Food and Addiction: A Comprehensive Handbook

Book Preface

FOOD AND ADDICTION: WHY AND WHY NOW?
With obesity’s stampeding rate throughout the world, and poor diet affecting longevity in billions of people by increasing risk of other diseases such as cancer and heart disease, there is great concern with promoting healthier eating. Part of this effort involves a search for factors that interfere with this objective. The addictive properties of food may be one such factor.
The concept of food and addiction is firmly established in the popular culture. Terms such as “chocoholic” and “carbohydrate addict” are common. Individuals in day-to-day life use terms such as craving and withdrawal; hence, people “get” the concept. The food industry has capitalized on this in their marketing, with advertisements promising delicious tasting foods that will conquer cravings.

Acceptance in popular culture does not make the food and addiction concept viable and valid. With that said, much can be learned from listening to people. Professionals have long heard the language of addiction in clinical settings. Individuals with an array of eating issues, including obesity, eating disorders, and binge eating, often use terms of addiction to describe their relationship with food. People speak directly about being addicted to food, and in many cases act as if they are. Eating in the presence of untoward consequences, compulsive eating, inability to stop, and a number of other behavioral patterns should have suggested that food might be addictive long before it did.
Clinical anecdote also does not prove the vitality of the food and addiction concept. Ultimately science will determine whether this concept is meaningful and helpful, can be defended with the best scientific methods, and helps describe eating problems beyond our descriptors available already.

MIXED OPINIONS
The two of us met some years back when Kelly Brownell invited Mark Gold to Yale University to speak about his work on food and addiction. Brownell believed that this concept was important, and other than pioneering work by Bartley Hoebel and his colleagues at Princeton University, was not being investigated much in the obesity and nutrition fields. Gold, a substance abuse researcher, was one of the first to address the issue from the perspective of the addiction field.
In 2007, we co-hosted an historic meeting at Yale University that brought together leading researchers in nutrition and obesity with top experts from the addiction field. Research was presented, new concepts were discussed, and there was extensive discussion about whether food and addiction was a concept worth pursuing. There was considerable agreement that the topic was important, that the implications were significant, and that much work remained to be done.
An observation we had from that 2007 meeting was that experts from the nutrition/obesity field were more reticent than those from the addiction field to accept the notion that some foods might act on the brain as addictive substances. At first glance this was not surprising, as more work had been done by addictions researchers, but there was still hesitation among nutrition experts beyond what we expected.

This hesitation has now given way, and leading scientists across both addictions and nutrition/obesity/ingestive behavior fields have kicked into higher gears and research is being published by scholars from a variety of disciplines. We believe the science has reached a critical mass to the point where an edited book is warranted. As in most scientific fields, available work is scattered across a variety of journals representing people from many disciplines, hence the need to have the most up-to-date and comprehensive information available in a single source.

WHY THIS WORK IS SO IMPORTANT
The full implications of work on food and addiction are difficult to predict, as the field is moving rapidly. It is our belief, however, that the way the world deals with issues such as obesity could be heavily affected by this concept and the work surrounding it.
Work on food and addiction could enrich our understanding of why people eat like they do. The confluence of biological, psychological, and social factors such as food marketing have created dietary mayhem. To what extent is food and addiction a player? Such information could be harnessed to develop better treatment programs for eating issues. This could include not only treatments for obesity, which are in dire need of improvement, but also programs designed to educate people about nutrition in general.

Information on food and addiction could be helpful for designing prevention programs. Understanding more clearly which foods should be avoided, removed from institutions such as schools, or targeted by public policy could be informed by research on food and addiction. As one example, agricultural subsidy policies favor the production of certain crops such as corn and soybeans. These are processed into a variety of foods, some referred to as “Frankenfoods” by some nutrition experts, in which a long list of chemicals get processed with commodity crops to form foods that dizzy the imagination with their colors, tastes, smells, textures, and other sensory properties that maximize consumption. As elected leaders consider changes in subsidies, different crops might be subsidized to better defend against vulnerabilities in human biology.
Vast numbers of people could be affected by the addictive effects of food on the brain, regardless of their weight or whether they eat in compulsive ways. When the bell rings and the high school day ends, and teenagers feel they need a sugary beverage, why? If the sugar in those beverages acts on the brain to create craving, withdrawal, or tolerance, one might look to the concept of food and addiction to help explain the ravages of nutrient-poor, calorie-dense foods on the public’s health.
One word in particular, one of the most common in our language, has special meaning in this book, “and.” We titled this book food and addiction rather than food addiction. This may seem like nuance, but it has profound implications. The term “food addiction” conjures up images of individuals who are eating out of control, who are extremely overweight, and who represent the tail end of the distribution of human eating. This book is relevant to that discussion, but ultimately more important is the concept of food and addiction—the impact of food on the brain of everyday people in everyday life.
Diseases related to poor diet do not require extreme eating. Small daily increments in calories or nutrients such as saturated fat, sugar, and sodium can increase risk for disease. A florid addictive process, like one might see with classic substances of abuse, may not be necessary for the addictive effects of food on the brain to be important. From a public health perspective, the key question is whether enough foods produce enough of an addictive effect on enough people to affect the health of the population.

This issue of addiction becomes complicated when the substance being considered is food. One must eat; hence, food is necessary for survival, but alcohol, cigarettes, or drugs are not. One might parody the interest in food and addiction by saying that people are also addicted to water and air. But people do not overconsume water and air. This is why the examination of food is so important and we must ask why eating occurs beyond the meeting of biological needs for energy and nutrients. The substance necessary for survival is consumed in ways that interfere with survival.
The aim of this book is to draw together the work of leading experts to highlight what is known on a broad range of topics pertaining to food and addiction. This begins with chapters on basic mechanisms of addiction and body weight regulation, followed by writings by authors who have tackled specifically the issue of the addictive impact of food using both animal and human models. There is also emphasis on the implications and importance of this work, including extension into legal and policy arenas. Consider, for instance, the First Amendment of the US Constitution. The food industry, among other corporate players, has been afforded a great deal of latitude in marketing products to all parts of the population, including children. As it protects political and religious speech, the constitution protects “commercial speech.” If certain foods or their constituents could be considered addictive, there might be justification for restricting their marketing, particularly to vulnerable populations, such as youth.

It is our hope that this book shines needed light on this very important topic. Researchers around the world are doing excellent work on this issue, and the implications are beginning to enter the public and policy realms. It is essential that this discourse proceed in a reasoned, thoughtful, and scientifically sound way. This book is designed with that purpose in mind.