If Food Addiction Is Real, How Do We Treat Eating Disorders?
How will evidence of "food addiction" affect eating disorders treatment?
Posted Apr 25, 2011
As promised, I'm devoting this post to a conversation I had recently with Chevese Turner, the founder and CEO of the Binge Eating Disorder Association (BEDA). Chevese contacted me after I posted on so-called sugar addiction, writing in an email, "This is an ongoing debate in the overall eating disorders community, as you know, and it reaches fever pitch in the binge eating disorder community on a regular basis."
As I discussed here, data is emerging to support the possibility that neurologically based sugar and/or food addiction exists in some people. One reason the topic is so sensitive to eating disorders specialists is that abstinence-the standard treatment for alcohol and drug addicts-is not an option they recommend for eating-disordered patients. This is why Chevese objects to programs that counsel abstinence from sugar, flour and wheat (including some 12-step-type programs such as Food Addicts Anonymous). She says, "I have a difficult time around the food addiction model, where certain foods are demonized. People have to learn how to manage food."
Turner knows from experience that for her and countless people who have come to BEDA for support, efforts at abstinence often backfire. "People try hard not to eat sugar and white flour, and get on a continual up-and-down weight cycling," she told me. "They don't address the issues that are propelling them toward food, such as trauma or major family issues."
One of her concerns is that the neurological explanation for binge eating ("Look, I can't help it-my brain is hard-wired to binge!) may undercut efforts to understand the role of environment and emotions in the disorder. There are effective therapeutic treatments that can truly improve quality of life, Turner says; she doesn't see how you can separate those environmental causes from the neurological addiction model. Patients need to get mental health support, whether it is behavioral therapy that will help them slowly shift their attitudes and behaviors around food, body image and size, or traditional talk therapy to help resolve underlying issues.
"I know there have been times in my life when I want everything I can find that has a high fat, high sugar content," admits Chevese. That might be her neural pathways talking, but she knows that addressing related psychological/emotional problems and working on changing negative behaviors has helped her become more healthy.
For her, that meant stabilizing her volatile moods and accepting herself and her body for what they are. Because she struggles with mood disorders, Chevese says that getting in touch with those moods and learning to separate them from her body's hunger cues was a vital first step. "As with most people with BED, when there is a mood disorder present and one goes into a depressive state, food use tends to increase," she explains. "Stabilizing mood was critical to stabilizing weight." This, in turn, allowed Chevese "to do the work of accepting myself where I was. When I could move more easily in my body and be less self-critical....I allowed myself to take care of myself. It's a bit cyclical."
"I now have 'subjective binges,'" she says. "Maybe I'll eat two or three Oreo cookies, and I'll feel like I've had a huge binge."
As her binges have become smaller and less frequent, Turner says her weight has dropped 50 to 60 pounds over the last several years and has stabilized. This type of progress, she says, "is really good for physical and mental health." (You'll also notice that it completely bypasses the issue of whether or not Cheves is "addicted" to food.)
"Weight stabilization," rather than weight loss, is important distinction to Chevese. Obesity scientists, she notes, acknowledge that some binge eaters "are not going to be able to lose weight and be in a normal range...once a large number of fat cells are in place, they are going to want to stay or return there. This leads to the phenomenon of the body feeling it's being starved, and compensating by holding onto fat."
In contrast, the "food addiction communities," says Turner, tends to "celebrate weight loss" and make it the goal. Her gradual weight loss was not through dieting and obsessing about "calories-in-calories-out," she emphasizes. "It was through paying attention to when I was hungry and when I was not."
This leads to another question: how might evidence of food addiction alter the weight expectations placed on BED sufferers? Chevese asserts that many binge eaters cannot and should not strive to achieve an average BMI for their height; research has shown that for the obese, even weight losses of 5 or 10 percent of total body weight can improve health drastically. Will an addiction model set up the expectation that a "food addict," through abstinence from trigger foods, should achieve greater losses? "To have everyone under a certain BMI," says Turner, "that would be really dangerous."Again, this is a question that we will have to wait to get the answers to.
One area in which the addiction model could be clearly beneficial is in reducing the stigma attached to eating disorders, just as it has done with alcohol and drug addiction. "We've got to address the weight stigma, or else we're going to be kept in a dark shameful place," says Chevese.
Recent studies showing how the brain drives addictive food behaviors can help reduce the shame and blame often associated with eating disorders, just as studies revealing strong genetic links to eating disorders have helped reduce stigma. Current research has shown that anorexia, bulimia and BED are not mental disorders that hinge on a lack of will, or some sort of moral weakness; they are biologically based illnesses and sufferers are entitled to compassion as well as treatment.
So the question we should be asking is: what kind of treatment is the addiction model going to promote? One possibility is that it will discourage procedures such as gastric-bypass surgery. A recent Yale study that claimed to prove the existence of food addiction noted that gastric-bypass, behavioral changes, and even an emphasis on "personal responsibility" may be only minimally effective. Both Chevese and Marcia have already seen the limits of gastric-bypass surgery among patients who undergo the procedure only to turn to alcohol abuse or other self-destructive behaviors. Will it come down to a matter of genetically susceptible individuals picking their addiction?
Chevese and I agreed that in the end, what really matters to us, our readers and the members of BEDA is how the new scientific addiction model conceptualizes recovery, and how it drives treatment of eating disorders." We'll keep monitoring this issue and hope you'll let us know where you stand on them.
Marcia Herrin and Nancy Matsumoto are co-authors of The Parent's Guide to Eating Disorders. Marcia is the author of Nutrition Counseling in the Treatment of Eating Disorders