Is Food Addiction Real?

When talking about ‘food addiction’ I’m generally met with one of two responses:

1. Interesting, I hadn’t thought about it like that – how does it work?
2. What nonsense – how can you be addicted to something that’s essential to life itself.

The first response encourages learning.

It enables us to consider the modern food environment and the challenges it presents to our health. It also helps us develop a better understanding of our current issues with obesity and how to address them.

The second response reflects a dismissive, limiting belief.

At its core, this belief holds that people need to stop making excuses for their weight issues. ‘They’ just need to exercise more and go on a diet – as if it’s really that simple. The belief interferes with the ability to understand a major health problem.

This article is written for both audiences. It aims to:

• Inform readers about the food addiction concept and its biological underpinnings
• Challenge the belief that the concept is ‘nonsense’.

The article covers:

• Why we eat – is it just about gaining energy and nutrients?
• What is food addiction – what are the mechanisms underlying it?
• The food industry and the concept of ‘free will’
• Why we need to take the food addiction concept seriously
• The NZIHF study – what did it find?

Why do we eat?

It’s assumed that we eat to gain the nutrients and energy essential for life. Now without doubt, failure to eat is hazardous to health, performance, and is terminal if prolonged.

So while technically correct, this assumption is also overly simplistic.

Consider a child refusing to eat their veggies – brussels sprouts as an example. Which of the following would convince the child to eat just three sprouts to make their parent(s) happy:

• Telling them that these super nutritious foods were essential for survival?
• Promising a chocolate ice-cream as a reward?

I’d bet on the ice-cream reward every time.

You see, the pleasure gained from eating motivates us to eat.

And quite simply, some foods provide more pleasure than others.

In terms of pleasure, chocolate ice-cream trumps brussels sprouts all day, every day.

For the majority of human history food was scarce and chocolate ice-cream didn’t exist. Early humans had to invest a lot of time and energy into hunting and gathering food.

To survive, humans needed a strong drive to search for naturally occurring food. We also needed the capacity to:

• Overeat when that food was available
• Convert and store excess calories.

The smooth ‘elastic’ muscle of our digestive system certainly enables us to overeat. And we’re particularly effective at converting excess calories into bodyfat.

In our Weight Management programme, we introduce students to the Positive Incentive Theory. This theory asserts that behaviours essential to survival (eating, procreating) are driven by the anticipated pleasure we gain from them.

We’re more likely to engage in behaviours we find pleasurable and rewarding.

Ponder this scenario. You’ve just had a large dinner. You feel ‘full’. I put a bowl of your favourite dessert in front of you – do you eat it?

If we eat simply to gain energy and essential nutrients, you shouldn’t feel tempted by the dessert. You have no need for it – you’ve got ample energy and nutrients on board.

But I reckon you’d eat the dessert – it’s your favourite, you know it’ll taste great. You’ll find room for it, and just thinking about it will make you feel somewhat…hungry!

We eat because it’s pleasurable to do so. Eating makes us feel good.

What is food addiction?

When we think about addiction, we tend to think about illegal drug use. Yet in New Zealand, by far the most harmful, addictive substances are legal – alcohol and tobacco.

Maybe ultra-processed food and sugary drinks need to be added to that list…

An expert in the field of addiction, Dr Gabor Maté [ref 1] defines addiction as:

‘’Any repeated behaviour, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on their life, or the lives of others’’.

The distinguishing features of addictions are compulsion, pre-occupation, impaired control, persistence, relapse, and craving.

According to Maté, all addictions engage the brains reward and incentive-motivation systems. Dopamine, the neurotransmitter associated with pleasure is implicated along with other mood enhancing neurotransmitters.

Schulte et al [ref 2] found that:

• Ultra-processed foods are capable of triggering the bio-behavioural mechanisms associated with addiction, namely dopaminergic desensitization, and enhanced motivation.

