Shedding Light on Food Addiction

Researchers from the United States, Brazil and Spain, including scientists from VTC’s Fralin Biomedical Research Institute, published an analysis in a special issue of the British Medical Journal with a timely and controversial recommendation: it is time for an international change in the way we think in ultra-processed foods.

Comments

"There is convergent and consistent support for the validity and clinical relevance of food addiction ," said Ashley Gearhardt, corresponding author of the paper and professor of psychology at the University of Michigan. "By recognizing that certain types of processed foods have properties of addictive substances, we will be able to help improve global health."

While people can stop smoking, drinking or gambling, they can’t stop eating , said co-author Alexandra DiFeliceantonio, an assistant professor at the Fralin Biomedical Research Institute. The challenge, and the open and controversial question, is to define which foods have the greatest potential for addiction and why.

His work was published in Food For Thought , a special edition of the British Medical Journal , a high-impact publication and one of the oldest medical journals in the world.

DiFeliceantonio is also associate director of the Health Behavior Research Center at the Fralin Biomedical Research Institute and assistant professor in the Department of Human Nutrition, Food and Exercise in the College of Agriculture and Life Sciences at Virginia Tech.

Not all foods have addiction potential, the researchers said.

"Most foods we consider natural or minimally processed provide energy in the form of carbohydrates or fat, but not both," DiFeliceantonio said.

The researchers gave the example of an apple, a salmon and a chocolate bar. The apple has a carb to fat ratio of about 1 to 0, while salmon has a ratio of 0 to 1. In contrast, the chocolate bar has a carb to fat ratio of 1 to 1, which seems increase the addictive potential of a food.

"Many ultra-processed foods have higher levels of both. That combination has a different effect on the brain," DiFeliceantonio said. The researchers also called for more studies on the role of food additives used in industrial processing.

Key takeaways from the analysis include:

Behaviors related to ultra-processed foods, which are high in refined carbohydrates and added fats , may meet the criteria for a substance use disorder diagnosis in some people. These behaviors include less control over intake, intense cravings, withdrawal symptoms, and continued use despite consequences such as obesity, binge eating disorder, poorer physical and mental health, and lower quality of life.

This global health challenge needs to consider geographical differences. In a review of 281 studies from 36 different countries, researchers found that addiction to ultra-processed foods is estimated to occur in 14 percent of adults and 12 percent of children. In some countries, ultra-processed foods are a necessary source of calories. Even within high-income countries, food deserts and other factors could limit access to minimally processed foods . People facing food insecurity rely more on ultra-processed foods and are therefore more likely to show food addiction, the researchers noted.

Considering some foods addictive could lead to novel approaches in social justice, clinical care, and public policy. Policies implemented in Chile and Mexico (taxes, labeling and marketing) are associated with reductions in caloric intake and purchases of foods high in sugar, saturated fat and salt, for example. And in the United Kingdom, a salt reduction program was associated with a decrease in deaths from stroke and coronary artery disease.

The co-authors represent international expertise in food addiction, nutrition physiology, gut-brain reward signaling, food policy, behavioral addiction, and eating disorders. They ask for more studies and science around ultra-processed foods.

"Given the prevalence of these foods (they make up 58 percent of calories consumed in the United States), there is a lot we don’t know." DiFeliceantonio said.

The researchers call for more studies to be conducted in areas such as: how the complex characteristics of ultra-processed foods combine to increase their addictive potential; better define which foods can be considered addictive; differences between countries and communities, including disadvantaged communities; the value of public health messages; and clinical guidelines to prevent, treat and control addiction to ultra-processed foods.

In addition to Gearhardt and DiFeliceantonio, authors include Nassib B. Bueno, professor at the Federal University of Alagoas in Brazil; Christina A. Roberto, associate professor in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania; and Susana Jiménez-Murcia and Fernando Fernández-Aranda, both professors in the Department of Clinical Psychology at the Bellvitge University Hospital in Spain.