Public perceptions of food addiction: a comparison with alcohol and tobacco

The Relationship between Addictive Eating and Dietary Intake: A Systematic Review

(1) Background: Research suggests that certain foods may have addictive effects; however, no reviews have systematically appraised studies in this area. The aims of this review were to determine the nutrients, foods and dietary patterns associated with addictive eating. (2) Methods: Published studies up to November 2020 were identified through searches of 6 electronic databases. Eligible studies included those in in children and adults that reported dietary intakes of individuals with 'food addiction'. (3) Results: Fifteen studies (n = 12 in adults and n = 3 in children/adolescents with Yale Food Addiction Scale defined 'food addiction') were included. Foods commonly associated with addictive eating were those high in a combination of fat and refined carbohydrates. Generally, intakes of energy, carbohydrates and fats were significantly higher in individuals with addictive eating compared to those without. (4) Conclusions: Due to the heterogeneity in study methodologies and outcomes across included studies, it is difficult to conclude if any specific foods, nutrients or dietary patterns facilitate an addictive process. Further research is needed to elucidate potential associations. However, present addictive eating treatment approaches could incorporate individualised dietary advice targeting foods high in fat and refined carbohydrates.

Characteristics of individuals seeking addictive eating treatment

PURPOSE

There is increasing interest in food addiction and its potential treatment. However, little is known about the characteristics of people seeking addictive eating treatment, which is important to develop appropriate treatment and referral pathways. The aim was to describe the characteristics of individuals seeking addictive eating treatment and examine differences between eligible participants who did and did not engage in treatment.

METHODS

Participants interested in an addictive eating treatment were recruited to an online screening survey. The 55-item survey included demographic questions, body satisfaction; weight-loss attempts; the modified Yale Food Addiction Survey (mYFAS); the Binge Eating Scale and mental health outcomes (DASS-21).

RESULTS

Individuals seeking addictive eating treatment (n = 309) were predominantly female (61%), from the obese BMI category (67%) and had accessed a range of services for weight loss (97%). Using multiple logistic regression, participants with higher mYFAS scores were more likely to engage in treatment (AOR 1.68; 95% CI 1.12-2.52), while participants with higher DASS total scores were less likely to engage in treatment (AOR 0.97; 95% CI 0.95-0.99).

CONCLUSION

This study indicates considerable interest from consumers in seeking addictive eating treatment. Individuals who did not engage in treatment displayed higher mental health comorbidity, suggesting that higher mental health symptomatology may be a barrier to treatment. Future qualitative research is needed to provide an in-depth understanding of the reasons for seeking and engaging in addictive eating treatment, as well as to identify the optimal treatments and referral pathways.

LEVEL OF EVIDENCE

Level IV.

A randomized study of effects of obesity framing on weight stigma

OBJECTIVE

Growing evidence suggests highly processed foods may trigger an addictive-like process, which is associated with obesity. Other research suggests an addictive-like process occurs in response to eating itself, rather than specific foods. Addiction-based obesity explanations raise concerns about double stigmatization of people with obesity and addiction. This study compared effects of obesity framings on external and internalized weight stigma.

METHODS

The study was preregistered via Open Science Framework. Four hundred and forty-seven adults read an informational passage that described food addiction, eating addiction, or calorie balance explanations for obesity or a control passage about memory. Participants then completed external and internalized weight stigma measures.

RESULTS

Participants in the food addiction condition reported higher internalized weight stigma compared with those in the control condition. Obesity framing did not significantly affect external weight stigma compared with the control.

CONCLUSIONS

These findings suggest that food addiction explanations for obesity may elicit greater internalized weight stigma than non-obesity-related messages. Addiction-based and traditional obesity explanations do not appear to influence external weight stigma. Illuminating the effects of obesity framing on stigma will help researchers communicate discoveries in ways that mitigate stigma.

