What does the science say?

Publications from 2009, 2011, 2016, 2018, and 2019, among others, have highlighted that palatable foods — or even foods in general — stimulate the same parts of the brain and share the same neuronal activities as illicit substances.

The hippocampus, caudate, and insula are three brain regions that researchers have pinpointed as being implicated in this relationship.

For instance, foods and illicit substances both result in the release of the hormones, such as dopamine, and endogenous opioids that the body naturally produces.

These hormones are a part of the “reward system” — or the mesolimbic circuit — in the brain, which is responsible for motivation, want, desire, and cravings.

Some studies even suggest that it is the anticipation of food rather than the consumption itself that may trigger food addiction — a “seeking” behavior that people with substance use disorder often display.

In theory, it is possible to explain this behavior by the phenomenon of incentive sensitization, which posits that it is possible for a person to want something even if they do not like it, as long as it stimulates the pleasure centers in their brain.

For example, people may crave a sugary beverage because it makes them feel good due to the release of dopamine rather than because they genuinely enjoy drinking that beverage.

Even though the DSM-5 does not list food addiction as a condition, researchers have referred to both the DSM-4 and DSM-5, as well as the Yale Food Addiction Scale (YFAS), when studying this phenomenon.

In fact, researchers developed the YFAS based on information in the DSM-4 about the symptoms and associated behaviors of substance use disorders. The YFAS contains 25 self-reported questions that may help identify food addiction.

The concept of food addiction has drawn a lot of interest in the scientific community, with some proposing it as a potential underlying contributor to obesity and others seeing it as a symptom
of having excess body weight.

Whichever way this association may lie, a 2017 review cites evidence that behaviors linked with food addiction occur at notably higher levels in people seeking bariatric or weight loss surgeries.

Despite the existing research, food addiction remains a controversial topic in the scientific community due to inconclusive evidence from numerous studies.

Here are some of the related controversies:

1. The brain on food vs. drugs: A crucial distinction

Many studies that argue that food addiction is a real phenomenon focus on the similarities between food cravings and cravings for illicit drugs.

However, the concept of food addiction raises the important question: If foods can become addictive, are they bad for us?

Although both foods and drugs stimulate the reward system and pleasure center in the brain, foods do not exert the same pharmacological effect as drugs.

Also, people consume foods very regularly and in complex combinations. This makes quantification difficult and blurs the line between use and misuse.

2. Which nutrient is the drug?

Not only is it difficult to classify the misuse of foods, but researchers have not yet determined which nutrient or combination of nutrients causes food addiction.

Studies in rats have identified that a diet high in fat and sugar — as many processed foods are — can induce addiction-like behaviors.

Some believe that the presence of sugar in the gut may be the causative nutrient, but this remains unproven.

More rigorous, long-term studies in humans are necessary to pinpoint any problematic nutrients.

3. Obesity, palatable foods, and food addiction

Some studies suggest that food addiction is a plausible cause of obesity, and the food addiction model even emphasizes being overweight or having obesity as one of the clinical criteria.

Some researchers have also associated food addiction with certain eating disorders, particularly binge eating disorder (BED).

However, one review highlighted that a substantial number of individuals with BED do not have obesity and that most people with obesity do not experience disordered eating or food addiction symptoms.

This brings the ability of YFAS to diagnose food addiction into question, and some researchers suggest that this scale simply identifies eating disorders and not an addiction.

Furthermore, palatability is not necessarily a factor in overconsumption and obesity, as one review reported that even a nonpalatable food — meaning one that is not high in fat or sugar — can become the subject of food cravings.

4. Yo-yo dieting as the cause of food addiction?

Many weight loss strategies have low success rates, and popular weight loss diets can be quite restrictive.

Although nutrition deprivation is not necessary to cause food cravings and overconsumption, switching between various diets and regularly restricting food potentially causes food addiction behaviors.

Regardless of whether a person has a food addiction or eating disorder or simply wants to improve their intake of nutritious foods, they may wish to give up unwanted eating behaviors.

Seek help

Anyone who suspects that they have an eating disorder or food addiction can contact the National Eating Disorders Association (NEDA) helpline at 800-931-2237. NEDA is available between 11 a.m. and 9 p.m. ET from Monday to Thursday and between 11 a.m. and 5 p.m. ET on Friday.

People looking for help with their nutritional intake can seek the guidance of a registered dietitian. Alongside the appropriate therapy, nutritional advice can help people manage their health.

Modify the environment

Environmental cues, which include the sight, smell, and even appearance of foods, may trigger food cravings.

Individuals can adjust their environment without creating restrictions by:

• portioning adequate amounts of food for meals, and then storing the remainder away and out of sight
• sitting away from buffet tables and reframing the dining experience to focus on the social aspects of human engagement and conversation rather than the foods available
• placing nutritious foods in visible places to s
  erve as reminders and encouragement for healthy eating — for example, putting fruits in a bowl or plate on the kitchen counter
• increasing the intake of whole foods and nonstarchy vegetables in preference to highly processed foods, when possible

Small changes go a long way

It is important to resist the urge to try fad diets that promise rapid results in a short time, as most people who have dieted to lose weight regain the majority of this weight within 5 years.

Instead, a person should plan to make gradual but sustainable dietary and lifestyle changes, including regular exercise, to support good health and disease management.

Obesity is a complex medical condition with many potential causes, and quick fix diets do not solve those underlying issues.

Some researchers propose food addiction as a potential underlying cause of obesity in the U.S. and liken it to the addictive behaviors that people with substance abuse often display.

However, it continues to be a controversial topic, with studies providing inconclusive results about whether this phenomenon is real.

More rigorous and long-term human studies are needed to examine the nutrients or eating patterns that may be responsible for the development of food addiction.

There is also a need for well-defined clinical criteria to facilitate the appropriate classification of symptoms and diagnosis of food addiction.