Addicted to Food

Food and misery

Source: RyanMcGuire/Pixabay

Some people depend on opioids or methamphetamine (or both), while far greater numbers of individuals in the United States and worldwide depend on sugar and highly processed foods to feel better or even normal. We’ve known about food addiction for some time; for example, in July 2007, Yale University brought together 40 experts on nutrition, obesity, and addiction to discuss the addictive potential of foods. Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA), then and now discussed commonalities in brain reward mechanisms related to compulsive eating as well as drug abuse. This conference is now called the Yale Historic Conference on Food and Addiction.

I asked University of Michigan Professor Ashley Gearhardt, Ph.D., a pioneer and leader in the field of food addiction and co-editor (with me and others) of the 2024 edition of Food and Addiction: A Comprehensive Handbook, what she remembered about the conference. She said, “The Yale Conference on Food and Addiction was a huge step in setting the field up to be seen as a viable and important area of study. Since that time, there have been over 400 articles and multiple meta-analyses that find that applying an addiction perspective to excessive intake of highly rewarding foods is valid and clinically significant.”

Food Addiction and the Brain

“People aren’t becoming addicted to apples or brown rice,” said lead author University of Michigan professor of psychology Ashley Gearhardt, Ph.D. “They’re struggling with industrial products specifically engineered to hit the brain like a drug—rapidly, intensely, and repeatedly.”

A new paper, published in Nature Medicine, synthesizes evidence from nearly 300 studies across 36 countries demonstrating that ultra-processed foods can hijack the brain’s reward system, triggering cravings, loss of control, and persistent use despite harmful consequences—key features of addiction. For years, researchers have theorized that the overeating-obesity epidemic was primarily caused by a sedentary lifestyle, and, consequently, the main solution was to exercise more. Others have suggested that the problem is not the lazy patient, but instead lies with the taste, palatability, variety, addictiveness, and ease of buying and consuming manufactured foods.

Looking Back in Time

The physician founder of Kellogg’s Corn Flakes, Dr. John Harvey Kellogg, was a health food and granola advocate. Dr Kellogg did not add sugar to his cereals. However, the addition of sugars to Kellogg’s breakfast cereals after his death drove up consumption of the products. Similarly, when Robert Cade, M.D., at the University of Florida, invented an oral fluid to replace sweat and electrolytes lost in exercise or sports, sales were initially flat. The addition of sugar turned the Gator football team’s secret hydrating weapon into Gatorade.

A Loss of Control

Lay's potato chips captured the truth when they introduced their slogan: "Betcha can't eat just one." The chips became an international business success.

Some processed foods stimulate their own consumption and, consequently, are eaten to excess. They are also major factors in the obesity epidemic. When people consume new and/or highly reinforcing foods, the brain's dopaminergic system, involved in rewards, takes over.

It is also true that drugs of abuse generate more brain excitement and change when taken on an empty stomach. As well, overeating and a feeling of satiety reduce illicit drug reinforcement. Drug withdrawal and a craving for drugs can be decreased by sugar. Scientists studying sugar and high-fructose corn syrup have reported that they act like drugs of abuse in classic addiction-liability laboratory studies.

My past laboratory research has shown that amphetamine, cocaine, tobacco, and even secondhand smoke cause loss of weight and appetite during consumption. They also cause increased appetite and weight after a person becomes dependent on the substance or tries to withdraw from it.

Highly Processed Foods (HPF)

Highly processed foods (HPF), or ultra-processed foods, are extremely popular. Unprocessed foods are foods such as fruits, vegetables, and unsalted nuts. HPFs may have many added ingredients, as well as artificial colors and flavors—sugar, salt, and oil. Some experts have reported that HPFs, such as cookies, cakes, and fast food, generate up to 58% of the calories consumed in the United States. The addictive potential of HPFs may be key to the high public health costs associated with a food environment dominated by cheap, accessible, and heavily marketed HPFs.

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Some Medications Are Prescribed for Overeating and Substance Use Disorders

Some medications are prescribed to treat dependence on alcohol or opioids as well as overeating behaviors. This suggests that the same underlying addiction-related brain changes cause the disorders. For example, the medication Contrave is a combination of the antidepressant bupropion and the opiate-antagonist naltrexone. Well-designed studies have shown that treatment with the drug can cause weight loss of about 1-2 pounds a week, as long as the pharmacological intervention is used with lifestyle, exercise, and diet changes. Naltrexone is also approved by the FDA for treating alcohol use disorders (AUDs) and opioid use disorders (OUDs).

Bupropion is a dopamine-augmenting antidepressant approved by the FDA for cigarette smoking cessation. So, bupropion combined with naltrexone to treat obesity suggests some overeating and weight gain is due to an underlying addiction-like disorder.

Another example of a medication used in weight loss is the combination of phentermine and topiramate (Qsymia). Phentermine is a stimulant. Topiramate is used in treating alcohol use disorders and reducing the amount of alcohol consumed. In addition, topiramate is used in treating binge eating and substance use disorders, as well as seizure disorders. Before the development of GLP-1 medications such as Ozempic, the anti-addiction medications offered the best alternative to bariatric (weight loss) surgery.

By far, the most blockbuster news in obesity treatment is the invention of GLP-1 inhibitors (think Ozempic) for treating type-2 diabetes. The efficacy of these new medications supports the idea that obesity is caused by a biochemical difference rather than a self-control weakness. This discovery could lead to a change in the perception of obesity as a chronic illness with biological and environmental causes, which, in turn, could also reduce the stigma of being overweight.

GLP-1s are also being tested in addiction, apparently reducing alcohol consumption. Ozempic, Wegovy, and other GLP-1s may interrupt the attachment and even desire to consume drugs, just like they reduce but do not eliminate eating. These medications interrupt loss of control.

The Yale Food Addiction Scale (YFAS)

Ashley Gearhardt is studying these fascinating weight loss medications at Michigan using the Yale Food Addiction Scale (YFAS) she helped develop in 2009. Says Dr. Gearhardt, “I think of the YFAS as measuring a substance addiction with the substance being highly rewarding, as with processed foods. We are starting to work on this, but a new study came out that suggests GLP-1s may be an important treatment avenue for addictive, highly processed food intake.”

Treating the Abstinence Aspect of Food Addiction

For many addictions, such as to alcohol, opioids, or tobacco, users are weaned from the drug. In addition, symptoms of abstinence withdrawal are treated, as are cravings and relapses.

Food addictions require slow detoxification. Dr. Gearhardt recommends encouraging people to eat three meals per day with one or two snacks of minimally processed foods (such as fruits, vegetables, intact whole grains, legumes, unsweetened dairy, lean meats, and nuts). But she knows it can be hard to do by oneself. “We work with meal delivery companies that deliver convenient, tasty, minimally processed meals that can help people reboot. For example, we are collaborating with the company Fresh N’ Lean to help people who are depressed to eat more nourishing foods.”

Conclusion

The idea that certain ultra-processed foods — such as candy, cookies, and chips — can be addictive is receiving increasing attention in the USA and elsewhere. During the past two years, some individuals have developed an addiction to foods, mainly highly processed foods, which we described over a decade ago as causing overeating, loss of control, overweight, and obesity. Congressional hearings have addressed the role of addictive ultra-processed foods in escalating rates of childhood chronic diseases. In December 2024, a lawsuit was filed in Philadelphia, accusing 11 ultra-processed-food companies of designing addictive food products and aggressively marketing them toward children. Newer medications like Ozempic, Mounjaro, and related drugs have demonstrated that obesity is treatable. It appears likely that these medications will have other important uses in addictions, including behavioral addictions.