What is food addiction?
Although there's no universally-agreed-upon definition of addiction, it’s commonly described as a condition in which a person compulsively engages in reward-seeking behaviors, despite negative consequences.[1] For instance, someone addicted to methamphetamine may prioritize seeking and taking the drug over finances, social relationships, health, and overall well-being.
The concept of food addiction (FA) was first introduced by Dr. Theron Randolph in 1956 and has gained research interest since. However, it’s important to note that food addiction isn’t formally recognized as a psychological disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Disease (ICD-11). Consequently, FA remains a contentious and debated concept, lacking verified validity.[2]
Although stimulation of motivational systems in the brain by food is a natural process, and often a healthy one, some researchers argue that certain highly-palatable foods (especially foods that are highly processed and rich in sugar and fat) can overstimulate these systems. In some cases, this overstimulation might lead to an addiction-like response akin to drug dependence. Food addiction may share some behavioral and neurobiological similarities with drug dependence, including neural alterations of impulse control, altered dopaminergic and endocannabinoid reward pathways, and downregulation of the dopamine system.[2][3][4]
What are the main signs and symptoms of food addiction?
People with food addiction typically struggle to control their consumption of specific foods, especially energy-dense or highly-palatable ones. Individuals with food addiction usually continue eating despite feeling full and despite the negative effects on their physical and mental health and daily functioning, such as relationships, work, and school performance. Moreover, food addiction is often linked to other health conditions, particularly obesity and eating disorders such as binge eating disorder and bulimia nervosa.[3][5]
Those affected by food addiction often invest substantial time and resources into their eating habits, sometimes prioritizing food consumption over other activities. Similar to individuals struggling with substance use disorders, people with food addiction experience intense cravings for certain foods, mirroring the cravings experienced by those addicted to drugs.[6]
How is food addiction diagnosed?
Food addiction is currently assessed using the Yale Food Addiction Scale (YFAS), a self-report questionnaire featuring 35 questions with responses ranging from ‘never’ to ‘every day’. The YFAS was designed by adapting the criteria for substance use disorder (drug addiction) found in the DSM-5 to the context of addictive-like eating behaviors. Individuals can be defined as affected by food addiction when they meet two or more of the 11 YFAS criteria and experience significant clinical impairment or distress as a result.[7] The YFAS has been tailored for various demographics (e.g., adults, and children) and is available in 13 languages.[5]
An alternative assessment tool for food addiction is the Addiction-like Eating Behavior Scale (AEBS), which doesn’t draw a direct parallel to drug addiction. Instead, this scale evaluates food addiction from a behavioral standpoint rather than a substance-addiction one.[8]
It’s worth noting that not everyone who perceives themselves as addicted to specific foods fulfills the YFAS “diagnostic” criteria. Because self-perceived food addicts may be at risk of developing problematic eating behaviors, diagnostic tools for food addiction may inadvertently prevent individuals in this category from receiving diagnoses and treatments for other eating disorders.[9]
Another limitation of the YFAS is that some studies reported frequent overlaps between positive scores of food addiction and other eating disorders, such as binge eating. Some researchers argue that rather than being considered a separate “disorder,” FA should instead be seen as a mechanistic explanation for binge eating.[10]
What are some of the main medical treatments for food addiction?
Although food addiction is not officially recognized as a medical disorder, there are some treatments and programs available to address it.
One common approach is cognitive behavioral therapy (CBT), a psychological method often used to treat disordered eating, addiction-like behaviors, and binge eating.[11] However, there is still limited research supporting CBT's efficacy in treating food addiction.
Certain medications, like the combination of naltrexone/bupropion or semaglutide, show potential for reducing food addiction scores and cravings.[12][13] However, there is currently a lack of studies specifically evaluating their effectiveness for treating food addiction.
Additionally, although it does not specifically target food addiction, bariatric surgery (e.g., sleeve gastrectomy) in individuals with obesity has been linked with decreased YFAS scores over 24 months compared to baseline.[14]
Have any supplements been studied for food addiction?
