I’ve been thinking a lot recently about food addiction. Earlier this year, I co-led a workshop with sugar addiction expert Dr. Nicole Avena and later participated in a panel discussion on the topic for an audience of eating disorder professionals. One of my favorite parts of teaching is the stimulating questions and discussions that inform my own thoughts. One issue that has been rattling around in my brain is how to explain the striking similarities between the symptoms of sugar addiction and the descriptions that I hear from my patients who struggle with cycles of dieting and binge eating.
I started to wonder: are food addicts really struggling from chronic dieting and binge eating?
Now, I know that this is a controversial question. People who identify as food addicts really identify as food addicts—not dieters—and the treatment for food addiction (abstinence from certain types of foods) is the exact opposite of the treatment for chronic dieting and binge-eating (reducing restrictive eating). To further understand the connection between food addiction, dieting, and binge-eating, I turned to the research literature. There isn’t much published on this topic, but I did find “An Examination of the Food Addiction Construct in Obese Patients with Binge Eating Disorder” by Gearhardt, White, Masheb, Morgan, Crosby, and Grilo (2012) published in the International Journal of Eating Disorders.
This study examined food addiction, as assessed by the Yale Food Addiction Scale (YFAS), in a sample of obese participants seeking treatment for binge eating disorder (BED). Results indicate that 56.8% of participants met diagnostic criteria for food addiction using the YFAS. Out of those participants who did not meet diagnostic criteria, 57.1% endorsed 3 or more symptoms but did not report significant clinical impairment or distress. Participants who met diagnostic criteria for food addiction were more likely to also meet criteria for a mood disorder diagnosis, specifically major depressive disorder. In addition, YFAS scores were significantly correlated with more negative affect, more emotion dysregulation, and lower self-esteem. Scores on the YFAS were positively correlated with frequency of binge eating, eating concern, shape concern, weight concern, and global eating disorder scores. Of note, the YFAS was not related to dietary restraint. However, the YFAS did significantly predict binge eating scores.
The authors conclude that there is a strong but not complete overlap between BED and food addiction. They suggest that patients with BED who also meet a diagnosis for food addiction represent a more severe subtype. These patients have higher levels of mood disorders (specifically MDD), greater negative affect, more emotion dysregulation, lower self-esteem, and more eating disorder pathology.
So, what does this study really tell us? There are many similarities between food addiction and binge-eating. Many people who are diagnosed with binge eating also meet criteria for food addiction. However, this does not apply to all binge eaters; some people who binge eat do not meet criteria for food addiction. The authors of the study discussed above do not believe that this association is due to dieting. However, dieting and restrictive eating has beein identified in previous research as a trigger for binge eating. I think that more research is needed to conclusively say one way or another the role that dieting has in food addiction. What do you think?
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