For many of us, eating particular foods can be comforting: a pick-me-up during a hard task; a reward after a long day at work; a satiating end to a lovely dinner.
But some people have a compulsive and uncontrolled urge to eat particular foods, especially hyper-palatable “junk” foods. This can impact on their day-to-day functioning, and their ability to fulfil social, work or family roles.
People who struggle with addictive eating may have intense cravings, which don’t relate to hunger, as well as increased levels of tolerance for large quantities of food, and feelings of withdrawal.
Rather than hunger, these cravings may be prompted by low mood, mental illness (depression and anxiety), high levels of stress, or heightened emotions.
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“Food addiction” or “addictive eating” is not yet a disorder that can be diagnosed in a clinical setting. Yet patients often ask health professionals about how to manage their addictive eating.
These health providers generally acknowledge their patients’ addictive eating behaviours but may be unsure of suitable treatments.
Food addiction is commonly assessed using the Yale Food Addiction Scale.
The science of addictive eating is still emerging, but researchers are increasingly noting addiction and reward pathways in the brain triggered by stress, heightened emotions and mental illness are associated with the urge to overeat.
How common is it? Many factors contribute to overeating. The abundance of fast food, junk food advertising, and the highly palatable ingredients of many processed foods can prompt us to eat whether we are hungry or not.
However, some people report a lack of control over their eating, beyond liking and wanting, and are seeking help for this.
Around one in six people (15-20%) report addictive patterns of eating or addictive behaviours around food.
While food addiction is higher among people with obesity and mental health conditions, it only affects a subset of these groups.
How can you tell if you have a problem? Typically, food addiction occurs with foods that are highly palatable, processed, and high in combinations of energy, fat, salt and/or sugar while being low in nutritional value. This might include chocolates, confectionery, takeaway foods, and baked products.
These foods may be associated with high levels of reward and may therefore preoccupy your thoughts. They might elevate your mood or provide a distraction from anxious or traumatic thoughts, and over time, you may need to eat more to get the same feelings of reward.
However, for others, it could be an addiction to feelings of fullness or a sense of reward or satisfaction.
There is ongoing debate about whether it is components of food that are addictive or the behaviour of eating itself that is addictive, or a combination of the two.
Given people consume foods for a wide range of reasons, and people can form habits around particular foods, it could be different for different people.
Through our research exploring the experiences of adults, we found many people with addictive eating attribute their behaviours to experiences that occurred in childhood.
These events are highly varied. They range from traumatic events, to the use of dieting or restrictive eating practices, or are related to poor body image or body dissatisfaction.
Our latest research found addictive eating in teenage years is associated with poorer quality of life and lower self-esteem, and it appears to increase in severity over time.
Children and adolescents tend to have fewer addictive eating behaviours, or symptoms, than adults. Of the 11 symptoms of the Yale Food Addiction Scale, children and adolescents generally have only two or three, while adults often have six or more, which is classified as severe food addiction.
The associations we observed in adolescents are also seen in adults: increased weight and poorer mental health is associated with a greater number of symptoms and prevalence of food addiction.
This highlights that some adolescents will need mental health, eating disorder and obesity services, in a combined treatment approach.
We also need to identify early risk factors to enable targeted, preventative interventions in younger age groups.
How is it treated? The underlying causes of addictive eating are diverse so treatments can’t be one-size-fits-all.
A large range of treatments are being trialled. These include: passive approaches such as self-help support groups trials of medications such as naltrexone and bupropion, which targets hormones involved in hunger and appetite and works to reduce energy intake bariatric surgery to assist with weight loss. The most common procedure in Australia is gastric banding, where an adjustable band is placed around the top part of the stomach to apply pressure and reduce appetite.
However, few of the available self-help support groups include involvement or input from qualified health professionals. While providing peer support, these may not be based on the best available evidence, with few evaluated for effectiveness.
Medications and bariatric surgery do involve health professional input and have been shown to be effective in achieving weight loss and reducing symptoms of food addiction in some people.
However, these may not be suitable for some people, such as those in the healthy weight range or with complex underlying health conditions. It’s also critical people receiving medications and surgery are counselled to make diet and other lifestyle changes.
Other holistic, personalised lifestyle approaches that include diet, physical activity, as well as mindfulness, show promising results, especially when co-designed with consumers and health professionals.
Our emerging treatment programme We’re also creating new holistic approaches to manage addictive eating. We recently trialled an online intervention tailored to individuals’ personalities.
Delivered by dietitians and based on behaviour change research, participants in the trial received personalised feedback about their symptoms of addictive eating, diet, physical activity and sleep, and formulated goals, distraction lists, and plans for mindfulness, contributing to an overall action plan.
After three months, participants reported the program as acceptable and feasible. The next step in our research is to trial the treatment for effectiveness. We’re conducting a research trial to determine the effectiveness of the treatment on decreasing symptoms of food addiction and improving mental health.
This is the first study of its kind and if found to be effective will be translated to clinical practice.
(By Tracy Burrows, Megan Whatnall, University of Newcastle Callaghan Australia)