Archive for June, 2013

June 25, 2013

the HAES® files: Exploring Food Addiction

by Health At Every Size® Blog

by Marsha Hudnall, MS, RD

Does food addiction really exist?  This question was a big subject of controversy at the national conference of the Binge Eating Disorder Association (BEDA) as well as that of International Association of Eating Disorder Professionals (IAEDP).

Two Sides of the Same Coin

Of those who have strong opinions about the subject, there are probably two sides whose opinions vary the greatest.

There are the researchers who study the issue, most recently via brain scans of larger-bodied folks who fall into the “obese” range of the BMI.  These professionals tend to support the idea of food addiction.

Then there are the dietitians and therapists who use mindful eating (or attuned eating or intuitive eating — all variations on the same theme of normal eating) to help people who struggle with eating and weight.  They tend to question whether food addiction really exists, at least beyond the fact that we’re all dependent on food.

The position of the researchers is that they see regions of the brain “light up” when people are exposed to highly palatable foods, which generally translates to those foods that most people think they shouldn’t eat but do so anyway.  You know the foods — the donuts, Ding Dongs and Doritos of the world.  And they’ve got brain studies to show that larger-bodied folks tend to have fewer D2 receptors in the brain that are involved in signaling pleasure, so that these folks need to eat more to get the same degree of pleasure from foods as people (usually thinner folks) with more D2 receptors.  They also use the Yale Food Addiction Scale as the tool to measure people’s attitudes about food and determine whether they rank as food-addicted.

The position of the counselors is that other pleasurable things light up those same brain centers.  Enjoyable things like music.  Are we going to say people are addicted to music because they feel pleasure when they hear it?

What’s more — and this is something I discovered as I prepared to give a talk at IAEDP on how to help binge eaters become attuned eaters — researchers don’t appear to be taking into consideration AT ALL the impact of dieting and the other restricted eating behaviors on the “weight of the nation” or the number of D2 receptors they’re seeing in larger folks.  Studies clearly show that restricted eating behaviors such as dieting, and plain old worry that food is going to make you fat, both cause people to gain weight and also can diminish the number and sensitivity of the receptors.  It’s as if the last 50+ years of calorie and weight obsession didn’t happen.

Finally, if you compare the Yale scale to questionnaires that measure restricted eating attitudes and behaviors, lo and behold, you see very similar outcomes. Statements like “I find that when I start eating certain foods, I end up eating much more than planned” or “I find myself continuing to consume certain foods even though I am no longer hungry” or “Not eating certain types of food or cutting down on certain types of food is something I worry about.”  Which makes me question just what is the scale really measuring — food addiction behaviors or restricted eating behaviors?

Who’s the Real Expert?

As I said at BEDA where I chaired a panel discussing how to effectively treat binge eating disorder, one thing I have learned in the last thirty years of working with women who struggle with eating and weight, is to listen to what they have to say.  If someone tells me that a certain food or ingredient such as sugar drives her to eat out of control, I am not going to argue with her. I will work with her to explore her experience based on my understanding, but I tend to not believe in absolutes — we need to leave room for individual differences.

But I will say it’s not fair to make pronouncements based on faulty data.  And that’s what I fear is going on with the current research: if we don’t take into account all the variables, we aren’t going to get clear answers.

I also encourage us all to start at the same place so we can compare apples to apples.  That is, if people aren’t eating regular, well-balanced meals that include plenty of whole foods, and aren’t viewing all foods from a neutral place — not labeling them as good or bad or fattening or “I shouldn’t eat” or “I can’t eat without going out of control” — more variables that can muddy the answers come into play.  I daresay that many of the larger-bodied folks who turn up as study subjects are people who have struggled for years with on-again, off-again dieting and worry about food and weight.  Their bodies are likely malnourished and out of balance, and they’ve likely got lots of anxieties about food. That must be taken into account when conducting the studies and analyzing their results.

I’ll end this discussion by sharing what we have seen repeatedly at Green Mountain.  And that is that once women get their bodies into balance physically and become curious about how food affects them, rather than pre-judging how they are going to feel when they eat it, and often, getting more in their lives than worry about food and weight, the vast majority find it doesn’t have the power over them they thought it did.

So I will admit my bias on the subject, but, again, I always leave the door open for the real expert to weigh in.  That expert is the individual with his/her own experience in his/her own body.

Still, I always say, why restrict something if you don’t have to?

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Note: A version of this blog post was originally posted on March 25, 2013 in the Green Mountain Blog.

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