One trial has evaluated a probiotic for FA. The participants in this double-blind placebo-controlled RCT were on people with obesity who underwent weight-loss surgery. The study analyzed the impact of 90 days of supplementation with a specific probiotic (Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07) on food addiction and binge eating scores, both 3 months and 1 year after surgery. Both placebo and probiotic groups showed reduced YFAS scores at the 3-month mark. However, those receiving probiotics maintained significantly lower YFAS and binge eating scores 1 year after the intervention.[15] It’s important to note that this study had some limitations: the effectiveness of probiotics was assessed post-bariatric-surgery, not as a standalone intervention, and changes in the gut microbiota were not analyzed.
How could diet affect food addiction?
Diet significantly impacts food addiction, and various studies revealed that a diet rich in highly processed, energy-dense foods may lead to addictive-like eating behaviors.[3]
One study examined the impact of a weight loss treatment (including a portion-controlled 1000- to 1200-kcal diet, behavioral obesity treatments, and some physical activity) on both total food cravings and specific food cravings (e.g., sweets, high-fat foods) among individuals with obesity. The findings revealed that people with YFAS-defined food addiction had higher levels of food cravings at baseline, but YFAS-defined food addiction didn’t significantly impact weight loss after the intervention. Cravings and YFAS symptoms were diminished both in people with and without food addiction. It’s worth noting that this study had a limited sample size, with only 12 out of 178 participants meeting the YFAS food addiction criteria, though, and there was no control group.[6]
Are there any other treatments for food addiction?
Abstinence-based programs called 12-step programs are often offered to people with food addiction. These programs, which are adapted from the 12-step program originally developed for alcoholism, take place over a series of face-to-face or online group meetings aimed at helping people to overcome addiction to specific foods through a support system. In this context, the term “abstinence” doesn’t refer to abstaining from food in general, since one can’t abstain from eating, but to abstaining from specific ingredients (e.g., refined sugar). Although 12-step programs are effective for alcoholism, there is currently limited evidence supporting their efficacy for food addiction.[16]
What causes food addiction?
The exact cause of food addiction is still unknown, and food addiction remains a highly debated topic. However, various hypotheses have been formulated both through preliminary in vivo animal and human studies.
It appears that drug and food stimuli impact similar regions of the brain (e.g., striatum, amygdala, and anterior insula), and share similar reward system pathways (e.g., dopaminergic, opioid, and cannabinoid systems). Notably, downregulating dopamine receptors (for example, by taking certain medications) might disrupt the reward system and trigger food addiction. The endocannabinoid system (ECS) also plays a role in modulating the brain's reward system and in regulating appetite. Conditions such as disrupted lipid metabolism, which is common in obesity, or an increased intake of polyunsaturated fatty acids (PUFAs), which is common in the western diet, can influence the production of endocannabinoids and the expression of cannabinoid type 1 receptors (CB1), which in turn promote both fat mass accumulation and appetite stimulation, the latter of which may lead to overeating. Obesity has been linked to a dysregulated ECS system, which may be influenced by food intake, and appears to be positively correlated with biomarkers of obesity. This suggests that food addiction in people with overweight or obesity could be linked to a heightened reward-system response to high-calorie/highly-palatable foods.[3][17][18]
Translating findings from animal studies to human conclusions is complex due to differing brain and body structures and the intricate human food and social environment, but animal studies can suggest pathways that might be involved in food addiction in people; these could then be explored and verified in clinical studies. For instance, rat studies exploring the potential addictive effect of sugar reported specific behavioral and neurochemical changes when sucrose consumption was stopped, including anxiety, nervousness, and an increase in body temperature, which are similar to the changes observed in drug-dependent rats when drug consumption is stopped.[3] Another rat study detected brain activity changes similar to those seen in drug addiction.[19]
Other studies found increasing evidence that food addiction may be connected to a disruption of the gut-brain axis and intestinal dysbiosis, which could have any one of a number of causes (e.g., prenatal and postnatal influences, breastfeeding, environmental factors, diet).[20] Dysfunctional emotional coping mechanisms may also contribute to food addiction. One study showed that people with food addiction displayed significantly higher emotional eating scores, suggesting that eating excessively may be triggered by feelings such as loneliness, anger, fear, or sadness, in an attempt to overcome them.[2]
Research FeedRead all studies
In this randomized controlled trial, a calorie-restricted/time-restricted eating diet reduced body weight without affecting food addiction symptoms in women with food addiction.