Food addiction and mental health in adolescents: a systematic review

The intersection between eating behaviours and mental health has garnered substantial attention in recent years. For this Review, we systematically reviewed the available research to find out the prevalence of food addiction as measured by the Yale Food Addiction Scale, and to investigate its association with mental health-related outcomes in adolescents. Eight databases were searched using keywords from Jan 1, 2009, to Aug 5, 2020, to identify studies reporting a Yale Food Addiction Scale diagnosis or symptom score, or both. In total, 27 studies were included. The prevalence of a food addiction diagnosis ranged from 2·6% to 49·9% in non-clinical and clinical populations, and prevalence was higher in women and adolescents with a higher weight status. Food addiction was associated with disordered eating, depressive and anxiety symptoms, and a poorer quality of life and self-esteem. These associations have important implications for the assessment and management of eating behaviours and mental health in adolescents. Transdiagnostic prevention and management intervention strategies could be explored.

Stigmatization of people with alcohol use disorders: An updated systematic review of population studies

BACKGROUND

We summarize research on the public stigmatization of persons with alcohol use disorder (AUD) in comparison with other mental health conditions and embed the results into a conceptual framework of the stigma process.

METHODS

We conducted a systematic search using Embase, MEDLINE, PubMed and PsycINFO (via Ovid), and Web of Science for population-based studies on the public stigma in AUD and at least 1 other mental health condition, published between October 1, 2010 and December 20, 2020, thus including all studies published since the last systematic review on this topic. The study is registered with PROSPERO (registration number: CRD42020173054).

RESULTS

We identified 20,561 records, of which 24 met the inclusion criteria, reporting results from 16 unique studies conducted in 9 different countries. Compared to substance-unrelated mental disorders, persons with AUD were generally less likely to be considered mentally ill, while they were perceived as being more dangerous and responsible for their condition. Further, the public desire for social distance was consistently higher for people with AUD. We found no consistent differences in the public stigma toward persons with AUD in comparison with other substance use disorders.

CONCLUSION

The stigmatization of persons with AUD remains comparatively high and is distinct from that of other substance-unrelated disorders.

The effect of a food addiction explanatory model of eating behaviours on weight-based stigma: An experimental investigation

Weight stigmatization and discrimination are pervasive issues that have numerous adverse consequences for those with excess weight. It has been proposed that some individuals may be addicted to hyperpalatable processed foods, resulting in weight promoting eating behaviours. The current study replicated and extended a study examining the effect of a food addiction explanation for eating behaviours on weight-based stigma and weight-controllability beliefs. Undergraduate students (N = 757) were randomly assigned to one of four conditions where they read a newspaper article accompanied by a photo of a woman 1) who was either of a higher body mass index (BMI) or a lower BMI, and 2) that attributed her eating behaviours to either food addiction or poor dietary and lifestyle choices. Stigma towards the woman and individuals with a higher BMI in general were assessed. Results indicated that the woman with a higher BMI elicited greater weight stigma. Attributing weight to food addiction increased perceptions of psychopathology towards the woman, whereas attributing weight to poor dietary and lifestyle choices elicited judgment towards the woman. Neither explanation about eating behaviours elicited stigma towards individuals with a higher BMI in general. Findings suggest that a food addiction explanation alone may not be sufficient to reduce weight stigma.

No control and overwhelming cravings: Australian adults' perspectives on the experience of food addiction

Research in the area of food addiction is continuing to increase with recent reviews suggesting that food addiction is a distinctive condition that has many symptoms similar to substance use disorders. The current study explored the perspectives and experiences of Australian adults seeking treatment for addictive eating. Quantitative data for this study was collected via self-report questionnaires completed online, including demographics, the Yale Food Addiction Scale 2.0, and the Depression, Anxiety, and Stress Scale-21. Qualitative data was collected via semi-structured interviews using open-ended questions about the individual experience of food addiction and perspectives regarding intervention and recovery. Interview data was available for 34 participants, with the majority (n = 33) being females who were overweight, (mean ± SD age = 42.9 ± 13.2 years, BMI=36.5 ± 6.8 kg/m²). Stress (19.9 ± 11.4 out of 21) and depression (16.8 ± 10.2 out of 21) were the most prominent negative emotional states. Thematic analysis identified two themes of compulsion and control. Compulsion distinguished the participants' experiences related to addictive eating behaviours, in particular the notion of craving. Control encompassed their perception of both the processes and outcomes of overcoming their addictive eating. The two themes identified were not mutually exclusive, and relationships between them and their influence on each other were observable. This study provides a unique contribution to understanding adults' experience of food addiction by highlighting the strong desire to be in control of eating behaviours, and the inability of participants to overcome their compulsions to eat specific food despite minimal anticipation of positive effect.

