Ultra-Processed Food Addiction & Eating Disorders Paper Background
I am an eating disorder dietitian who took an interest in ultra-processed food addiction in 2012 when I started running groups in substance use disorder treatment facilities. Around this time, compelling evidence in humans showed that food consumption patterns could mimic behavioral patterns of drug use.
Neurobiological overlaps between food and drug use were described in high quality studies and received attention in the popular press. This research matched what I had observed in addiction treatment and elsewhere. During this time, food companies were exposed for leveraging the science of food addiction to maximize profit at the expense of public health.
I took great interest in the field of food addiction recovery and predicted it would blossom into a robust area of scientific inquiry. And guess what? It did! To date, the phenomenon of food addiction has been mentioned in over 2,500 peer-reviewed papers. WOW.
The eating disorder community has outright rejected the concept of ultra-processed food addiction. Some dietitians are vehemently opposed to this idea, mostly because it does not match the classic nutritional approach for restrictive eaters. Messages like “it’s not about the food” and “there are no bad foods” conflicts with messaging about food having addictive qualities for some.
The eating disorder field is mostly focused on targeting diet culture, reducing cognitive rigidity around food, challenging weight stigma, and putting an end to punitive messaging around food and body. Unfortunately, the concept of recovery from food addiction does carry a lot of this energy. As an eating disorder dietitian, I am often turned off by people discussing food addiction without any background knowledge of eating disorders. There are many proponents of food addiction spreading harmful messages.
Many advocates of ultra-processed food addiction have legitimate biological responses to food that make it difficult for them to enjoy certain foods in moderation. This is impossible to deny. Science and people in the field tell us so. It is generally food that is consider ultra-processed and engineered to elicit the highest possible dopamine response. Not food, but ultra-processed food. Do you understand the difference?
Others have food addiction symptoms that stem from excessive dieting or reflect subjective eating experiences (perceived food addiction). Others are simply dissatisfied with their bodies and want to lose weight, and gravitate to food addiction messaging to support this goal. So there is wide range of possibilities. So how do we discern?
Being a Dietitian, I stepped in. My first paper on this topic was called Incorporating Food Addiction into Disordered Eating: The Disordered Eating Food Addiction Nutrition Guide proposed that an individual’s alcohol and drug history could be used to help determine if someone had an actual food addiction or more of a classic restrictive eating disorder, requiring more specific eating disorder help. This was a good beginning.
Then I became interested in the link between dietary restraint and food addiction symptoms. Which one came first? The next relevant paper was called Separating the Signal from the Noise: How Psychiatric Diagnoses can Help Discern Food Addiction from Dietary Restraint and integrated important data on trauma, particularly during the first 18 years of life, in order to determine if the food addiction is legit or not and is food addiction an eating disorder or not.
Most recently, my paper Clinical Considerations of Ultra-Processed Food Addiction Across Weight Classes: An Eating Disorder Treatment and Care Perspective took this conversation to the next level. Are you here for it?
Abstract
Purpose of Review: To examine the prevalence rates of ultra-processed food addiction across different weight classes and offer guidelines for diagnosis and treatment. Clinicians are provided with practical considerations in the assessment of ultra-processed food addiction recovery plan beyond the use of validated instruments.
Is food addiction an eating disorder? Not technically, but there is a lot of overlap. We help people where they lie on these different spectrums. Recovery from food addiction looks very different from person to person. Dr. David Wiss is a leading expert on this topic.
Recent Findings: The weighted mean prevalence of ultra-processed food addiction is approximately 20% worldwide and varies widely based on the sample. At first glance, there appears a linear relationship between ultra-processed food addiction and BMI class. Further investigation indicates a J-shaped curve with heightened prevalence among the underweight. These findings highlight the need to assess for additional factors that may increase objective or subjective food addiction symptoms including eating disorders, dietary restraint, and other mental health diagnoses.
Summary: While clinical considerations across different weight classes vary, overemphasis on weight status may detract from the clinical utility of the ultra-processed food addiction construct. Considering weight status in conjunction with other psychiatric symptoms helps to better understand the various biopsychosocial mechanisms that influence eating behavior and can inform individualized treatment strategies.
David Wiss
David became a Registered Dietitian Nutritionist (RDN) in 2013 and founded Nutrition in Recovery, a group practice of RDNs specializing in treating eating and substance use disorders. In 2017, David received the “Excellence in Practice” award at the National Food and Nutrition Conference and Expo. The California Academy of Nutrition and Dietetics awarded him the “Emerging Dietetic Leader Award” in 2020. He earned his Ph.D. from UCLA’s Fielding School of Public Health in the Community Health Sciences department (with a minor in Health Psychology) by investigating the links between adverse childhood experiences and various mental health outcomes among socially disadvantaged men. His treatment philosophy is based on a biopsychosocial model which incorporates an understanding of biological mechanisms, psychological underpinnings, and contextual factors that integrate the social determinants of health. Wise Mind Nutrition's website offers a fully online interactive treatment program in Spring 2023.