Frequently asked questions
Although there's no universally-agreed-upon definition of addiction, it’s commonly described as a condition in which a person compulsively engages in reward-seeking behaviors, despite negative consequences.[1] For instance, someone addicted to methamphetamine may prioritize seeking and taking the drug over finances, social relationships, health, and overall well-being.
The concept of food addiction (FA) was first introduced by Dr. Theron Randolph in 1956 and has gained research interest since. However, it’s important to note that food addiction isn’t formally recognized as a psychological disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Disease (ICD-11). Consequently, FA remains a contentious and debated concept, lacking verified validity.[2]
Although stimulation of motivational systems in the brain by food is a natural process, and often a healthy one, some researchers argue that certain highly-palatable foods (especially foods that are highly processed and rich in sugar and fat) can overstimulate these systems. In some cases, this overstimulation might lead to an addiction-like response akin to drug dependence. Food addiction may share some behavioral and neurobiological similarities with drug dependence, including neural alterations of impulse control, altered dopaminergic and endocannabinoid reward pathways, and downregulation of the dopamine system.[2][3][4]
Studies have shown that cravings play an important role in food addiction. However, a key distinction between drug addiction and food addiction is that cravings for foods are widespread and often experienced by the general population. In contrast, cravings for substances like alcohol or nicotine are typically associated with a substance use disorder. Therefore, cravings shouldn’t automatically equate to addiction. Food cravings can be temporary and triggered by factors such as stress, hormonal changes (e.g., during the menstrual cycle, during menopause, or pregnancy), or exposure to enticing food marketing.[6] Further research is required to define the threshold for pathological food cravings and understand their role in the development of food addiction.
The main distinction between a chemical addiction (e.g., drug addiction) and a behavioral addiction (e.g., gambling) lies in the fact that in the latter, individuals aren't addicted to a specific substance (e.g., nicotine, alcohol); instead, they are addicted to the behavior itself or to the emotions that arise from engaging in that behavior.[22]
Drug addiction has both a behavioral and chemical component; for instance, people addicted to smoking are addicted both to nicotine and to the act of smoking itself. However, one important difference is that the addictive nature and the neurological influence of addictive substances (e.g., cocaine, methamphetamine, nicotine) on the reward system are well established. In contrast, research still struggles to establish the addictive properties of any specific substances in food. This leads to the likelihood that behavioral factors hold more sway over chemical ones in food addiction and overeating. However, as this is still an ongoing debate, more studies are required to clarify the exact relationship between the behavioral and chemical components of food addiction.[6][22]
The recognition of food addiction as a mental health disorder remains unsettled, with ongoing debates about its validity. There are three primary perspectives on food addiction:[23]
- Substance use disorder view: Some argue that food addiction should be classified as a substance use disorder because of the addictive potential of some foods (particularly energy-dense foods which are high in fat and/or carbohydrates).
- Behavioral-type addiction view: Others argue that food addiction aligns more with behavioral addictions like gambling.