To clarify, this means that the consumption of such foods produces:

• A large release of dopamine in the brain – perceived as extremely pleasurable
• Dopamine desensitization – progressively less pleasure is gained with further consumption
• A craving for the initial dopamine-related high – which leads to an increase in consumption.

This is the mechanism by which a weekly can of Coke graduates to become:

• A daily can,
• Then a 600ml bottle,
• And eventually, a daily 1.5L bottle (which are always ‘conveniently’ on sale).

Colantuoni et al [ref 3] found that the consumption of ultra-processed, high sugar foods was chemically addictive because they:

• Temporarily raise levels of the mood enhancing neurotransmitter serotonin
• Provide a quick fix of endorphins – the body’s natural opioid (pain reducing) neurotransmitters.

Does the term ‘comfort food’ ring any bells?

Interestingly, Dr Maté notes that Naloxone (an opioid blocking drug) reduces the consumption of sweet, high fat foods.

If the comforting effects aren’t gained – the incentive to consume declines.

The food industry and ‘free will’

In Salt, Sugar, Fat [ref 4] journalist Michael Moss investigated the practices of ultra-processed food manufacturers.

According to Moss, billions of dollars are invested in research and development. The objective is simple – to determine how products can be manufactured to deliver maximum physiological pleasure upon consumption.

Measured by neural activity in the brains pleasure centres, the optimal sugar quantity is referred to as a ‘bliss point’.

For a can of soft drink, the bliss point is achieved with nine teaspoons of added sugar because:

• Eight teaspoons won’t produce as much dopamine-infused bliss as nine
• 10 teaspoons won’t deliver anymore bliss than nine.

With regard to fat, Moss notes that there is no bliss point. In terms of its ‘pleasurable mouthfeel’ fat can be added to foods without limit. And it is.

Over a short time-period, ultra-processed foods, perfectly engineered to compel over-consumption, have come to dominate our food environment.

Common 30 years ago, the local greengrocer with shelves of fresh, affordable, unprocessed produce is now rare or non-existent.

The ultra-processed food industry intentionally manipulates our drive to eat – with no regard to the health consequences.

Not only is our ability to access healthy food limited, so to is our ability to resist ultra-processed food.

With regard to the ‘impaired control’ feature of addiction, Dr Maté notes that:

• Impulses to act are generated in lower brain systems
• The job of higher brain systems (the cortex) is to permit or inhibit certain actions.

To clarify, lower brain systems control most of our actions automatically. For example, our heartbeat, breathing, sweating and shivering, our emotions, and feelings such as hunger.

Dr Maté notes that once the impulse to act is initiated, the cortex only has a split second to inhibit acts it judges to be inappropriate.

For example, if your partner unloads on you after a rough day, you only have a split second to suppress the urge to respond in anger.

The problem in relation to eating is that the cortex is primed to achieve the goals it deems essential. Fighting with your partner isn’t essential or valuable, so the cortex may intervene to stop you saying something you’ll regret.

In contrast, because eating is essential, valuable, and pleasurable, no ‘red flags’ get raised in the brain. The cortex won’t inhibit you from indulging your sweet tooth or feasting on fast-food.

Additionally, the cortex is usually preoccupied with whatever is ‘top of mind’ for us – such as an impending exam, work issue, or relationship spat.

Our ability to make healthy food choices and resist temptation consciously and consistently is constrained by our reality. Quite simply, we’re too busy to focus our energy on making healthy food choices.

Ultimately, we have less ‘free will’ than we think.

Why should we take the food addiction concept seriously?

It’s likely that the legitimacy of the food addiction concept will continue to be debated for some time.

At the scientific level however, there is a consensus [ref 5] that:

• Addictive-like eating exists
• Bio-behavioural mechanisms implicated in substance-related and addictive disorders contribute to overeating and obesity
• Food industry practices are a key contributor to the phenomenon.

Regardless of whether food addiction is real or not, the debate is important. It draws our attention to the modern food environment and the challenges this environment presents to our health.

