A growing body of research suggests that food can be as addictive as drugs like cocaine and nicotine. In addition to being unhealthy, processed, sugary, wheat-based, fatty and salty, foods affect the reward circuitry in the brain, resulting in compulsive eating despite the well-known risks of heart disease, diabetes, high blood pressure, high cholesterol, cancer and other negative consequences.
Late Princeton psychologist Dr. Bartley Hoebel hypothesized that both drugs and sugar are governed by three characteristic phases of addiction: binge, withdrawal, and preoccupation. Like drugs, studies show that people can develop a tolerance to sugar, needing more and more to feel pleasure, and experience withdrawal-like symptoms when cut off from sugar. Interestingly, drugs we use to block opiate receptors in the brain, such as naltrexone and topiramate, also reduce cravings for fatty and sugary foods.
Other studies have revealed some interesting findings about food addiction:
• A Yale study found that the brain activity of women with three or more symptoms of food addiction who viewed images of and then drank a chocolate milkshake was similar to drug addicts. Just as drug addicts’ brains light up when viewing drugs or drug paraphernalia, food addicts’ brains light up in the areas governing pleasure and reward when looking at high-fat foods and show reduced activity in regions involved with self-control when actually consuming those foods.
• In animal studies, rats given fatty and sugary products demonstrated binge eating, withdrawal symptoms such as anxiety and tremors, and cravings. Brain scans showed the same pattern that occurs with escalating use of cocaine.
• A 2007 French study showed that rats actually prefer sugar water to cocaine.
• A Brookhaven study showed that obese people had lowered levels of dopamine receptors than a lean control group.
• Dr. Gene Bowman of Oregon Health & Science University published a small study last December suggesting that people with high levels of trans fats in their blood had significantly worse cognitive performance and less total brain volume. In essence, trans fats, which are typically found in fast food and processed foods with vegetable shortening or partially hydrogenated ingredients, can make the brain smaller and slower.
Implications for Treatment
If food is addictive, what does that mean for the treatment of eating disorders, obesity and other addictions? In substance abuse treatment, we recognize the risk of cross-addiction and the importance of a developing a healthy lifestyle during drug rehab. It is not uncommon for drug addicts to get sober and promptly gain 20-plus pounds. Thus, we approach food addiction as we would any other co-occurring disorder or cross-addiction – with simultaneous, multidisciplinary treatment and education about nutrition, exercise and emotional eating.
Unlike drug addicts, people struggling with food addiction cannot follow an abstinence-based model. They must learn to eat moderately and in ways that are nourishing to the body. As with other addictions, the best approach is often a combination of:
• Therapy that addresses the underlying emotional issues driving the addiction and promotes long-term behavioral change rather than dieting or a quick fix
• 12-Step fellowship, such as Overeaters Anonymous and Food Addicts Anonymous meetings
• Nutrition education, dietary counseling and fitness planning
• Mindfulness (often through meditation, journaling or yoga)
• Stress management and coping skill development
Of course, the most effective approach lies in prevention, ensuring that people of every socioeconomic status have access to unprocessed, natural foods, schools offer wholesome snacks and lunches, and processed foods become the exception rather than the norm in the American diet. This requires a functional shift in the way our society views food, markets products to the public and subsidizes the production of different foods.
To make definitive judgments, we need more research. If studies continue to suggest that food is truly an addictive substance, we may see medications and behavioral therapies playing a more significant role in treatment. Whether we call it an addiction, compulsion or something else, one fact is clear: Blaming those who struggle with compulsive overeating, binge eating and obesity for a lack of willpower or poor judgment denies scientific research and will only exacerbate a problem that has already reached epidemic proportions.
David Sack, M.D., is board certified in Addiction Medicine and Addiction Psychiatry. He serves as CEO of Elements Behavioral Health, a network of addiction treatment programs that include treatment for binge eating disorder, drug addiction, alcoholism, and sex addiction.
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Last reviewed: 28 Feb 2012