- Nonrecognition view: Skeptics of the concepts of food addiction and eating addictions assert that these aren’t valid concepts and they shouldn’t be recognized as mental health disorders. They contend that unless specific addictive food components can be identified, establishing an addiction to food may be challenging. Additionally, some studies show that there is often an overlap between food addiction and other eating disorders, particularly binge eating, suggesting that food addiction should perhaps not be considered a separate entity.[10][2]
Advocates for the concept of food addiction argue that, unlike specific substances causing addiction to drugs or alcohol (e.g., ethanol, nicotine), it’s the combination of macronutrients (typically fat and carbohydrates in high-calorie foods) and food processing that affect the reward system. They note that addiction is not uniform across all substances — for instance, cocaine and nicotine have different addiction patterns, with cocaine use disorder being characterized by binge consumption followed by a break period, and nicotine having a more consistent daily-use pattern — suggesting that food addiction could have its own pattern, while still being considered an addiction.[10][4] However, some researchers argue that due to limited data on foods’ addictive properties, food addiction might be better approached as a behavioral addiction in which food cravings play a key role, and should therefore be addressed using strategies such as stimulus control or acceptance-based behavioral techniques.[24][6] These strategies may improve weight loss outcomes among patients with high levels of baseline food cravings by focusing on normalizing cravings, accepting thoughts about cravings rather than attempting to change them, redefining and stepping back from cravings, and acting in ways that are in accordance with one’s goals and values.[25]
Physical overeating occurs when people consume more food than their body can process. This may occur during a special occasion such as holiday celebration, when distracted while eating, or when presented with a larger than usual portion. However, restrained eaters (people who limit the amount or types of food they eat in order to not gain weight or to lose weight), or those on weight-loss diets, may label breaking their self-imposed dietary patterns or exceeding their personal notion of appropriate intake as “overeating”, even if their consumption isn't disproportionate and would be acceptable to non-dieters. Similarly, some people perceive any amount of a "forbidden" food as overeating, even in moderate quantities. For restrained eaters, such self-perceived overeating can lead to guilt or dysphoria, and can potentially result in more “transgressions” or in actual overeating, using the initial breach as justification since the "diet rules" are already broken.[26]
Furthermore, individuals often adapt their eating behaviors in social settings. Consuming a subjectively "normal" amount of food typically means aligning our consumption with that of those around us. Thus, surpassing this socially established norm might make us feel like we have overeaten. Dieters may also apply restraints in social contexts but struggle to resist tempting foods when alone, possibly leading to objective and physical overeating.[26]
People with food addiction typically struggle to control their consumption of specific foods, especially energy-dense or highly-palatable ones. Individuals with food addiction usually continue eating despite feeling full and despite the negative effects on their physical and mental health and daily functioning, such as relationships, work, and school performance. Moreover, food addiction is often linked to other health conditions, particularly obesity and eating disorders such as binge eating disorder and bulimia nervosa.[3][5]
Those affected by food addiction often invest substantial time and resources into their eating habits, sometimes prioritizing food consumption over other activities. Similar to individuals struggling with substance use disorders, people with food addiction experience intense cravings for certain foods, mirroring the cravings experienced by those addicted to drugs.[6]
Food addiction is currently assessed using the Yale Food Addiction Scale (YFAS), a self-report questionnaire featuring 35 questions with responses ranging from ‘never’ to ‘every day’. The YFAS was designed by adapting the criteria for substance use disorder (drug addiction) found in the DSM-5 to the context of addictive-like eating behaviors. Individuals can be defined as affected by food addiction when they meet two or more of the 11 YFAS criteria and experience significant clinical impairment or distress as a result.[7] The YFAS has been tailored for various demographics (e.g., adults, and children) and is available in 13 languages.[5]
An alternative assessment tool for food addiction is the Addiction-like Eating Behavior Scale (AEBS), which doesn’t draw a direct parallel to drug addiction. Instead, this scale evaluates food addiction from a behavioral standpoint rather than a substance-addiction one.[8]
It’s worth noting that not everyone who perceives themselves as addicted to specific foods fulfills the YFAS “diagnostic” criteria. Because self-perceived food addicts may be at risk of developing problematic eating behaviors, diagnostic tools for food addiction may inadvertently prevent individuals in this category from receiving diagnoses and treatments for other eating disorders.[9]
Another limitation of the YFAS is that some studies reported frequent overlaps between positive scores of food addiction and other eating disorders, such as binge eating. Some researchers argue that rather than being considered a separate “disorder,” FA should instead be seen as a mechanistic explanation for binge eating.[10]
The 11 diagnostic criteria in the YFAS have been adapted from the criteria for substance use disorder in the DSM-5, and include:[7][21]
- Eating more food than planned even if not feeling hungry any more
- Unsuccessful attempts to control eating
- Spending a lot of time either trying to obtain specific foods, or a lot of time eating, or a lot of time recovering from overeating to the point of feeling sluggish and tired
- Cravings for specific foods
- Impaired daily functioning (e.g., at work, home, or school) because of the food addiction
- Eating despite negative interpersonal or social consequences
- Giving up activities because of food
- Continuing eating even when it puts you in danger. For instance, overeating sweets despite having diabetes, or being distracted by eating while driving a car.
