An Article on Food Addiction
“I spent decades calling myself a ‘chocoholic’ with a smile on my face yet knowing the truth. I hoped that someone would take me seriously rather than brush it aside as something all women love.” Lynn.
Lynn spent thousands of pounds on her weight loss journey, only to lose and regain the same weight many times: “I became morbidly obese and ashamed of my body. My weight affected my life, and I worried about my health. After being diagnosed with hypertension and a fatty liver in 2022, I was desperate and searching for support when I signed up for a webinar on Food Addiction (FA) with Combe Grove.”
Later we’ll learn how Lynn fared at Combe Grove’s FA retreat, but first …
What is FA?
Coined in 1956, FA is “the continued consumption of highly palatable foods even after energy requirements have been met and despite known negative physical and psychological consequences in response to uncontrolled food ingestion (Gupta et al, 2020). Like other types of substance abuse, FA “represents an addiction-like response to food (especially foods rich in sugar and fat) or the process of eating itself in susceptible individuals” (Gupta et al, 2020).
Combe Grove’s Practice Manager Dr Rebecca Hiscutt PhD, a registered dietitian specialising in metabolic health, says, “Looking back more than twenty years, FA, although unrecognised as such then, was a challenge for many of my clients. However, over this time there’s been a sharp rise in the number of people struggling with their relationship with food and the symptoms of FA which have negatively impacted their lives.”
FA prevalence and risk factors
Evidence cited by Gearhardt et al (2023) includes 281 studies from 36 different countries and shows an overall FA prevalence– according to the Yale Food Addiction Scale (YFAS) – of 14% in adults. However, Gearhardt et al (2023) further note that questionnaire- based surveys and studies using other assessment methods show that FA is present in 25–37% of individuals with obesity, reaching “up to 60% in those who have morbid obesity or in patients who undergo bariatric surgery.”
And Florio et al (2022) report that women are at greater risk for FA and eating disorders than men; women are more likely to report FA symptoms compared to men; and FA is associated with patients with current higher body-mass index (BMI) and higher lifetime BMI.
Unwin et al (2022) state that FA symptoms “are captured using the 11 criteria for substance use disorder … and applying those to foods high in refined carbohydrates/sugar, fat, and salt.” These include:
• Consuming the substance in larger amounts or for longer than intended.
• Efforts to cut down or stop using the substance but not managing to.
• Time spent getting, using, or recovering from the substance.
• Cravings and urges to use the substance.
• Not managing to perform at work, home or school because of substance use.
• Continuing to use the substance despite causing problems in relationships.
• Giving up important social, occupational, or leisure activities because of substance use.
FA and other addictions
Similarities between FA and drug addiction have been found, and include, write Florio et al (2022), an intense urge for food/drug; compulsive use despite adverse consequences; denial of the problem; use of food/drug to relieve negative affect, with subsequent guilty feelings after use; and high recurrence, especially when exposed to triggers. And Gearhardt et al (2023) report that FA based on the YFAS is associated with core addiction mechanisms like “reward-related neural dysfunction, impulsivity, and emotion dysregulation, as well as poorer physical and mental health and lower quality of life.”
FA and food types
Are some foods more addictive than others? Dr Jen Unwin, a clinical psychologist specialising in FA, is clear: “Most patients I see struggle with ultra processed foods (UPFs) like pizza, doughnuts, ice creams and confectionery, but for some it’s bread, cereals and even home-made cakes and biscuits which wouldn’t strictly be classified as UPFs.”
According to Rauber et al (2019) UPFs are “industrial formulations of many ingredients, mostly of exclusive industrial use, that result from a sequence of industrial processes”; there’s a positive association between UPF consumption and excessive dietary added (or free) sugar intake; and excessive free sugar intake “is associated with obesity, type 2 diabetes, dental caries and several other health outcomes.” Yet “UPFs account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet” (Rauber et al, 2019).
