It’s a lot more common than you might think!
Dr Riekie Smit, an Aesthetic and Sports Practitioner from Pretoria, says that food addiction is a definite contributor to obesity, but one that is very challenging to treat which may be why it is so often overlooked.
“The obesity epidemic is a global problem with alarmingly high incidences rising in various categories regardless of age, race and income levels,” she says. Fortunately, an increase in recent studies and scientific literature has brought more attention to the issue of food addiction, a term defined as “an abnormal pattern of excessive consumption and often referred to in specific eating behaviours”1.
Interestingly, food addiction, particularly a person’s behavioural and neurophysiological changes that occur with certain foods, have been found to closely resemble findings found in persons with substance dependence. “It was found that the brain mechanisms in people with food addiction were similar to those in people with substance dependence, such as people addicted to drugs”2, she says.
While food addiction has not been officially classified as a disease, the most commonly used assessment tool to date is the Yale Food Addiction Scale (YFAS) which uses a 25-point questionnaire based on existing codes for substance dependence criteria, to assess food addiction in individuals.
SEVEN CRITERIA OF FOOD ADDICTION (ACCORDING TO THE YALE FOOD ADDICTION SCALE ) ARE :3
1: Substance taken in larger amount and for longer period than intended
2: Persistent desire or repeated unsuccessful attempt to quit
3: Much time/activity to obtain, use, recover
4: Important social, occupatonal, or recreation activities given up or reduced.
5: Use continues despite knowledge of adverse consequences (e.g. failure to fulfil role obligation, use when physically hazardous)
6: Tolerance (marked increase in amount; marked decrease in effect)
7: Characteristic withdrawal symptoms; substance taken to relieve withdrawal.
A person who meets at least three of the above symptom criteria, as well as scores for clinically significant impairment or distress, can be identified as suffering from a food addiction4.
Not surprisingly, foods most notably identified to cause food addiction were those high in fat and high in sugar.
The following foods were listed on the YFAS questionnaire5:
- Sweets like ice cream, chocolate, doughnuts, cookies, cake, candy
- Starches like white bread, rolls, pasta, and rice
- Salty snacks like chips, pretzels, and crackers
- Fatty foods like steak, bacon, hamburgers, cheeseburgers, pizza, and French fries
- Sugary drinks like cool drinks.
Scientists, who have proven the significant overlap between food addiction and other forms of addictive behaviour, believe that traditional therapies in other areas of addiction can also be applied to solve a weight problem. These could include motivational talks, cognitive-behavioural therapy and problem-solving programmes such as the12-step recovery programme.
One study concluded that the following guidelines could be useful to help their patients with food addiction6:
Do not starve
Hunger leads to uncontrolled cravings for unhealthy food and wrong choices of food as well as its portion sizes.
Eat only when hungry and stop when full:
This is where the restraint problem should be managed with psychotherapy in combination with pharmacotherapy where needed.
Control stress and emotions:
Food should not be used to recover from stress, anxiety or sadness. Emotional overeating has similar correlations to food addiction patterns.
The evidence behind the advantages of exercise in weight loss strategies is in no doubt. Exercise increases the amount of dopamine receptors in the brain, to name but one effect.
Weight loss with lifestyle changes in specific dietary and physical activity changes remain the cornerstone in the treatment of obesity. Unfortunately, often these weight control methods produce only short-term success7.
In patients whose obesity has a major association with uncontrolled eating patterns, greater hunger and less restraint, approved pharmaceuticals could further assist to reduce these symptoms.
Studies in patients using a specific medically approved appetite suppressant found that around 85% achieved a 5% weight loss, and approximately 50% achieved a 10% weight loss8. Another study found that patients using this medication not only experienced reduced hunger, but also stronger control of eating, diminution or absence of food cravings, and improved ability to follow eating plan9.
Furthermore, a study which investigated whether gradual weight loss was associated with greater long-term weight reduction than rapid initial loss, found that fast initial weight loss had both short- and long-term advantages over gradual weight loss. People who lost weight faster achieved greater weight reduction and long-term maintenance, and were not more susceptible to weight regain than gradual weight losers10.
Food addiction is more prevalent than initially thought, especially among those who are overweight or obese. In fact it is estimated that more than 6% of the general population has food addiction, with women being twice as likely as men to suffer from this condition.
Speak to your doctor about what weight loss and / or therapy options might be most suitable should you suspect that you are suffering from a food addiction. Go to www.ilivelite.co.za for more information.
DISCLAIMER: This editorial includes independent comment and opinion from an independent healthcare provider and is the opinion and experience of that particular healthcare provider and not necessarily that of iNova Pharmaceuticals.
References: 1. Gearhardt, A.N.; Corbin, W.R.; Brownell, K.D. Food addiction: An examination of the diagnostic criteria for dependence. Addict. Med. 2009, 3, 1–7. 2. Meule, Adrian, and Ashley N. Gearhardt. “Five years of the Yale Food Addiction Scale: Taking stock and moving forward.” Current Addiction Reports 1.3(2014): 193-205. 3. Levitan DR & Davis C: Emotions and Eating Behavior: Implications for the Current Obesity Epidemic. University of Toronto quarterley 2010; 79:784-799. 4. Gearhardt, AN, Corbin, WR, and Brownell, KD. “Preliminary validation of the Yale Food Addiction Scale.” Appetite 52(2009): 430-436. 5. “Home – UConn Rudd Center for Food Policy and Obesity” (PDF). Retrieved August 28, 2016. 6. Gearhardt AN, Yokum S, Orr PT, Stice E, Corbin WR & Brownell KD. Neural correlates of food addiction. Arsch Gen Psychiatry, 2011. 7. Thomas EA et al. Greater hunger and less restraint predict weight loss success with phentermine treatment. Obesity (Silver Spring). 2016 January; 24(1): 37 – 43. 8. Hendricks Ed J, Rothman RB and Greenway FL. How physician obesity specialists use drugs to treat obesity. Obesity (2009) 17, 1730-1735. 9. Hendricks EJ et al. Bloodpressure and heart rate effects, weight loss and maintenance during long-term phentermine pharmacotherapy for obesity. Obesity (Silver Spring). 2011; 19:2351-2360.10. Nackers LM, Ross KM, Perri MG. The Association Between Rate of Initial Weight Loss and Long- Term Success in Obesity Treatment: Does Slow and Steady Win the Race? Int J Behav Med. 2010 September ; 17(3): 161–167