The feasibility of a personality targeted intervention for addictive overeating: FoodFix

Recent reviews have identified potential treatment targets for addictive overeating. These include: motivational interviewing, development of specific coping strategies for emotional regulation and the use of harm minimisation strategies based on interventions for substance use disorders. However, there is very little experiential evidence. The aim of this study was to determine the feasibility of a personality-targeted motivational interviewing intervention in adults above the healthy-weight range with symptoms of addictive eating, to reduce symptoms of addictive overeating and improve dietary profiles. Individuals with overweight and obesity (BMI >25 kg/m²) with addictive eating as defined by the modified Yale Food Addiction Scale (mYFAS) were recruited to a three-session intervention held over 3 months. Sessions were conducted by telehealth and facilitated by dietitians. Fifty-two individuals were randomised to either intervention or control (mean age 43.6 ± 12.2yrs, mean BMI 36.7 ± 6.8 kg/m², 96% female). At three month follow up, there were significant reductions from baseline (BL) for both groups in total YFAS 2.0 symptoms, however, these changes were not significantly different between groups (intervention BL 8.0 ± 2.7; 3-months 6.5 ± 3.8, control BL 8.1 ± 2.5; 3-months 6.9 ± 3.9, p > 0.05). At 3 months the intervention group significantly reduced their energy from non-core foods compared with control (intervention BL 48% energy/day; 3-months 38%, control BL 41% energy/day; 3-months 38%, p < 0.01). The FoodFix intervention provides insight to the development of future management interventions for addictive eating.

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

Health Professionals' and Health Professional Trainees' Views on Addictive Eating Behaviours: A Cross-Sectional Survey

Despite increasing research on the concept of addictive eating, there is currently no published evidence on the views of health professionals who potentially consult with patients presenting with addictive eating behaviours, or of students training to become health professionals. This study aimed to explore the views and understanding of addictive eating behaviours among health professionals and health professionals in training and to identify potential gaps in professional development training. An international online cross-sectional survey was conducted in February–April 2020. The survey (70 questions, 6 key areas) assessed participants’ opinions and clinical experience of addictive eating; opinions on control, responsibility, and stigma relating to addictive eating; and knowledge of addictive eating and opinions on professional development training. In total, 142 health professionals and 33 health professionals in training completed the survey (mean age 38.1 ± 12.5 years, 65% from Australia/16% from the U.K.) Of the health professionals, 47% were dietitians and 16% were psychologists. Most participants (n = 126, 72%) reported that they have been asked by individuals about addictive eating. Half of the participants reported that they consider the term food addiction to be stigmatising for individuals (n = 88). Sixty percent (n = 105) reported that they were interested/very interested in receiving addictive eating training, with the top two preferred formats being online and self-paced, and face-to-face. These results demonstrate that addictive eating is supported by health professionals as they consult with patients presenting with this behaviour, which supports the views of the general community and demonstrates a need for health professional training.

The Effect of a Food Addiction Explanation Model for Weight Control and Obesity on Weight Stigma

There is increasing scientific and public support for the notion that some foods may be addictive, and that poor weight control and obesity may, for some people, stem from having a food addiction. However, it remains unclear how a food addiction model (FAM) explanation for obesity and weight control will affect weight stigma. In two experiments (N = 530 and N = 690), we tested the effect of a food addiction explanation for obesity and weight control on weight stigma. In Experiment 1, participants who received a FAM explanation for weight control and obesity reported lower weight stigma scores (e.g., less dislike of ‘fat people’, and lower personal willpower blame) than those receiving an explanation emphasizing diet and exercise (F_(4,525) = 7.675, p = 0.006; and F_(4,525) = 5.393, p = 0.021, respectively). In Experiment 2, there was a significant group difference for the dislike of ‘fat people’ stigma measure (F_(5,684) = 5.157, p = 0.006), but not for personal willpower weight stigma (F_(5,684) = 0.217, p = 0.81). Participants receiving the diet and exercise explanation had greater dislike of ‘fat people’ than those in the FAM explanation and control group (p values < 0.05), with no difference between the FAM and control groups (p > 0.05). The FAM explanation for weight control and obesity did not increase weight stigma and resulted in lower stigma than the diet and exercise explanation that attributes obesity to personal control. The results highlight the importance of health messaging about the causes of obesity and the need for communications that do not exacerbate weight stigma.

