Many people with ultraprocessed food addiction not identified as needing treatment
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Key takeaways:
- People with ultraprocessed food addiction may present similar vs. those with substance use disorder.
- Pharmacotherapy and harm reduction may be key to management of addiction to industrially produced food.
BOSTON — Addiction to ultraprocessed food may be diagnosed similarly to other substance use disorders, and reducing stigma and tailored treatment are both important to improving cardiometabolic health, a speaker reported.
Erica M. LaFata, PhD, assistant research professor at the Drexel University Center for Weight, Eating, and Lifestyle Science (WELL Center) in Philadelphia, discussed the signs and symptoms of ultraprocessed food addiction, its prevalence and avenues for potential management, during a presentation at the Cardiometabolic Health Congress.
“Over the past 15 years, there’s been this growing body of research that has strongly suggested that ultraprocessed foods can uniquely trigger addictive responses in certain individuals. This presentation is starting to become more and more referred to as ultraprocessed food addiction. It was previously food addiction, but obviously quite a misnomer, with not specifying which foods are driving this presentation,” she said during the presentation. “Research is needed to identify that addictive agent in the same way it’s been identified in other addictive substances: nicotine in cigarettes and ethanol in alcohol.”
Within the NOVA food classification system, foods with the highest degree of processing, or ultraprocessed foods, are made using industrial formulations containing sugar, fat, refined carbohydrates and salt, a nonnaturally occurring combination with little to no whole food ingredients, according to the presentation.
Examples of such foods include pastries, frozen desserts, candy, white flour products, fast foods, processed meats, sugary breakfast foods and sweetened beverages.
“These are industrial formulations designed to be hyperpalatable by intentionally combining a bunch of rewarding reinforcing ingredients that often involve artificially high amounts of oils, white flours, salts and additives that have been intentionally designed to increase palatability texture, color and flavor,” LaFata said during the presentation. “There’s really a key distinction between foods we’ve been evolved to need for survival and these foods that have been intentionally designed by industry.”
Prior studies published in the European Eating Disorders Review and Obesity Reviews estimated that ultraprocessed food addiction was prevalent in approximately 12% of youths, 14% of adults and up to 25% of people with obesity.
Ultraprocessed food addiction was evaluated using the Yale Food Addiction Scale 2.0, which relied on the 11 Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria to diagnose substance use disorder.
LaFata said a diagnosis of ultraprocessed food addiction may be considered if an individual exhibits two or more of the following criteria on top of clinically significant impairment or distress: tolerance, withdrawal, excessive intake, can’t stop, drug-seeking behavior, cravings, failing other obligations, reducing important activities, social/interpersonal problems, use when physically hazardous and continued use despite consequence.
“This is a really controversial area of research. One of the main misconceptions I get all the time is ‘we need food to survive, so food can’t be addictive.’ It’s like saying we need to drink to survive, so alcohol can’t be addictive. There’s this really specific class of foods that’s been developed by the industry to be intentionally reinforcing to drive cravings, to drive profits. ... We’re not talking about foods that we need for survival,” LaFata said. “Another one is, ‘I can make cookies at home.’ Are those addictive? Yes. Homemade wine is still an addictive substance. Most importantly, the industrialization of these ultraprocessed foods exponentially increased access, portability and convenience, which really makes this much more problematic over time.”
Proposed treatments for ultraprocessed food addiction include pharmacology, abstinence and harm reduction.
LaFata said pharmacological therapies could interrupt the neurobiology that feeds addictive use with the growing acceptance of GLP-1 receptor agonists as therapy for individuals behaviorally lost to treatment.
In addition, harm reduction with a focus on individualized risk factors, such as substance variations and patient mood and situation, may also be considered. An example of the latter is avoidance of emotional eating, she said.
LaFata said abstinence of ultraprocessed food intake in those with addiction may likely be unattainable due to the current food environment and the wide variety of easily available ultraprocessed foods.
“Most people with ultraprocessed food addiction are not identified as needing treatment. ... When we’re looking at the lifetime prevalence rate for binge eating disorder, it is 2%. [But] we see 14% of individuals struggling with addictive-like consumption of ultraprocessed foods. So we’re missing a large number of individuals who are reporting clinically significant impairment and distress related to their behavior,” LaFata said.
“With respect to importance for cardiometabolic health, there’s a lot of overlap of risk factors and ultraprocessed food addiction. Importantly, this construct has the potential to decrease the stigmatizing narrative of personal responsibility. People have not become less responsible over time. That’s not why rate of obesity, diabetes and cardiometabolic diseases have increased. Our food environments fundamentally changed and with the guidance of telling people to eat things in moderation and reduce their calorie consumption, we have a blind spot around influence and direct contributions of what is driving why it’s so difficult to integrate some of those changes,” she said.
References:
- Praxedes DRS, et al. Eur Eat Disord Rev. 2022;doi:10.1002/erv.2878.
- Yekaninejad MS, et al. Obes Rev. 2021;doi:10.1111/obr.13183.
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LaFata EM. Session II: Obesity. Presented at: Cardiometabolic Health Congress; Oct. 17-19, 2024; Boston.
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