My Concerns with the Food Addiction Model: Insights from Research and Clinical Practice

If you haven’t already, I strongly recommend the first three articles in this series:
Part 1 – What is Food Addiction and How is it Diagnosed?
Part 2 – Linking Dietary Restriction and Food Addiction
Part 3 – Evolutions in the Food Addiction Research Landscape: Then and Now

Below is a non-exhaustive list of some of my own critiques and concerns with the Ultra-Processed Food Addiction theory. These are the things that swirl around in my brain as I read and reflect on the research and particularly how it compares/contrasts to the clinical work I do as an ED provider. Here are some thoughts, in no particular order.

Anti-Fat Bias & Weight Stigma

Much of the research on food addiction contributes to weight stigma, resting on the assumption that high weight = pathology. This is demonstrated by persistent attempts made by both researchers and providers to both explain and treat high weight through an addiction model with insufficient consideration of the harm caused by placing people on highly restrictive diets and treating their bodies as an illness. There has been little to no reckoning from the food addiction community on the role that severe dietary restriction perpetuates “addictive-like” eating for many individuals. For many, the “treatment” amplifies “the addiction.” 

Evidence demonstrates that perceived weight stigma positively correlates with food addiction scores and that fear of weight stigma worsens “addictive-like” eating (Huang et al., 2022; Huang et al., 2024; Meadows and Higgs, 2020; O’Brien et al., 2016; Papatsaraki et al., 2024). The food addiction community must reckon with this, adopt a weight-inclusive approach, and abandon utilizing food addiction as a strategy to treat weight (Wiss, 2022). Further, this points to the need for clinicians to focus on underlying mechanisms, such as addressing the negative consequences of weight stigma and supporting clients to identify if restricting or reducing ultra-processed food will reduce or amplify stress in both the short and long term.

Role of Social Factors/Context and Neurobiological Research

Neurobiological research and neuroimaging frequently fails to account for highly complex social, cultural, and environmental contexts. And these contexts are critical to our understanding the development and persistence of an ED as well as our relationships to food. Brain activity, neurotransmitters, and structural abnormalities tell us how a brain is responding to a stimulus but not why. Thus, these findings are interpreted by individuals whose theories are shaped by their own experiences, perspectives, norms, assumptions, and biases. Certainly part of what is being revealed in the neurobiological research of ultra-processed food addiction is our client’s decades of experience and sociocultural messaging with these foods. We all know that the moral valence applied to chocolate and potato chips is different from dried lentils and broccoli. I want to be clear, I do believe that the nutrition we provide our bodies plays an incredibly important role in our physical, mental, emotional, and spiritual well-being. I see the harmful consequences of malnutrition in my clinical practice and supervision every day. But I do believe that nutritional science is held within complicated layers of social, cultural, familial, and spiritual legacies and experiences and the current modes of research do not and cannot parse those layers apart.

Ultra-Processed Food Addiction Research in Its Infancy

Individuals who research the topic of Ultra-Processed Food Addiction repeatedly state that this field is in its infancy. Most notably, there has yet to be a causal link established between specific foods driving the addictive presentation. As previously discussed in the last newsletter, Ultra-Processed Foods are identified as foods organized in the fourth group of Nova classified foods. But this includes a massive array of foods and this proposed system of organization is not all that precise. A recent episode of the Maintenance Phase Podcast provides a critique of the concept of Ultra–Processed Foods. I personally get a little antsy when proposed interventions, which have a track record of leading to significant harm, are resting on such early-stage research and unanswered questions.

Semantics, Languaging, and the Addiction Framework

There is an abundance of evidence demonstrating that people experience profound internal dysregulation around certain types of food, so much so that they act against their own interests and values. And there is no doubt some individuals experience heightened responses to some foods and not others. I don’t know a single ED specialist who would argue this. But food addiction has such a fraught history and the associations with it don’t necessarily reflect some of the currently proposed treatment approaches (Dennis et al., 2024). For a number of reasons, I remain unconvinced that the addiction framework is the most helpful when it comes to food. The degree of nuance and care that must be taken as part of clinical assessment, treatment, and recovery with food is very different from other drugs of abuse. Given the fact that food abstinence or reduction is not accessible, desirable, or sustainable for so many (particularly those in ED treatment), how is relying on an addiction frame helpful or harmful (Laurent et al., 2022)? I hope we wrestle with this and remember that ultimately our clients get to decide what is best for them. AND most clients in more acute stages of their illness will be vulnerable to overly-prioritizing food restriction as part of their treatment and recovery.