Because, as Professor of Health Policy, Laura Schmidt [ref 6] states:

“Our food supply is making some of us very sick”.

When we consider the New Zealand food environment, it’s not surprising that:

• Our consumption of fast-food and junk-food is alarmingly high
• Only a minority of kiwis consume the recommended daily serves of fruit and vegetables.

It also makes the ‘just go on a diet and exercise more’ approach appear naively deficient.

The food addiction concept is valuable because it opens the door to interventions that:

• Better understand and consequently address the multiple causes of obesity
• Remove the blame for failure away from those who struggle with their weight
• Enable people to be supported as they learn how to navigate the obstacles their food environment presents.

Such interventions form the basis of our Weight Management programme.

The NZIHF study – what did it find?

In 2019, NZIHF graduates were invited to participate in a study focusing on obesity stigma [ref 7].

We investigated how framing obesity differently could challenge the belief that obesity is caused by a lack of willpower. This belief is strong amongst those who think that:

• Obesity is simple and best addressed by just dieting or exercising more
• People with obesity are lazy and need to take responsibility for their weight and stop blaming others.

The study participants were randomly assigned to groups where they read an article about obesity as either a:

• Food addiction,
• Disease, or
• Caloric imbalance.

Based on what you’ve read so far, our findings might not surprise you. Participants in the food addiction group were least likely to attribute obesity to a lack of willpower.

The study was important because it only included graduates who had gone on to work as fitness practitioners. They had practical experience helping people improve their health and fitness, and most likely, lose weight.

The study confirmed to us that the food addiction concept helps:

• Practitioners understand the challenges faced by those struggling with their weight
• To remove the blame often ascribed to people with obesity for the failure to lose weight
• Shape comprehensive interventions that address the multiple causes of obesity.

A final word on food addiction

I read this ‘news’ article recently: NZ customers fuming over McDonald’s McFlurry menu change.

The article concerned McDonald’s removing hot fudge sauce from their ‘McFlurry’ ice-creams.

In response to the ‘outrage’, McDonald’s explained that they had been required to reduce the overall sugar content. With the menu change the sugar content of a McFlurry was reduced to approximately 50 grams (10 teaspoons).

What astounded me was the tone of the article. It was all ‘how dare they make this change and deny us the sugary sensation’. There was no hint of alarm at the extremely high sugar content in the ‘reduced sugar’ McFlurry. The author made no attempt to link fast-food and high sugar intakes to our major health problems.

There was no mention that 50 grams is the maximum recommended daily intake of added sugar.

A serious disconnect exists between our collective understanding of health and the food environment that surrounds us.

The food addiction concept helps us see this environment for what it is – a serious problem that must be addressed. It makes the dangers and manipulative practices of the ultra-processed food industry obvious and hard to ignore.

In itself, this is a major step towards improving our collective health.

References

1. Maté, G. (2018). In the realm of hungry ghosts – close encounters with addiction. https://drgabormate.com/book/in-the-realm-of-hungry-ghosts/
2. Schulte et al. (2021). Advances in the neurobiology of food addiction. Current Behavioral Neuroscience Reports. https://doi.org/10.1007/s40473-021-00234-9
3. Colantuoni et al. (2001). Excessive sugar intake alters binding to dopamine and mu-opioid receptors in the brain. NeuroReport. https://doi.org/10.1097/00001756-200111160-00035
4. Moss, M. (2013). Salt, sugar, fat: how the food giants hooked us. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059590/
5. Gearhardt & Hebebrand, J. (2021). The concept of “food addiction” helps inform the understanding of overeating and obesity: Debate consensus. The American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqaa345
6. Schmidt, L. (2016). Why we can’t stop eating unhealthy food. TEDMED. https://www.youtube.com/watch?v=wTNlHyjip94
7. Speirs et al. (2022). Examining how framing obesity as disease vs. food addiction influences stigma amongst fitness practitioners. Obesity Research and Clinical Practice. https://doi.org/10.1016/j.orcp.2022.08.006