Food and Addiction: A Comprehensive Handbook
Publication: American Journal of Psychotherapy
Kelly D. Brownell and Mark S. Gold (Editors): Food and Addiction: A Comprehensive Handbook. Oxford University Press, New York, NY, 2012, 462 pp., $96.86, ISBN 978-0-19-973816-8.
This volume is edited by Mark S. Gold, M.D., a substance abuse researcher and Chair of Psychiatry at the University of Florida and Kelly D. Brownell, PhD., Professor of Psychology and Professor of Epidemiology and Public Health, and Director of the Rudd Center for Food Policy & Obesity at Yale University. It is a collection of 66 short (5 to 8 pages) chapters written by 107 contributors. The volume is divided into seven Parts:
I)
The Neurobiology and Psychology of Addiction,
II)
Regulation of Eating and Body Weight,
III)
Research on Food and Addiction,
IV)
Clinical Approaches and Implications,
V)
Public Health Approaches and Implication,
VI)
Legal and Policy Implications, and
VII)
Concluding Comments.
The volume compiles the proceedings of a 2007 meeting at Yale that assembled leading researchers in the fields of nutrition, obesity, and addiction. This meeting had its origins in the work of Bartley Hoebel and colleagues at Princeton University. They explored, in an animal model, whether sugar could be a substance of abuse and promote a “natural form” of addiction. According to Hoebel, “food addiction” is a plausible concept because the brain pathways that evolved to respond to natural rewards are also activated by addictive drugs. Thus sugar, as a substance that releases opioids and dopamine, might also be expected to have addictive potential.
Food and Addiction is ambitious in scope. It broadly covers the topics of addiction and obesity, including chapters on the neurobiology of addiction and the regulation of energy balance. Its primary goal is to identify the factors interfering with healthy eating amidst the rampant increase of global obesity and its associated health risks. The editors’ contention is that the “addictive properties of food” may be one such factor.
The secondary goal is to separate popular cultural and clinical anecdotal notions of addiction from scientific data. By bringing together the work of leading experts on a broad range of topics pertaining to food addiction, the editors proposed to address this subject from the vantage point of “food AND addiction”—the impact of food on the brains of everyday people. This is posed as an important differentiating concept from “food addiction”.
The editors query:
1)
whether food and addiction is a concept worth pursuing; if it is,
2)
whether exploration of the notion that some foods might act on the brain as addictive substances is instructive; and
3)
if certain foods can be considered addictive, whether there might be justification for restricting their marketing, particularly to vulnerable populations, such as youth.
Initially, the editors’ concept of food AND addiction raises hopes for a neutral scientific exploration of the concept that certain foods might link to the same neural pathways in the brain as do drugs and alcohol, and thus be addictive. However, although the editors seem to want to separate themselves from the anecdotal notion of “food addiction” (and caution us about this notion) they do not succeed. At best, it seems that a bias towards this concept appears throughout the book as a foregone conclusion, with the added assumption that public policy should follow suit.
Needless to say, foods laden with sugar, fats and salt are highly palatable and health hazard on their own merits. The introduction highlights “Frankenfoods,” which are processed to “dizzy the imagination with their colors, tastes, smells, textures, and other sensory properties” (p. xxii). However, the questions that need to be addressed in the present context are: is food addictive? If so, which ones and how much? How does one identify addictive items? Is everyone an “addict?” If not, who is more vulnerable and why? Why are the rest not addicts? How much does food addiction contribute to the onset and maintenance of obesity?
Only some chapters address these questions, and with not enough evidence to be convincing. The book includes some very important and interesting data from animal studies and the area of drug addiction. However, the crossover to human food addiction gives some pause, since the evidence does not fully substantiate which substances are addictive and in what amounts. The idea of food addiction is in its nascent stages. Programs based on the addiction model are not consistent with other models of disordered eating, such as Terence Wilson’s recent work on binge eating disorder. It is interesting to note that while binging behavior may satisfy some of the criteria of addiction, not all bingers are obese.
Food intake is a tricky subject, since it is necessary for all living creatures, along with air and water. However, the material in the book does not clarify the issue of hunger versus craving. Symptoms of hunger are quite similar to craving. As the work of Ancel Keys demonstrated, people, whether obese or lean, obsess about food when they are hungry. Can a food addict distinguish between hunger and craving? Does a weight-reduced individual with obesity believe, rightly or wrongly, that he or she is a “food addict?” On a neurological level, do all people with obesity have functional dopamine receptor deficits? If so, are these deficits the result of obesity or the cause of it? The assumption is that dopamine receptor alterations are a result of eating “addictive” foods, but what is the evidence for this?
Part I
This section of the book includes nine highly scientific chapters that briefly review the definition and characteristics of drug addiction, covering animal models of addiction, the neuroanatomy and genetics of addiction, and the co-occurrence of addiction and psychiatric disorders. Also included are chapters on cellular epigenetic changes in addiction and eating disorders, and a comparison of feeding systems and drugs of abuse. The theme of epigenetic changes caused by various stressors inducing vulnerability to addictions is certainly a topic of current interest and concern. The section is rich in scope, yet lacking in full development of the concept of what exactly a “food addiction” is. The section’s downfall is the interweaving of concepts of drug and alcohol addiction with the potential of palatable foods to create “food addiction.” Craving food is a problematic and complex issue, since everyone at one time or another “craves” a particular food, and not everyone craves the same food. In sum, there seems to be a tendency to throw “food addiction” in with the more solid evidence of drug addiction, without truly developing this theme.
