Food Addiction

Educational Objectives

The goal of this lecture is to improve knowledge of proposed mechanisms of food addiction. After hearing and assimilating this lecture, the clinician will better be able to:

1. Identify characteristics of food that are associated with addictive-like eating behaviors.

2. Describe how certain foods cause changes in behaviors and neurochemical patterns similar to those observed in drug addiction.

Summary

Food Addiction

Interview with: Nicole Avena, PhD

Proposed mechanisms: The concept of food addiction is a new approach to understanding a possible cause of overeating and obesity. Researchers have used the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for substance dependence to determine whether rodent or human models show signs of addiction in response to certain foods. Although the concept of food addiction is controversial, animal studies have shown that overconsumption of sugar leads to behaviors associated with addiction (eg, binging, withdrawal, cravings) and changes in the brain similar to those observed with drug addiction (eg, changes in dopamine and opioid release sensitivity, receptor binding). Recent clinical experiments using functional magnetic resonance imaging show that human individuals who overeat or prefer highly palatable foods have changes in activity of the reward centers in the brain relative to individuals who do not overeat.

Assessment scale: Ashley Gerhardt, PhD, developed a scale for identifying food addiction by adapting DSM criteria for substance dependence based on attitudes toward food. Questions investigate thoughts and feelings about food and whether an individual spends an excessive amount of time planning access to food.

Characteristics of addictive foods: Initial studies of food addiction in animal models investigated sugar, because many experts anecdotally identified sugar as problematic. Additionally, correlational analyses have shown an association between the obesity epidemic and increased sugar consumption, and other studies showed that foods with added sugars appeared to produce addiction-like changes in behavior. A recent study published in PLOS One asked individuals to rate their addictive tendencies toward 35 foods using a validated scale of food addiction. The foods varied in level of processing, quantity of added fat, and glycemic index. Pizza was most problematic (addictive). A high level of processing (as in cookies, cakes, and pasta) was the strongest positive predictor of whether a food elicited addictive-like eating behaviors, followed by fat content and glycemic load, respectively. Future research may investigate addictive-like eating behaviors in solid vs liquid foods, as previous studies have shown that people tend to consume more of a liquid food than its solid counterpart.

Countermeasures and potential treatment: A study in rats showed that administration of baclofen with naltrexone suppressed addictive-like feeding behavior associated with highly palatable food but did not affect consumption of standard food. Although experts are investigating pharmacologic agents that could mitigate addiction, more research is needed to understand the concept before prescribing pharmacologic therapies that target food addiction. The goal of treating food addiction is to suppress appetite for highly palatable foods, but not appetite for all food. Weight-control programs that target the psychologic processes involved in drug addiction may also help control overeating behaviors.

Take-home messages: It is important to have multiple approaches (eg, pharmacologic, cognitive behavioral therapy, addiction therapy) available for primary care physicians when treating obesity. Food consumption is a community-oriented event, and community-based approaches (eg, Weight Watchers, YMCA programs) may be effective for long-term weight loss. Obesity is caused by many factors; therefore, investigating multiple contributors (eg, biology, psychology, social aspects) is important when developing treatment.

Future directions: Research will focus on food addiction, animal models of other eating disorders (eg, anorexia nervosa and binge eating disorder), pharmacologic therapies for addictive-like overeating, and brain areas and neurochemicals perturbed by overeating. Interventions that target causes of obesity (eg, overeating) are critical for long-term success.

Readings

Abeelen FM et al: Famine Exposure in the Young and the Risk of Type 2 Diabetes in Adulthood. Diabetes 2012 Sept; 61(9):2255-2260; Avena NM et al: Effects of baclofen and naltrexone, alone and in combination, on the consumption of palatable food in male rats. Exp Clin Psychopharmacol. 2014 Oct;22(5):460-7; Francis-Emmanuel PM et al: Glucose metabolism in adult survivors of severe acute malnutrition. J Clin Endocrinol Metab. 2014 Jun;99(6):2233-40; Hardikar AA et al: Multigenerational Undernutrition Increases Susceptibility to Obesity and Diabetes that Is Not Reversed after Dietary Recuperation. Cell Metab. 2015 Aug 4;22(2):312-9; Kahleova H et al: Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. Diabet Med. 2011 May;28(5):549-59; Kahleova H et al: Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study. Diabetologia. 2014 Aug;57(8):1552-60; van Schulte EM et al: Which foods may be addictive? The roles of processing, fat content, and glycemic load. PLOS One. 2015 Feb 18;10(2):e0117959.

Disclosures

For this program, the following was disclosed: Dr. Anderson reported relationships with Amylin Pharmaceuticals (G), Daichi Sankyo Company (B), Eli Lilly and Company (B), Novo Nordisk (B), and sanofi-aventis UC (A). Nicole Avena reported relationships with Penguin Random House LLC (B) and The Sugar Association (C). Members of the planning committee reported nothing to disclose.

A=Advisory panel B=Speakers bureau C=Consultant G=Grant or other research support

Acknowledgements

CME/CE INFO

Accreditation:

Lecture ID:

DI070801

Qualifies for:

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.