Dr Hiscutt’s experience confirms the relationship between UPFs and FA: “Clients have never told me about beef or broccoli being connected to the difficult and complex emotions that arise when they discuss foods containing cleverly manipulated combinations of fat and sugar. It’s not about hunger; it’s not about enjoying UPFs or wanting UPFs; it’s about the instant reward these food-like concoctions induce; and it’s UPFs which make my clients feel out of control, feel shame, feel depressed and impact their relationship with food and themselves.”
Meeting the challenge of FA
Dr Jen Unwin and colleagues undertook the first study “to demonstrate the short-term clinical effectiveness of a low carbohydrate ‘real food’ intervention delivered in an online group format with education and social support for individuals with FA symptoms” (Unwin et al, 2022). And the Combe Grove retreat, explains Dr Unwin “follows the protocol we used in our research which demonstrated such good outcomes, and which we now know are further improved over 12 months’ follow up. Essentially, we explain the symptoms of food, and other addictions to people; what’s happening in the brain: and why abstinence is the key.”
Dr Unwin’s team also do motivational work, inspiring people with hope for the future, and explain a real whole food diet that’s restricted in refined carbohydrates: “All the food at the Combe Grove retreat is congruent with this advice so when participants go home, they’ve experienced a few days of abstinence and its benefits. We then invest time helping people implement and maintain abstinence in their lives.”
Dr Unwin emphasises that “follow-up support is essential, plus the group support participants get from others on the programme.”
Lynn, who attended Combe Grove’s first FA retreat in March 2024, confirms its successful, evidence-based approach to FA. She found that “Eliminating sugar and adopting a low-carb strategy has brought huge improvements in how I feel: improved mood; loss of fatigue; sleeping through the night; better skin; no aching joints; and I’ve lost 11kg in weight without restrictive dieting. The enhanced wellbeing helps me keep going when cravings and old habits seek to take me off- plan. Abstinence is the path, no matter how much you may protest.” Lynn further advocates joining “a support group of people who’ve gone through it because even though the answer is simple, the journey requires more than willpower.”
Dr Hiscutt explains that following the success of the March 2024 FA retreat, “on 15 July 2024 we’ll be welcoming back our special first cohort on the first day of our second FA retreat on July 15th. This will provide an opportunity to immerse themselves in the soothing environment of Combe Grove, to reflect on their journey so far and supplement their learning. They’ll also be able to share their wisdom, elaborate on challenges they’ve faced and pass on tips that have helped them.”
Finally
FA is deep rooted, observes Dr Hiscutt, often going back into childhood with many years of embedded patterns, habits and pain: “This takes time and expertise to unravel before rebuilding a healthier relationship with food. But know that you are not alone, and that it’s possible to feel freedom from FA and take steps to better metabolic health.
References
Florio L, Lassi DLS, Perico C A-M, et al. Food Addiction A Comprehensive Review. J Nerv Ment Dis. 2022; 210: 874–879. https://doi.org/10.1097/NMD.0000000000001555
Gearhardt AN, Bueno NB, DiFeliceantonio AG, et al. Social, clinical, and policy implications of ultra processed food addiction. BMJ. 2023;383: e075354. https://doi.org/10.1136/bmj-2023-075354
Gordon EL, Ariel-Donges AH, Bauman V, Merlo LJ. What Is the Evidence for “Food Addiction?” A Systematic Review. Nutrients. 2018; 10: 477. https://doi.org/10.3390/nu10040477
Gupta A, Osadchiv V, Mayer EA. Brain–gut–microbiome interactions in obesity and food addiction. Nat Rev Gastroenterol Hepatol. 2020; 17: 655–672. https://doi.org/10.1038/s41575-020-0341-5
Rauber F, da Costa Louzada ML, Steele EM, et al. Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ Open. 2019;9: e027546. https://doi.org/10.1136/bmjopen-2018-027546
Unwin J, Delon C, Giæver H, et al. Low carbohydrate and psychoeducational programs show promise for the treatment of ultra-processed food addiction. Front Psychiatry. 2022; 13:1005523. https://doi.org/10.3389/fpsyt.2022.1005523