Questions and Reflections from YOU!!

I have heard back from several of you over the course of this series. Thank you!! Below are two responses from fellow ED dietitians who shared with me their own thoughts on this topic. 

“My curiosities surround nervous system states and interoception. Say someone is “diagnosed” with “food addiction” per the current criteria, it would be interesting to see what is happening in their limbic system while eating UPFs. I imagine their limbic system is likely flooded, and they’re in a dysregulated nervous system state (for a variety of reasons, with so many different factors depending on the individual). But does that mean they are unable to access ventral while eating UPFs? If not (say they learn nervous system regulation techniques), how do they then behave/present/score when they are able to be in ventral vagal and have access to interoception while eating UPFs?”

Taylor Wolfram, MS, RDN, LDN

One question Liz has been sitting with, especially in light of how “ultra-processed food addiction” is discussed in media, healthcare, and even by political figures (hi, RFK Jr), is:

How do we resist the moralizing of food choices that places responsibility—and often blame—on individuals, rather than addressing the systemic issues that make certain foods the most accessible, affordable, and shelf-stable options?

There must be a way to provide affordable, safe, good-tasting food to a growing population without pathologizing those who rely on it. Even if there is such a thing as an addictive neurobiological response to ultra-processed foods, asking a single person to change their health behaviors within a system designed to promote hyper-individualism and materialism seems like the opposite of supporting true well-being and wholeness.

I’ve been sitting with some observations from my own small but meaningful sample of clients—particularly those with ADHD diagnoses who spend long stretches at their computers, often gaming. These clients are also the ones most frequently described (by themselves or others) as having “addictive” patterns with ultra-processed foods.

And it makes me wonder:

What if the issue isn’t the food itself, but the context that surrounds it?

Planning, prepping, cooking, and cleaning up meals from scratch requires a level of executive function, time, and energy that not everyone has access to—especially those navigating neurodivergence, trauma histories, or the demands of living in a productivity-obsessed world.

“Ultra-processed food addiction” might be too narrow a diagnosis for what is actually a modern phenomenon:

A system that has moved us further and further away from community, nourishment, and rest… while simultaneously raising our expectations for convenience, efficiency, and pleasure. In this kind of culture, when something—food, an interaction, an experience—doesn’t meet our ideal, the response is often “I deserve better.” But maybe that reaction isn’t rooted in entitlement. Maybe it’s loneliness. Or grief. Or a deep spiritual hunger for something real.

Which leads me to wonder:

Could what we’re calling “addictive” be a relational or even spiritual wound, misnamed as a pathology of consumption?

Are our clients reaching for food to meet needs that aren’t nutritional, but existential—connection, comfort, clarity, grounding?

I don’t have answers, just musings. But I think it’s worth asking.

I’m really grateful for the way you’re holding complexity here, and for how your voice helps make space for deeper reflection and better questions.

Liz Brinkman, RDN

In the next and final part of this series on Food Addiction, I’ll offer up some additional thoughts particular to the eating disorder profession, since that’s where I spend all of my time.

What questions does this series on food addiction have you considering? Let me know by sending me a message on Instagram.

 

 

 

 

Be sure to check out 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 3 – Evolutions in the Food Addiction Research Landscape: Then and Now
• Part 5 – Bridging the Gap Between Food Addiction and Eating Disorder Treatment
  

Looking for more training – especially on weight science research? 

Be sure to check out the workshop that Ragen Chastain and I did – which is now available as a self-study course, A Clinician’s Guide to Weight Inclusive Research: What to Know and How to Apply It.

You can also check out all the Eating Disorder and Body Image training courses offered by visiting 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:

• 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
• Laurent, J., Martin, A. R., & Tompkins, C. L. (2022). Persistent and Unsuccessful Attempts to Cut Down on Ultra-Processed Foods and the Associated Challenges for Dietary Adherence. Current Addiction Reports, 9(4), 275–281. https://doi.org/10.1007/s40429-022-00418-7
• 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
• ’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
• Wiss, D. (2022). Clinical Considerations of Ultra-processed Food Addiction Across Weight Classes: an Eating Disorder Treatment and Care Perspective. Current Addiction Reports, 9(4). https://doi.org/10.1007/s40429-022-00411-0