Why a food addiction many Americans say they struggle with is one experts can’t agree on

By Kristen Rogers, CNN

(CNN) — About 1 in 8 Americans over 50 struggle with an unhealthy relationship with highly processed food that goes well beyond the occasional binge or midnight snack, according to a recent poll.

Known as food addiction, the condition isn’t limited to older adults — previous food addiction data had primarily centered around young- to middle-age adults up to around 50, said Ashley Gearhardt, lead author of the latest research by Michigan Medicine and a pioneer in the field of food addiction studies.

Results have been similar for younger age groups included in previous studies, with about 14% of adults and 12% of children fitting criteria for food addiction, Gearhardt said.

The symptoms resemble typical signs of addiction: intense cravings, inability to cut down on highly processed foods — also known as junk food or comfort food — despite negative consequences, signs of withdrawal, and loss of control over intake, said Kristin Kirkpatrick, a registered dietitian for the Cleveland Clinic, who wasn’t involved in the research.

People might also do inconvenient or harmful things to satiate their urges. “I care about this work so much because I talk to people and they say, ‘I know I’m killing myself. I know that I have unmanaged type 2 diabetes, (but) the pull of this food, this donut is so strong I will drive 40 minutes out of my way even though we have food at home. And I will go eat a dozen of those, even though I could go into diabetic shock,’” said Gearhardt, who is also an associate professor of psychology at the University of Michigan.

Despite its apparent prevalence, food addiction hasn’t been officially recognized as a real addiction, disorder or diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the handbook used by health care professionals as the authoritative guide to diagnosing mental disorders.

The body of research on food addiction has only recently gotten to the point where it can support a proposal for inclusion in the DSM, Gearhardt said, but she’s currently working on one she expects to submit within the year.

“If you simply just look at the studies, they’re still at the place where they’re saying, ‘We need more research,’ but if we use these criteria that are similar to what we have for (addictions to) tobacco and alcohol, they’re seeing a lot of similar correlations,” Kirkpatrick said.

Because food addiction isn’t in the DSM, health providers can’t diagnose someone with it, Gearhardt said. But as research in this area continues, some medical professionals and nutritionists have come to acknowledge the condition — and the need to address it.

“It’s not a standard part of our diagnostics training that we do,” Gearhardt added, but “people who are reporting this addiction to highly processed foods are suffering.”

Most people seeking treatment for food addiction are probably diagnosed with binge eating disorder “because that’s the closest thing that we have to it, that we can offer a diagnostic code for so that they can receive treatment,” Avena said. But the type of treatment that would be offered for food addiction would be very different, because not everyone who reports having food addiction is binging, and the underlying neurology of food addiction and binge eating disorder aren’t the same.

Food hijacking the brain

The criteria defining food addiction revolve specifically around highly processed food, instead of all food, because of how the brain responds to its consumption, experts said.

It’s not so much the sugar or carbohydrates themselves that are addictive, but rather “how they are being delivered in ultraprocessed foods that also have additional compounds, chemicals — ingredients that are not natural,” Kirkpatrick said.

“The actual chemical pathway of what’s happening is really this opening up of the reward systems,” she added. “You eat the food, you get an increase in dopamine, in serotonin — you get all these increases that make you feel good. But then once those go down, you start feeling bad, and you need more of it.”

This change in the way the brain functions “resembles addictions to things like morphine or nicotine or even alcohol,” said Nicole Avena, a New York state-based neuroscientist with expertise in nutrition, diet and addiction.

Ultraprocessed foods make up 70% of packaged foods in the US, and account for about 60% of calories consumed by Americans, Kirkpatrick said.

“Some people would argue that these shouldn’t be called foods, that they’re really processed and refined substances that are man-made, that we’ve created, that deliver unnaturally high levels — at rapid rates — of rewarding ingredients like sugar, like fat, that our brain doesn’t really seem to know exactly how to manage that level of food reward because it really surpasses what exists in nature,” Gearhardt said.

