Food Addiction and Dietary Restraint
Anyone who has followed David Wiss’s work knows he has particular interest in the psychology of eating. The concept of dietary restraint is very important to study and understand in the context of eating disorders and obesity. Traditionally, approaches toward obesity management have been focused on teaching people how to restrain themselves, either through limiting calories, macronutrient categories, or specific foods (e.g., highly processed foods). But more recently it has become clear that dietary restraint is a risk factor for disordered eating, by precipitating bingeing, purging, and/or obsession with food, and even full-blown anorexia nervosa.
So the concept of restrained eating has received an increasing amount of negative attention. Mr. Wiss has written several peer-reviewed journal articles on food addiction but has recently shifted focus toward the importance of considering dietary restraint as a contextual factor related to food addiction, as well as the role of other psychiatric diagnoses. His recent paper Separating the signal from the noise: how psychiatric diagnoses can help discern food addiction from dietary restraint was published in the high-impact Nutrients journal. Below is the abstract from that paper, and then there is a 2-hour video in which David breaks down the paper in an invited training to food addiction professionals! There is a fantastic discussion of the three clinical vignettes.
Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction “diagnosis” among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, post-traumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or “the signal”) from the more classic eating pathology (true negatives, or “restraint”) that can potentially elevate food addiction scores (false positives, or “the noise”). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.