- Eating despite negative physical or psychological consequences caused or exacerbated by that eating. For instance, eating despite its causing emotional problems or despite its causing physical issues (e.g., stomach cramps, diarrhea, headache)
- Tolerance, which is the increasing need for more food to feel satisfied
- Withdrawal symptoms (physical or psychological) when reducing food intake (e.g., disproportionate irritability or anxiety)
To be “diagnosed” with food addiction, people must both experience significant distress and meet two or more of the above criteria. It’s worth noting that food addiction is not a formally recognized mental health disorder, meaning both that the YFAS can’t be considered an official diagnostic tool and that there is some variability in the criteria utilized across different studies.
Although food addiction is not officially recognized as a medical disorder, there are some treatments and programs available to address it.
One common approach is cognitive behavioral therapy (CBT), a psychological method often used to treat disordered eating, addiction-like behaviors, and binge eating.[11] However, there is still limited research supporting CBT's efficacy in treating food addiction.
Certain medications, like the combination of naltrexone/bupropion or semaglutide, show potential for reducing food addiction scores and cravings.[12][13] However, there is currently a lack of studies specifically evaluating their effectiveness for treating food addiction.
Additionally, although it does not specifically target food addiction, bariatric surgery (e.g., sleeve gastrectomy) in individuals with obesity has been linked with decreased YFAS scores over 24 months compared to baseline.[14]
One trial has evaluated a probiotic for FA. The participants in this double-blind placebo-controlled RCT were on people with obesity who underwent weight-loss surgery. The study analyzed the impact of 90 days of supplementation with a specific probiotic (Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07) on food addiction and binge eating scores, both 3 months and 1 year after surgery. Both placebo and probiotic groups showed reduced YFAS scores at the 3-month mark. However, those receiving probiotics maintained significantly lower YFAS and binge eating scores 1 year after the intervention.[15] It’s important to note that this study had some limitations: the effectiveness of probiotics was assessed post-bariatric-surgery, not as a standalone intervention, and changes in the gut microbiota were not analyzed.
Diet significantly impacts food addiction, and various studies revealed that a diet rich in highly processed, energy-dense foods may lead to addictive-like eating behaviors.[3]
One study examined the impact of a weight loss treatment (including a portion-controlled 1000- to 1200-kcal diet, behavioral obesity treatments, and some physical activity) on both total food cravings and specific food cravings (e.g., sweets, high-fat foods) among individuals with obesity. The findings revealed that people with YFAS-defined food addiction had higher levels of food cravings at baseline, but YFAS-defined food addiction didn’t significantly impact weight loss after the intervention. Cravings and YFAS symptoms were diminished both in people with and without food addiction. It’s worth noting that this study had a limited sample size, with only 12 out of 178 participants meeting the YFAS food addiction criteria, though, and there was no control group.[6]
Abstinence-based programs called 12-step programs are often offered to people with food addiction. These programs, which are adapted from the 12-step program originally developed for alcoholism, take place over a series of face-to-face or online group meetings aimed at helping people to overcome addiction to specific foods through a support system. In this context, the term “abstinence” doesn’t refer to abstaining from food in general, since one can’t abstain from eating, but to abstaining from specific ingredients (e.g., refined sugar). Although 12-step programs are effective for alcoholism, there is currently limited evidence supporting their efficacy for food addiction.[16]
The exact cause of food addiction is still unknown, and food addiction remains a highly debated topic. However, various hypotheses have been formulated both through preliminary in vivo animal and human studies.
