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.

7 Comments to “the HAES® files: Exploring Food Addiction”

  1. Thank you Marsha for this insightful post. Your clear thinking on this is very helpful.Thanks.

  2. I believe addiction is addiction. I’ve had many addictions in my life, but they all are to suppress certain emotions or to get a payoff. Currently I’m overcoming online gaming addiction. It’s real. Food addiction is real. Alcohol addiction is the most widely “accepted” because its more recognized as a “bad” behavior.

    • But so called “food addiction” isn’t an addition to substance, it’s an addiction to behavior. Just as an online gambling addiction doesn’t mean you’re addicted to the computer, or a game – the addiction is to the behavior of gambling online. There is a difference between chemical dependency (alcohol, drugs, etc.) and addiction. All eating disorders are rooted in dependence on a behavior, not a chemical dependence on certain foods.

  3. Reblogged this on Verslanking and commented:
    Hierdie pas in by wat ek ook dink: Die klein persentasie vet mense wat wel ‘n ongesonde verhouding met kos het, het in daai posisie beland nie as gevolg van te min dieet en worry oor hulle gewig nie, maar juis as gevolg daarvan.

  4. Great post, Marsha! I really appreciate how you clearly explained all of the angles. Another angle to consider is that some are addicted to dieting…maybe for another blog.

  5. I learned this interesting analogy from a residential fitness institute about 15 years ago.

    They said, suppose you held your breath and ran up the side of one of the nearby mountains. What would happen when you started breathing again?

    Everybody immediately exclaimed that they’d be gasping for air, their hearts would be pounding and they’d be panting extremely hard.

    And … continued the fitness educator … nobody would accuse you of “over-breathing” would they?

    Why no, said the audience. We’d have a pent up demand fo r air and our bodies would be hungry to take in that air as quickly as possible.

    Well, said the speaker. That’s the same thing that happens when you are coming off a diet. You are no more “over-eating” than you would be “over-breathing” if your body were starving for air. The body knows what it needs, and filling those needs is not a “sin” or being “weak willed” or in need of treatment. Its normal.

    Their point was trying to get all these dieters to quit dieting to lose weight (one of the reasons that many of them had visited a residential fitness training facility in the first place).

    So far as I know, nobody there ever mentioned HAES or size acceptance. That was just their fitness philosophy. Trust your body to know when it needs to breathe (and how much) and when it needs to eat (and how much). Their point was that you cannot start even working on metabolic fitness if you aren’t going to give your body the nourishment it needs in order to do that. And they absolutely believed that, no matter what size your body was or how fit or unfit it was the day you arrived.

  6. This is spot on Marsha. I recently did a literature analysis that showed that rats engaged in binge-eating when they had intermittent, not-regularly scheduled access to highly palatable chow, even in the absence of calorie restriction (meaning the rats got enough food to meet their energy needs). When the access was regular, there was no binge eating – almost as though they knew they could rely on getting their favorite food daily (as much as rats can know these things). Trying to study binge eating without factoring in other variables like restriction won’t ever give us a clear picture.

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