Part II
This section covers the regulation of eating and body weight. This section is most informative, providing a total of 15 chapters covering not only on the biological bases of feeding behavior, but also the prevalence of overweight and obesity among adults and children worldwide. The chapters on energy balance provide excellent brief reviews of the biological factors involved in feeding regulation. Included are chapters on genetic factors, brain reward circuitry, taste responsiveness, and prenatal programming of obesity. Barbara Rolls provides a thought-provoking chapter (Chapter 23) on the role of portion size and energy density in overeating. Cara Ebbeling, Walter Willett, and David Ludwig (Chapter 22) contribute a chapter on the adverse effects of sugar-sweetened beverages, and the mechanisms which may mediate their effects. Regarding the epidemiological data, it would seem that overweight and obesity are not just a problem of the affluent, economically more developed world. The poor are now more overweight than the rich. The focus is on rapidly changing global food systems and the shift in available diet items, with an increase in processed foods, caloric sweeteners, and unregulated processed oils.
Part III
In this section research on food and addiction is covered, and it addresses the conceptual link between drug addiction and feeding. At last the field is narrowed to the topic at hand—from the diagnosis of food addiction to the issue of palatable food items, stress and reward systems. The section attempts to make a case against sugar-sweetened beverages with articles reviewing animal models of sucrose craving and sugar addiction. The lead chapter reviews DSM IV-TR diagnostic criteria for substance dependence. It would seem that the idea of eating as addictive is being “squeezed” into the criteria. Of note, Ashley Gearhardt and William Corbin (Chapter 25) suggest that tolerance and withdrawal of food has not been adequately studied. Gene-Jack Wang, Nora Volkow, and Joanna Fowler contribute a very important chapter (Chapter 28) linking dopamine deficiency to overeating and the onset of obesity. In contrast to their chapter, Sonja Yokum and Eric Stice (Chapter 29) indicate that there is much more to learn about brain reward circuitry, and as yet nothing definitive: “Extant data do not lend clear support to a simple hyperresponsivity or a simple hyporesponsivity model of obesity” (p. 195). Several chapters attempt to compare drug addiction craving and withdrawal to food craving and withdrawal. Daniel Blumenthal and Mark Gold (Chapter 39) indeed make a case for food addiction being a neurobiobehavioral disease. They push the concept of “food addiction”, but do so even handedly. The best chapter, reviewing the concepts of liking versus wanting food in human appetite by Graham Finlayson, Michelle Dalton and John Blundell (Chapter 33), concludes “We await further evidence before regarding all overconsumption as a form of addictive behavior” (p. 223).
Part IV
The section covers what seems to be an interweaving of psychological treatments of drug addiction with those directed at eating disorders and food addiction. Some of the articles are excellent in their specific focal coverage, notably Orli Rosen and Louis Aronne (Chapter 46) on pharmacotherapy for obesity, Mirion Vetter, Lucy Faulconbridge, Noel Williams, Thomas Wadden (Chapter 47) for the surgical treatment for obesity, and Carlos Grillo (Chapter 49) for current interventions for binge eating disorder. Richard Shriner (Chapter 51) reminds us that for BMI’s over 35 or 40 with metabolic stressors, bariatric surgery is increasingly being advocated as a “sensible and cost effective option” (p. 342). Chapter 53, “From the Front Lines, A Clinical Approach to Food and Addiction,” by Philip Werdell, should have headed the book. It addresses very clearly the clinical categories that this volume purports to examine—the key differences between overconsumption—induced obesity, eating disorders, and chemical dependency on food.
Parts V, VI, and VII
These sections address all of the possibilities of changing public policy with regard to food availability and composition. The chapters are interesting and illuminating in terms of the regulatory and legal implications of public policy changes. The aim seems to be to alter current nutritional, educational, and advertising practices, which in fact may be required in light of the dramatic increase of obesity seen in the last three decades. Perhaps this is the real goal of this book, worthy of our consideration independently of the purported role of food addiction in obesity.
In sum, this is a worth while read both for experts and newcomers to the field. It will certainly give the reader a multidimensional tour of the world of eating and addiction. The volume covers topics beyond eating and addiction, from the biological and genetic basis of feeding to public policy changes and their legal implications. Many of the chapters are too short to really provide convincing evidence, but do raise valuable questions for the reader. Each of the topics is substantial, and the work as a whole is thought provoking. The volume would have had more weight if it could have stayed focused on the specific properties of food addiction, and on what elements of foods are addictive. To say one is addicted to food without clear guidelines does not seem to be helpful, since we all get hungry, eat frequently, and enjoy palatable foods. This being said, the volume is rich in contribution and substance.
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Published in print: 2013, pp. 215–307
Published online: 30 April 2018
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