Living with food addiction

Not everyone who eats highly processed food develops an addictive relationship to it. For those who do, experts think there could be several reasons why.

A person’s brain chemistry can play a role, as well as family history of problematic or addictive relationships with substances, experts said. People who are stressed out, depressed, anxious or dealing with trauma might consume these kinds of foods to deal with negative emotions, Kirkpatrick said.

Those who are food insecure are more likely to choose highly processed foods, Kirkpatrick said, especially if that’s all they have access to — making them more at risk of food addiction.

Some people with food addiction graze on highly processed foods over the course of a day, Gearhardt said, while others binge then feel gross or sluggish and say they’ll never do it again. Over time, eating too much highly processed food can catch up to people in terms of consequences for their overall health — such as obesity, cancer, early death, cardiovascular disease, dementia and diabetes, according to previous research.

When people try to cut down on these foods, they can experience withdrawal symptoms such as irritability, agitation or low energy, Gearhardt said. “And people report, over time, eating more and more of these foods to get the same level of enjoyment that they used to in the past.”

Food addiction, and unsuccessful attempts to change, can cause an “incredible sense” of guilt, shame, hopelessness and frustration, Gearhardt said.

Loneliness and social isolation can be both contributing factors to — or consequences of — food addiction. In the Michigan Medicine research, addiction to highly processed foods was seen in 51% of female participants and 26% of men who said they often felt isolated from others, compared with 8% of women and 4% of men who rarely felt isolated.

Food addiction can hit your wallet, too. And temptation is everywhere — in the office when someone brings donuts to work, at the gas station, at parties, in store checkout lines.

“Often, by the end of the day, the stress, the constant tug of needing to use your willpower to try and resist can trigger another binge, continuing the cycle,” Gearhardt said.

‘A controversial topic’ among researchers

Scientific opinion on whether food addiction is real is still mixed, Kirkpatrick said. Some researchers wonder where the line should be between overdoing it on highly processed foods every so often and getting out of control with it.

“Right now, it’s still a controversial topic,” Gearhardt said. “Where there’s consensus is that when we look at how people consume these highly processed foods, there’s relative agreement that yeah, we see these signs of addiction.”

“There was a huge debate about whether tobacco was addictive that raged for decades, even though hundreds of thousands of people were dying,” Gearhardt said. “It didn’t look like other addictions — you’re not intoxicated, it was legal, people could, like, drive their car while they smoked a cigarette.”

The debate is now more focused on the role of the food and whether it’s truly addictive, she added.

“We’re kind of in a similar space now, where the highly processed food changes our paradigm again, because it’s like, ‘Well, we all need food to eat,’” she added. “But we don’t need these really unnaturally, intensely rewarding, novel, man-made, highly processed foods.”

Changing your relationship to food

Effectively tackling food addiction more broadly probably requires a combination of individual choices and policy changes, Kirkpatrick said.

“Because we’ve been stuck in this place where we’re just arguing about whether it exists, the development (of) treatment models has sincerely lagged behind,” Gearhardt said. “So, I don’t have science to say, ‘Here is the best treatment for this addiction,’ which is unfortunate.”

Though food addiction, on a surface level, has to do with diet, working with a therapist to figure out how you got there and how to overcome it is critical, experts said. A therapist could also help you learn to cope with stress in healthier ways, such as journaling or going for a walk.

However, the therapist should work together with a dietitian, Kirkpatrick said.

“People that are less likely to become out of control are people who, for the most part, have pretty healthy behaviors,” she said. “They’re following, let’s say, a Mediterranean diet, they’re cooking, they’re eating a lot of plants, and they’re doing that the majority of the day.”

If you’re struggling with food addiction, recovery could be difficult because in the US, the food system “is essentially setting us up for failure,” Avena said. “But it’s possible to get help and … navigate this food environment in a way that they can be happy and healthy.”

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