It appears that drug and food stimuli impact similar regions of the brain (e.g., striatum, amygdala, and anterior insula), and share similar reward system pathways (e.g., dopaminergic, opioid, and cannabinoid systems). Notably, downregulating dopamine receptors (for example, by taking certain medications) might disrupt the reward system and trigger food addiction. The endocannabinoid system (ECS) also plays a role in modulating the brain's reward system and in regulating appetite. Conditions such as disrupted lipid metabolism, which is common in obesity, or an increased intake of polyunsaturated fatty acids (PUFAs), which is common in the western diet, can influence the production of endocannabinoids and the expression of cannabinoid type 1 receptors (CB1), which in turn promote both fat mass accumulation and appetite stimulation, the latter of which may lead to overeating. Obesity has been linked to a dysregulated ECS system, which may be influenced by food intake, and appears to be positively correlated with biomarkers of obesity. This suggests that food addiction in people with overweight or obesity could be linked to a heightened reward-system response to high-calorie/highly-palatable foods.[3][17][18]
Translating findings from animal studies to human conclusions is complex due to differing brain and body structures and the intricate human food and social environment, but animal studies can suggest pathways that might be involved in food addiction in people; these could then be explored and verified in clinical studies. For instance, rat studies exploring the potential addictive effect of sugar reported specific behavioral and neurochemical changes when sucrose consumption was stopped, including anxiety, nervousness, and an increase in body temperature, which are similar to the changes observed in drug-dependent rats when drug consumption is stopped.[3] Another rat study detected brain activity changes similar to those seen in drug addiction.[19]
Other studies found increasing evidence that food addiction may be connected to a disruption of the gut-brain axis and intestinal dysbiosis, which could have any one of a number of causes (e.g., prenatal and postnatal influences, breastfeeding, environmental factors, diet).[20] Dysfunctional emotional coping mechanisms may also contribute to food addiction. One study showed that people with food addiction displayed significantly higher emotional eating scores, suggesting that eating excessively may be triggered by feelings such as loneliness, anger, fear, or sadness, in an attempt to overcome them.[2]
To identify potentially addictive foods, one study utilized the YFAS questionnaire, asking participants to select the most addictive or challenging-to-control foods from a list of 35 options. The foods included in the list varied in fat content, glycemic load (GL; the GL reflects both the amount of refined carbohydrates in a food and their absorption rate), and level of processing. The extent of processing seemed to predominantly influence a food’s link to addictive-like eating behaviors. Foods at the top of the list were highly processed and palatable, with added amounts of fat and/or refined carbohydrates or sugar; the top of the list included chocolate, ice cream, french fries, pizza, cookies, chips, cake, buttered popcorn, cheeseburgers, and muffins. Additionally, the fat percentage and GL also emerged as good predictors of a food’s addictive potential.[4] This study presents several limitations. The list of foods was not exhaustive, no food was reported as extremely addictive, and not all participants presented YFAS-measured food addiction symptoms. Furthermore, this study didn’t explore the impact of these foods on specific regions of the brain involved in the reward system, and results were based on self-reporting.
It’s worth noting that the addictive properties of certain foods are also reported by people not formally “diagnosed” with YFAS-defined food addiction. Quite often people declare that they have an addiction to specific foods despite not fulfilling the YFAS criteria for food addiction. One study revealed that self-perceived food addicts were more inclined to consume high-fat foods (e.g., chocolate, crisps) than low-fat foods (e.g., grapes), and consumed more calories overall. Furthermore, despite self-perceived food addicts and non-addicts displaying similar hunger levels across that study, self-perceived food addicts consumed significantly more chocolate.[9]
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References
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