evidence from animal and human studies. In G. K. W. Frank & L. A. Berner (Eds.), Binge Eating: A Transdiagnostic Psychopathology. Springer Nature.