Obesity Stigma: Is the 'Food Addiction' Label Feeding the Problem?

Obesity is often attributed to an addiction to high-calorie foods. However, the effect of "food addiction" explanations on weight-related stigma remains unclear. In two online studies, participants (n = 439, n = 523, respectively, recruited from separate samples) read a vignette about a target female who was described as 'very overweight'. Participants were randomly allocated to one of three conditions which differed in the information provided in the vignette: (1) in the "medical condition", the target had been diagnosed with food addiction by her doctor; (2) in the "self-diagnosed condition", the target believed herself to be a food addict; (3) in the control condition, there was no reference to food addiction. Participants then completed questionnaires measuring target-specific stigma (i.e., stigma towards the female described in the vignette), general stigma towards obesity (both studies), addiction-like eating behavior and causal beliefs about addiction (Study 2 only). In Study 1, participants in the medical and self-diagnosed food addiction conditions demonstrated greater target-specific stigma relative to the control condition. In Study 2, participants in the medical condition had greater target-specific stigma than the control condition but only those with low levels of addiction-like eating behavior. There was no effect of condition on general weight-based stigma in either study. These findings suggest that the food addiction label may increase stigmatizing attitudes towards a person with obesity, particularly within individuals with low levels of addiction-like eating behavior.

Ethical, Stigma, and Policy Implications of Food Addiction: A Scoping Review

The concept of food addiction has generated much controversy. In comparison to research examining the construct of food addiction and its validity, relatively little research has examined the broader implications of food addiction. The purpose of the current scoping review was to examine the potential ethical, stigma, and health policy implications of food addiction. Major themes were identified in the literature, and extensive overlap was identified between several of the themes. Ethics sub-themes related primarily to individual responsibility and included: (i) personal control, will power, and choice; and (ii) blame and weight bias. Stigma sub-themes included: (i) the impact on self-stigma and stigma from others, (ii) the differential impact of substance use disorder versus behavioral addiction on stigma, and (iii) the additive stigma of addiction plus obesity and/or eating disorder. Policy implications were broadly derived from comparisons to the tobacco industry and focused on addictive foods as opposed to food addiction. This scoping review underscored the need for increased awareness of food addiction and the role of the food industry, empirical research to identify specific hyperpalatable food substances, and policy interventions that are not simply extrapolated from tobacco.

Food Addiction Support: Website Content Analysis

Background

Food addiction has a long history; however, there has been a substantial increase in published literature and public media focus in the past decade. Food addiction has previously demonstrated an overlap with overweight and obesity, a risk for cardiovascular disease. This increased focus has led to the establishment of numerous support options for addictive eating behaviors, yet evidence-based support options are lacking.

Objective

This study aimed to evaluate the availability and content of support options, accessible online, for food addiction.

Methods

A standardized Web search was conducted using 4 search engines to identify current support availability for food addiction. Through use of a comprehensive data extraction sheet, 2 reviewers independently extracted data related to the program or intervention characteristics, and support fidelity including fundamentals, support modality, social support offered, program or intervention origins, member numbers, and program or intervention evaluation.

Results

Of the 800 records retrieved, 13 (1.6%, 13/800) websites met the inclusion criteria. All 13 websites reported originating in the United States, and 1 website reported member numbers. The use of credentialed health professionals was reported by only 3 websites, and 5 websites charged a fee-for-service. The use of the 12 steps or traditions was evident in 11 websites, and 9 websites described the use of food plans. In total, 6 websites stated obligatory peer support, and 11 websites featured spirituality as a main theme of delivery. Moreover, 12 websites described phone meetings as the main program delivery modality, with 7 websites stating face-to-face delivery and 4 opting for online meetings. Newsletters (n=5), closed social media groups (n=5), and retreat programs (n=5) were the most popular forms of social support.

