Food addiction behaviour - how can we help?
Rebecca McKenna is a PhD candidate in the School of Health Sciences and Priority Research Centre for Physical Activity and Nutrition at the University of Newcastle. Her PhD study is in personality traits for people with addictive eating behaviours: A personality-based intervention for the treatment of the symptoms of food addiction. Rebecca has a strong interest in mental health, and the psychology of food and eating. Rebecca has a bachelor’s degree in Nutrition & Dietetics from the University of Newcastle, and a Graduate Diploma in Counselling for Health & Social Care from the University of New England.
There is a lot of debate about food addiction (FA) and whether it actually exists. What is your understanding of FA and how common is it?
Food addiction is certainly a controversial topic. FA is defined as a compulsive consumption of foods, for example processed foods that may be high in sugars, fats and salt. A recent review of all the evidence for FA in humans and animal studies suggests it is a generally valid diagnostic concept, and current research indicates the prevalence of FA is around 20%. Despite this, FA is not yet a condition with official diagnostic criteria. It is an area of research that has been growing at a fast rate over the past 10 years and I believe it will continue to grow.
How does FA differ from drug or alcohol addiction?
To date we cannot fully answer this question. Both drug and alcohol addiction are referred to as ‘substance’ addictions because they are substances that induce an addictive response in the brain. Drug and alcohol addiction have criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that incorporates clinical impairment to classify substance-use disorder as mild, moderate or severe. The validated Yale Food Addiction Scale (YFAS) to measure FA has been modelled off the DSM-5 criteria for substance-use disorder. There are similar links between personality traits, such as depression and anxiety, in both substance-use disorder and FA, and there is some evidence that similar pathways are involved but research is lacking. Some animal studies show similar responses in the brain to ‘substances’ and sugar, however this research has only just started to be translated to humans. Aspects of drug and alcohol addiction such as pre-occupation, social impairment and risky use have not been as closely researched in FA. These are key areas that would help distinguish addictive consumption of food compared to drugs and alcohol.
Is it chemical or behavioural?
A lot of the research in food addiction is focused around answering this question, and current evidence suggests it is most likely a combination of both. There has been no chemical response found in humans that explains the addictive properties of food. Foods comprise of multiple substances and are consumed for many reasons, both social and physiological. This has led many researchers to look at FA from a behavioural perspective, like gambling addiction. However, it is not clear cut as the way we eat is influenced by both chemical and behavioural factors.
Apart from the scientific debate, what do we know about beliefs around FA in the general community?
There is a strong belief amongst the general community that FA exists and is a large contributing factor to overweight and obesity. People who are experiencing FA are looking for answers. The research into FA is aiming to provide these answers, utilise appropriate diagnostic criteria, and move towards support and treatment for FA.
Are there any foods that seem to create FA behaviours?
There has been minimal research into foods that may specifically lead to FA. It appears any food or drink can become addictive and preferences for foods are highly individual. The foods that are most likely to be related to food addiction are discretionary foods, which are foods high in sugar, fat and sodium. There is some evidence showing those with higher dietary fat intakes have increased risk of being assessed as food addicted according to the YFAS.
The term ‘sugar addiction’ has been used in lay media. Have you found any evidence for this in the literature?
There is very strong evidence in animal studies that sugar can be considered as an addictive substance. However, there is no evidence of ‘sugar addiction’ in humans, although research is ongoing. In humans the most addictive-like, symptom inducing foods are those containing both sugars AND fats, such as doughnuts, croissants and ice cream. The combination of sugar and fats in foods like these create a ‘perfect storm’ of deliciousness that can pose a problem for some people.
If a person identifies as having a FA, what help is available to them and is it evidence-based?
Most support available for FA is from support groups or individual services provided online from the USA. Our recently published review of available support options demonstrates very few of these services involve credentialed dietitians and psychologists. There have been small treatment interventions conducted in the past, however these are typically for eating disorder treatment, weight loss, or 12-step programs, and are mostly in females. There is very little published research on treatment of addictive eating in males. Due to the lack of support options for FA we are currently trialling an evidence-based intervention targeting personality traits for FA.
Tell us about the research are you undertaking for your PhD at the University of Newcastle?
My research is focused on developing a novel intervention for those with addictive eating. The intervention represents a collaboration of a multidisciplinary team of researchers and health professionals led by Associate Professor Tracy Burrows and is based on previous successful interventions for substance-use. I have been looking at all the available evidence, current treatment and support services available for FA, and working towards developing an evidence-based approach that incorporates appropriate nutrition information delivery and counselling techniques. The intervention will be focused around goal setting and personality traits that have been linked in other addictions, and then providing coping skills matched to the individual. The main goal of the treatment intervention is to improve mental health outcomes: to reduce the levels of anxiety and depression related to food addiction.
We are currently recruiting and welcome subjects to participate by completing the eligibility questionnaire here.