Conclusions

This is the first review to analyze online support options for food addiction. Very few online support options include health professionals, and a strengthening argument is forming for an increase in support options for food addiction. This review forms part of this argument by showing a lack of evidence-based options. By reviewing current support availability, it can provide a guide toward the future development of evidence-based support for food addiction.

Food Addiction Beliefs Amongst the Lay Public: What Are the Consequences for Eating Behaviour?

PURPOSE OF REVIEW

The current paper reviews recent research on perceptions of food addiction in the lay public. It also examines the potential consequences of such beliefs for eating behaviour.

RECENT FINDINGS

Surveys suggest that, within community samples, the majority of individuals believe that certain foods are addictive, and that food addiction causes obesity. Further, many people believe themselves to be 'food addicts', and these individuals demonstrate increased patterns of aberrant eating. However, there is also initial experimental evidence to suggest that believing oneself to be a food addict leads to short-term food restriction.

SUMMARY

To reconcile these findings, a self-perpetuating relationship between food addiction beliefs and aberrant eating is proposed. Specifically, in the short term, food addiction beliefs may encourage individuals to avoid certain foods. However, attempts at restriction may eventually lead to increased cravings and disinhibition, thus reinforcing perceptions of oneself as a food addict. These possibilities merit scrutiny in future research.

Is it time to consider the "food use disorder?"

In the contemporary milieu, the term "addiction" brings to mind issues of physical dependence, uncontrolled behavior, psychoactive substances, and disease. Thus, the use of the term "food addiction" which has become common in research on binge eating and obesity, suggests a disease state characterized by craving, compulsive eating and, possibly, the presence of food constituents with drug-like properties which weaken the will power to abstain from consumption. In this commentary, the case is made that, following the trends in substance use disorder terminology, adoption of "food use disorder" as a term for compulsive eating associated with subjective loss of control may foster continued research in this area without the connotations suggested by "food addiction."

Believing in food addiction: Helpful or counterproductive for eating behavior?

OBJECTIVE

Obesity is often attributed to an addiction to food, and many people believe themselves to be "food addicts." However, little is known about how such beliefs may affect dietary control and weight management. The current research examined the impact of experimentally manipulating participants' personal food addiction beliefs on eating behavior.

METHODS

In two studies, female participants (study 1: N = 64; study 2: N = 90) completed food-related computerized tasks and were given bogus feedback on their performance which indicated that they had high, low, or average food addiction tendencies. Food intake was then assessed in an ad libitum taste test. Dietary concern and time taken to complete the taste test were recorded in study 2.

RESULTS

In study 1, participants in the high-addiction condition consumed fewer calories than those in the low-addiction condition, F(1,60)  = 7.61, P = 0.008, ηp (2)  = 0.11. Study 2 replicated and extended this finding, showing that the effect of the high-addiction condition on food intake was mediated by increased dietary concern, which reduced the amount of time participants willingly spent exposed to the foods during the taste test, b = -0.06 (0.03), 95% confidence interval = -0.13 to -0.01.

CONCLUSIONS

Believing oneself to be a food addict is associated with short-term dietary restriction. The longer-term effects on weight management now warrant attention.

A psycho-genetic study of hedonic responsiveness in relation to "food addiction"

While food addiction has no formally-recognized definition, it is typically operationalized according to the diagnostic principles established by the Yale Food Addiction Scale-an inventory based on the symptom criteria for substance dependence in the DSM-IV. Currently, there is little biologically-based research investigating the risk factors for food addiction. What does exist has focused almost exclusively on dopaminergic reward pathways in the brain. While brain opioid signaling has also been strongly implicated in the control of food intake, there is no research examining this neural circuitry in the association with food addiction. The purpose of the study was therefore to test a model predicting that a stronger activation potential of opioid circuitry-as indicated by the functional A118G marker of the mu-opioid receptor gene-would serve as an indirect risk factor for food addiction via a heightened hedonic responsiveness to palatable food. Results confirmed these relationships. In addition, our findings that the food-addiction group had significantly higher levels of hedonic responsiveness to food suggests that this bio-behavioral trait may foster a proneness to overeating, to episodes of binge eating, and ultimately to a compulsive and addictive pattern of food intake.